Rhythms of Recovery: Patient-Centered Virtual Reality Exergame for Physical Rehabilitation in the Intensive Care Unit

TL;DR

This paper tackles ICU-acquired weakness by introducing a patient-centered VR exergame designed to support early upper-body Mobilization in the ICU. It employs interdisciplinary design to integrate progressive mobility levels, embodied guidance via Lumi, and real-time clinician monitoring using Quest 3 body tracking, validated against a gold-standard motion capture system. Across two studies, the exergame achieved high engagement and demonstrated measurable mobility improvements while maintaining safe physiological responses, supporting its potential as a clinically acceptable adjunct to conventional rehabilitation in critical care. The work advances ICU rehabilitation by delivering quantitative mobility metrics and practical integration into busy ICU workflows, with implications for personalized, scalable recovery programs.

Abstract

Early mobilization is a structured protocol designed to facilitate motor recovery in intensive care unit (ICU) patients with ICU-acquired weakness. This process is typically implemented by an interdisciplinary team of nurses, physical therapists, and other healthcare professionals. However, its application is often constrained by the patients' critical conditions, limited mobility, and the challenges of coordinating care within resource-intensive ICU environments. In this study, we developed a patient-centered virtual reality (VR) exergame through an interdisciplinary design process involving clinicians and therapists, tailored to the constraints of critical care. The exergame incorporates progressive mobility levels that mirror early mobilization practices, and includes an embodied avatar to provide guidance and motivation. Using Meta Quest 3 body tracking, the system captures and visualizes patients' movements, thereby providing motivational engagement and quantifiable mobility metrics. We evaluated the exergame in two stages: a dual-user study involving healthy participants and healthcare professionals or students (N = 13), and a subsequent study with cardiothoracic ICU patients (N = 18) to assess feasibility, design validity, and clinical acceptance. Across both studies, participants reported high enjoyment and engagement without discomfort or stress. Furthermore, patients demonstrated increases in movement speed, range of motion, and workspace volume of the upper body across game levels. Physiological monitoring further indicated that the exergame elicited exertion without inducing excessive cardiovascular responses. These findings highlight the feasibility of VR exergames as a clinically acceptable and engaging adjunct to early mobilization in critical care, offering a novel pathway to improve rehabilitation outcomes for ICU patients.

Figures (8)

• Figure 1: The overall flow of the gameplay during our VR exergame: patients setting the maximum range of motion (a), a brief tutorial shown to the patients on how to catch the lines (b), patients playing four game levels consisting of various types of mobility challenges (wrist, lateral, bilateral, and overhead movements) (c), and Lumi celebrating the achievements at the end of each game level (d).
• Figure 2: Experimental setup of OptiTrack motion capture system for tracking hand, elbow, and shoulder joints (a). APE for each joint (LH/RH: left/right hands, LE/RE: left/right elbows, LS/RS: left/right shoulders) for each game level (L1-L4) and additional motion tasks (M1, M2) with casting (b).
• Figure 3: User study designs; User Study I, a dual user study consisting of 13 healthcare professionals or students and 13 healthy participants and (a), and User Study II, consisting of the ICU Care team and 18 cardiothoracic ICU patients (b).
• Figure 4: User Study I results: percentage changes in healthy participants' heart rates measured in BPM across four game levels, L1-L4 (a), average scores for each category in GEQ (b), and survey questions on Lumi in 5-point Likert scale; SA: strongly agree, A: somewhat agree, N: neither agree nor disagree, D: somewhat disagree, SD: strongly disagree (c).
• Figure 5: User Study I results: healthy participants' motion analysis from Quest 3 body tracking for each body joints (LH/RH: left/right hands, LE/RE: left/right elbows, LS/RS: left/right shoulders) in terms of speed (a), range of motion (b), and workspace volume (c).