A few days without physical therapy, painful as it is, would invariably bring Nirmal Krishna down. As his mother Manju puts it, daily physiotherapy is as important as food for the well-being of 24-year-old Nirmal, who lives with spastic cerebral palsy (CP), a neurological condition that makes his arms and legs stiff, rigid, and resistant to bending movements near limb joints.
This intrinsic need for physiotherapy in his life, however, has done little to translate into his interest in partaking in it. “The process can be incredibly painful and tiresome for the kids, so we parents have to force them to do it,” says Manju. But that was until a new experimental virtual rehabilitation project was introduced in 2017 at Nirmal’s school — the Adarsh Charitable Trust at Tripunithura, in the Ernakulam district of Kerala.
VHab (Virtual Habilitation), developed by a team of researchers led by Robin Tommy at the Tata Consultancy Services (TCS) Innovation Lab in Thiruvananthapuram, is a gamified therapy platform that helps persons with disabilities gain interest in their own physical rehabilitation process, by combining virtual reality with motion sensors and gesture analysis. “It was five years ago that a team from TCS approached us with VHab. Within three to four months of its implementation, we saw visible changes in how our neurodivergent students approached rehabilitation,” says Ambili Francis, who is a physiotherapist at Adarsh.
According to Ambili, like in most special schools, the students at Adarsh are hardly fans of the traditional physiotherapy process. Many of them are even hesitant to come to school, because all the stretching and turning can be painful for them. “But VHab has made everything a game, which automatically generates interest in students. On screen, there are ‘avatars’ that represent the children. As they play new games, progressing through different types of physiotherapy, their avatars keep gaining points. This motivates the kids and they even compete with each other,” she says.
For instance, there is a game in which they have to tap on and burst blocks that keep appearing on the screen. “Raising their hand to do that might actually be pain-inducing for some of them, but they forget all that due to their excitement and competitive mood. They do it all by themselves, without anyone to prompt them,” Ambily says.
“VHab has essentially restructured their exercise regimen into a game, which gets the children invested in the process. Now, instead of resisting our attempts to convince them to do physical therapy, they are making attempts to move by themselves,” she adds. And this change, beneficial to atypical people, is happening because of gamification, says Robin Tommy, who leads the research team that developed VHab.
Atypical is a term used to refer to people who are neurodivergent — having different brain processes or learns/behaves differently from what is considered typical.
“Our aim is to create advanced technological products and platforms for the betterment of the atypical society — VHab being one among them. So we have done a fair share of research into various types of neurodivergence and their rehabilitation processes. The traditional rehabilitation processes used in our schools are still almost completely human-dependent. There has been very little technological development in this field,” Robin tells TNM. Besides, technological interventions can also be very costly, he points out, adding that the schools can rarely afford to import foreign technology and implement them here.
In addition to this is an even bigger problem — the pain. “Many special schools have a room dedicated to physical therapy. We visited some of them, and it was heartbreaking to see how some of the children reacted to this process. As soon as the treatment began, they would start to scream and cry, and try to run away. After two days of this, they simply won’t come to school on the third day. They get scared by the idea of school, because for them, school means pain,” he says.
That was how Robin and team arrived at the decision that their first technological intervention in the field would aim to address this problem. “We realised that it was necessary to make physical therapy more engaging to kids. That was how VHab, a gamified physiotherapy process, was launched at Adarsh in 2017,” he says. “What VHab essentially does is to present the children with a personalised, simulated on-screen environment that draws them in, thus turning their exercise regimen into more than just a chore. It works because they no longer think of it as a tiring routine, but instead see it as a fun activity and that keeps them engaged.”
Besides Adarsh, VHab has been implemented in four other schools so far, which includes the Alphons Sadhan Special School at Vengoor and Jeevaniyam Hospital and Research Centre at Thammanam in Ernakulam, the Centre for Autism and other Disabilities Rehabilitation Research and Education (CADRRE) in Thiruvananthapuram, and the ZEP Rehabilitation Centre in Pune. All of these institutes have reported positive results, Robin says.
Reena Joju, a physiotherapist at Alphons Sadan where VHab was introduced in December last year, concurs. “As soon as the kids arrive at school now, they start asking for VHab. They love doing it. We usually will have to work with them and explain the process to them for the first two days or so. They are usually cooperative because the games, the colourful screens etc get them hooked immediately. By the third day, they would have picked up the game. From then on, they would be enthusiastically waiting for their turn.”
The most important change that VHab has brought about in kids is behavioural, says Robin. “Now they are actually interested in coming to school because they want to play these games. They may even be going through a lot of pain, but they don’t realise it, because the game is triggering the release of oxytocin and serotonin in their brains. All elements of the game, such as the colours and the sounds, have been designed such that it aids their cognitive improvement,” he explains.
“The results are visible,” says Manju, Nirmal’s mother. “Nirmal likes racking up scores on the app. So he takes maximum effort to do it by himself. Earlier, he never used to stand without holding on to something, but now he is trying.”
Nirmal is 24 now and his parents find it hard to make him do the stretching and other exercises now. But now, he is taking the effort by himself, says Manju. “He usually has to depend on us for everything, but now he has this feeling that he is able to do something by himself. It has visibly helped improve his balance, and also bettered his attention span. This has been a great change for him,” Manju says.
Ambili, of Adarsh School, too has several success stories to list. “A student’s mother used to tell us how she struggled to take her son, who had athetoid CP, a type of Cerebral Palsy, upstairs to their flat in case of a lift malfunction in their building. He was scared to climb the stairs because of his issue with balance. One of the games in VHab addresses this concern; you have to pick up your leg and place it on a block to burst it. After doing this for a few days, he has actually begun to slowly climb the stairs now,” she says.
Then there is another student, who simply would not walk without the support of her mother, even if she had crutches, adds Ambili. “With the help of VHab, she is actually walking by herself now. She still needs crutches, but her dependency on her mother has reduced.”
Initially, Adarsh had started the project with just around 25 students. “We were initially focussing on kids with cerebral palsy. But after we saw the improvement in them, we decided to include more students from all sections, including those with autism, down syndrome and other neurological conditions,” Ambily tells TNM.
Reena is of the opinion that the project has to be implemented in all special schools in Kerala. “We have been lucky enough to be one of the few schools to receive access to this facility. But more kids should be able to benefit from this,” she says. This benefit need not be just for kids even, adds Ambili. “This can also be used to aid other rehabilitation procedures, such as for stroke patients. It will be very effective for them as well,” she says.
Robin feels that government support can widen the scope of the project as it would make the technology accesable to more children. Also, VHab is not alone in this venture now. Taking inspiration from this project, many startups have joined the cause of building a neurodivergent-friendly ecosystem in the state.” Robin is also mentoring one such startup, the Punarjeeva Technology Solutions.
In addition, there are non-profit organisations like Inclusys Org that provide vocational IT training using assistive technology to eligible neurodivergent people, Robin points out. “A job of their own would automatically mean that they become financially independent, in turn aiding their self-esteem as well. This is a group effort. Together, we want to use the latest research and technology to transform their lives and create a better tomorrow,” he adds.