"The ExerCube is a tool that will hopefully help many patients in rehabilitation"

"Smart health" has long since arrived in physiotherapy. The ExerCube from Zurich start-up Sphery is not just a fun way to train your fitness. Thanks to a project by Zurich University of Applied Sciences (ZHAW) and Zurich University of the Arts (ZHdK), the cube can also be used for rehabilitation after knee injuries. Project manager Eveline Graf explains in an interview what the future of physiotherapy could look like with digital solutions like this.

Ms Graf, what is the ExerCube and how does it work?
EvelineGraf: It's a large cube, about 3 by 3 meters, which is open at the back and in which you move around. The ExerCube from ZHdK-SpinOff Sphery offers a physically immersive environment in which a wide variety of holistic, game-based training scenarios for body and mind can be completed. A wide variety of game scenarios are projected onto the 3 walls, giving you exercises to perform at the right time. You wear sensors on your ankles and wrists, collect points and the game adapts to your performance. As part of our research project, we at the ZHAW, together with the ZHdK and Sphery, have developed a new game concept for sports rehabilitation.

Prof. Dr. Eveline Graf is a lecturer and researcher at the ZHAW Institute of Physiotherapy, where she heads the movement laboratory, among other things.

How did the collaboration with the start-up Sphery and the Zurich University of the Arts (ZHdK) come about?
Sphery and the ZHdK came into contact with the ZHAW a few years ago via Win4, as an initial study was underway there with the ExerCube for young athletes. From a research perspective, we are always interested in products and services that are suitable for physiotherapy. And we very quickly saw a lot of potential for rehabilitation in the ExerCube, which was also the result of years of research work, so we decided to get to know each other. Due to Sphery's scientific background, they were also interested in an exchange and so the idea for a game for sports rehabilitation quickly emerged in our discussions. We then quickly initiated the first preliminary projects together with the ZHdK, which strengthened our collaboration and laid the foundation for the joint ExerUP! project.

The ExerUP! study ran from 2021-2023. What insights did the research team gain from the study?
As part of ExerUP!, we worked together in an interdisciplinary team to develop a completely new game concept for the ExerCube, which can be used specifically in rehabilitation after a knee injury, for example a cruciate ligament rupture, in addition to conventional physiotherapy. The team first spoke to physiotherapists and patients to determine their needs. Based on this, we developed a game concept, which was then realized by game designers from ZHdK and Sphery. The final prototype has already been translated into a product by Sphery and can now be played in any ExerCube worldwide.

Will the ExerCube be available in every physiotherapy practice at some point?
Due to the dimensions of the ExerCube in its current form, it is unlikely that all physiotherapy practices will have one - although Sphery is already working on an additional, smaller version. But in larger practices that are associated with a fitness center, it is very conceivable, as you can see from Sphery's existing physio customers. The training appeals to a diverse audience. As it is intended for sports rehabilitation in addition to conventional physiotherapy, it is also conceivable that patients will be able to train independently in the ExerCube.

The study primarily examined the rehabilitation of athletes after a knee injury. Are there plans to use the ExerCube for other patient groups and after other injuries?
Yes, that is certainly possible. As part of ExerUP!, we have developed two different games that can be played together or separately. One game is very specific to the knee. This game makes little sense for another injury, for example the shoulder. But of course we are also interested in developing games for these injuries in other projects. We are currently working on new project ideas. The second game we have developed does not specifically train a joint, but trains the ability to react, orientation in space and also complex body movements. This game can be used in many different ways.

Could the Cube also be used in retirement homes to mobilize senior citizens?
This is already the case. There are some games that specifically train attention, memory and dual-tasking (i.e. performing two tasks at the same time, for example walking and talking) with the aim of reducing the risk of falls. This game concept was also developed and evaluated in an interdisciplinary research and development project with other institutions.

How open are rehab centers to working with the ExerCube?
Sphery's customers already include a number of rehab centers worldwide where the ExerCube is being used successfully. In general, however, it always depends on the focus and resources of a rehabilitation center. In general, there is a great deal of interest in new forms of therapy that are motivating and effective, and physiotherapists are open to such technologies.

Do you think that an ExerCube will eventually make tried-and-tested physiotherapy methods superfluous?
No, technologies like the ExerCube are good additions, but not replacements. People are very different and their needs after an injury are very individual. On the one hand, because a similar injury has different consequences for different people and therefore the need for rehabilitation varies greatly. Secondly, because patients react differently to one treatment approach. In addition, needs change over the course of rehabilitation. Different techniques are used immediately after a cruciate ligament rupture than for an athlete shortly before she can return to sport. Physiotherapy therefore requires different tools that can be selected and applied individually. And the ExerCube is a tool that will hopefully help many patients, but only covers part of the rehabilitation process.

Is it possible to try out the Cube for yourself?
Yes, the ExerCube can be tried out at various locations, for example directly at Sphery in Zurich. We are also happy to present our project at events, for example at the House of Winterthur Smart Health event on February 27.

Interview: Linda Stratacò, February 2024