Cosmin Mihaiu: Physical therapy is boring — play a game instead

When I was growing up, I really
liked playing hide-and-seek a lot. One time, though, I thought climbing
a tree would lead to a great hiding spot, but I fell and broke my arm. I actually started first grade
with a big cast all over my torso. It was taken off six weeks later,
but even then, I couldn’t extend my elbow, and I had to do physical therapy
to flex and extend it, 100 times per day, seven days per week. I barely did it, because
I found it boring and painful, and as a result, it took me
another six weeks to get better. Many years later, my mom
developed frozen shoulder, which leads to pain
and stiffness in the shoulder. The person I believed for half of my life
to have superpowers suddenly needed help
to get dressed or to cut food. She went each week to physical therapy,
but just like me, she barely followed the home treatment, and it took her
over five months to feel better. Both my mom and I
required physical therapy, a process of doing a suite
of repetitive exercises in order to regain the range of movement
lost due to an accident or injury. At first, a physical therapist
works with patients, but then it’s up to the patients
to do their exercises at home. But patients find physical therapy
boring, frustrating, confusing and lengthy before seeing results. Sadly, patient noncompliance
can be as high as 70 percent. This means the majority of patients
don’t do their exercises and therefore take
a lot longer to get better. All physical therapists agree
that special exercises reduce the time needed for recovery, but patients lack
the motivation to do them. So together with three friends,
all of us software geeks, we asked ourselves, wouldn’t it be interesting if patients
could play their way to recovery? We started building MIRA,
A P.C. software platform that uses this Kinect device,
a motion capture camera, to transform traditional exercises
into video games. My physical therapist has already set up
a schedule for my particular therapy. Let’s see how this looks. The first game asks me
to fly a bee up and down to gather pollen to deposit in beehives, all while avoiding the other bugs. I control the bee by doing
elbow extension and flexion, just like when I was seven years old
after the cast was taken off. When designing a game,
we speak to physical therapists at first to understand what movement
patients need to do. We then make that a video game to give patients simple,
motivating objectives to follow. But the software is very customizable, and physical therapists can also
create their own exercises. Using the software, my physical therapist recorded herself performing
a shoulder abduction, which is one of the movements
my mom had to do when she had frozen shoulder. I can follow my therapist’s example
on the left side of the screen, while on the right, I see myself
doing the recommended movement. I feel more engaged and confident, as I’m exercising alongside my therapist with the exercises my therapist
thinks are best for me. This basically extends the application
for physical therapists to create whatever exercises
they think are best. This is an auction house game
for preventing falls, designed to strengthen muscles
and improve balance. As a patient, I need to do
sit and stand movements, and when I stand up, I bid for the items I want to buy. (Laughter) In two days, my grandmother
will be 82 years old, and there’s a 50 percent chance
for people over 80 to fall at least once per year, which could lead to a broken hip
or even worse. Poor muscle tone and impaired balance
are the number one cause of falls, so reversing these problems
through targeted exercise will help keep older people
like my grandmother safer and independent for longer. When my schedule ends,
MIRA briefly shows me how I progressed throughout my session. I have just shown you
three different games for kids, adults and seniors. These can be used with orthopedic
or neurologic patients, but we’ll soon have options
for children with autism, mental health or speech therapy. My physical therapist
can go back to my profile and see the data gathered
during my sessions. She can see how much I moved,
how many points I scored, with what speed I moved my joints, and so on. My physical therapist can use all of this
to adapt my treatment. I’m so pleased this version is now in use in over 10 clinics
across Europe and the U.S., and we’re working on the home version. We want to enable physical therapists
to prescribe this digital treatment and help patients play their way
to recovery at home. If my mom or I had a tool like this
when we needed physical therapy, then we would have been more successful
following the treatment, and perhaps gotten better a lot sooner. Thank you. (Applause) Tom Rielly: So Cosmin, tell me
what hardware is this that they’re rapidly putting away? What is that made of,
and how much does it cost? Cosmin Milhau: So it’s
a Microsoft Surface Pro 3 for the demo, but you just need a computer
and a Kinect, which is 120 dollars. TR: Right, and the Kinect is the thing
that people use for their Xboxes to do 3D games, right? CM: Exactly, but you don’t need the Xbox,
you only need a camera. TR: Right, so this is less
than a $1,000 solution. CM: Definitely, 400 dollars,
you can definitely use it. TR: So right now, you’re doing
clinical trials in clinics. CM: Yes. TR: And then the hope is to get it
so it’s a home version and I can do my exercise remotely, and the therapist at the clinic
can see how I’m doing and stuff like that. CM: Exactly. TR: Cool. Thanks so much.
CM: Thank you. (Applause)


  1. Look, this presentation is about as innovative as the 1970's.  My parents are both PT's and have been doing games their whole careers.  This is stupid.

  2. How can one be so short sighted? I'm impressed! Perhaps it's human nature, and thus the doctors fault not to enlighted their patients…

  3. wow! fixing the first world problem of boredom with hightech gear my grandma couldnt afford if she needed it.

  4. I like the idea of it and I've heard people have actually been working on this a while now, but is it actually practical? How long can a person actually stay motivated to play a game like bidding. The motivation to do home exercises should come from the person wanting to get better, not from a simple child's game. At some point the game is going to get boring and patients won't want to play them and you'll be back to square one.  Nevertheless, when looking at certain patient populations like pediatrics, there is lots of potential. Hopefully, they'll do a good job of it!

  5. Future DPT candidate here

    The motivation is supposed to come from the fact that you don't want to spend another 6-8weeks injured and lose a significant amount of strength and range of motion. If this doesn't motivate you strongly I don't know what to say

  6. Great idea, although it raises a bigger question: 70% failure to do physical therapy home exercises?  We really need to figure out WTF is wrong with humans; we have very serious motivation issues.

  7. Yes, 25yr old man after terrible car crash who isn't motivated to follow doctor's recommendation suddenly will start exercising it when asked to help little smiling bee fly between pink flowers.

    Are you serious?

  8. I'm sure that insurance companies will NEVER use this data to deny coverage. Gee Mr Mihaiu you only made the bumblebee jump 23 times. In order for us to cover this PT session you had to make the bumblebee jump 25 times. So sorry. Claim denied.

  9. C'est génial ! J'ai eu tellement du mal à me remettre pour mon genoux, ça, avec des jeux un peu plus drôle, ça aurait été top.

  10. This idea is really cool and I liked the part where he said he is going to make an option available for autistic kids. If that feature is available, then, I am very much interested in purchasing it.

  11. It's a good idea, but one of the biggest issues is cost. Either the price for the software and hardware needs to be very cheap or insurance companies would have to agree to pay for it. Cooperating with insurance companies is hard to do and could result in higher premiums for customers.

  12. We have been using Nintendo Wii for our physical therapy patients for years now and it works perfectly, i haven't had anyone complain and everybody likes it. its great.

  13. We have computers telling us when to cross the street and when to stop and i see many people actually stopping to a red light when there is no car even close. And i see people crossing the street without even watching left and right, just following the green light like lemmings. Now we have computers for improving our own health, as improving our health would not be important enough to motivate by itself… Just another thing to make humanity more stupid and non-independent sheep robots as they already are 😉 please invent a computer game that makes people actually think by themselves!

  14. Would love to see more intensive therapies for patients with neuromuscular issues. I have grown up with Muscular Dystrophy, and PT was always tedious.

  15. This is a cool idea. I am a physical therapist and I have used the Nintendo Wii in the past for patients. This is more specific than that, which is nice. I just don't like the title of this post because saying "play a game instead" suggests that you don't actually have to go to physical therapy in the first place, but that's not the case. You still need to be under the guidance of a physical therapist to use this program in order to perform the proper exercises and not exercises that will further the injury. You also need to initially go to a physical therapist for manual treatment, manipulation, modalities, and other things that you are not able to perform on your own. I love this idea and the potential it creates, just not the way it is advertised by saying "play a game instead"

  16. You have no idea, how a good (there are quite a few.) physical therapist can actually help you son, so sit down with your childish video games and be quiet.

  17. This is cool, but nothing truly new. Rehab gyms have been using Wii games an Kinect games as therapy for a some years.

  18. This is a very good idea, but the cost of a Kinect is expensive. I doubt that a patient who is injured for  a short amount of time will invest in a game this expensive. Maybe if this plan of treatment could also be used with a computer (camera built in) and just an app or download to access the PT exercise program.

  19. Physical Therapists have been using games for decades; and electronic games since it has become mainstream. We use WiiFit, Kinect, and many other brands for neuro and orthopedics. We use all current technology now too. But your oversimplification of the profession is overwhelmingly ignorant. What you are asking for is what is called Repetitive Active Range of Motion which is a sliver of what physical therapy is about. Your product has good intentions but is very insulting in presentation.

  20. As a Physical Therapist who loves technology, this would only create more non-essential and possible technical hurdles in the rehab world. Keep things simple. In my experience, Patients just need more education and coaching for compliance. If they understand WHY they are doing something and the consequences of not doing it, it usually gets done.

  21. First of all great talk. Second, using playful activities as a therapy intervention has been part of occupational therapy (OT) since its early beginnings. OT's would always take the motivational aspect (client centeredness), the clients environment and its personal capacities into acount to promote adherence.

  22. Hey everyone, just wanted to let you know i have a whole series of videos on getting into physio on my channel. I'd love to help future students as I am a current 3rd year Physio student, so if you're reading this and interested, get @ me!! 🙂

  23. You aren't updated with the recent advances in Physiotherapy.
    Have you heard of Mckenzie Physiotherapy, which is painless therapy.
    Search on the internet.,
    N all exercises can't be game oriented..
    Yes you may design the way u wanna do it.

    But why can't we trust our own body and brains.

  24. It is limited to 0.001 of the conditions in physio domain, what about spinal or extremities manipulation or Mackenzie exercises?

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