Game design meets biomechanics for a rehab journey in the ExerCube.


The ZHAW Zurich University of Applied Sciences, the Zurich University of the Arts (ZHdK) and Swiss startup Sphery have taken the gamification of fitness to the next level with an immersive rehabilitation program for athletes with ACL injuries. 

“This project came about through discussions we had with Sphery, the company who developed the ExerCube. We saw the potential for exergames to fill a gap in rehabilitation, something that the physiotherapist cannot offer by themselves,” says Eveline Graf, Professor of Physiotherapy at ZHAW Zurich University of Applied Sciences.

The idea was to go beyond the generic fitness offering that was pioneered on gameconsoles and advanced by the ZHdK spinoff Sphery. The developers planned to offer an extremely focused program drawing on the expertise of biomechanists, PTs and games designers. “We know that there’s a lot of untapped potential in this field of interdisciplinary R&D when it comes to exergames,” says Anna Lisa Martin-Niedecken, founder and CEO of Sphery, as well as head of the Institute for Design Research at Zurich University of the Arts.

Sphery describes the ExerCube as an ‘immersive fitness game setting’. It consists of three walls, which serve as projection screens for 3D game environments and provide haptic feedback when players make contact with them. There are currently ExerCubes at around 50 different fitness and rehabilitation centers globally.

“In our project we specialized in ACL injuries,” says Graf. “The ACL is one of the most commonly torn ligaments in sports, and it leads to a long rehabilitation process.”

The earlier crop of ‘exergames’ for the ExerCube provide users with a workout by having them jump virtual obstacles, reach for different objects, and respond to a host of other virtual inputs. To provide effective rehabilitation, however, the developers needed deeper insights into how participants were responding to different elements of the games.

Establishing ground truth

“The first step is that we need to know in more detail how people actually move during an exergame, and how they do it while playing it over 25 minutes—maybe they get fatigued, and there are different levels of physical and also cognitive challenge” says Graf.

“That hadn’t been done at the level of kinematics of the joints,” she explains. “So the first step was to use an existing ExerCube game and record movement data of people playing the game. We looked at athletes, and then also athletes after an ACL injury, to see what kind of movement patterns they are producing. We needed to determine which movements are safe and which ones are a little more risky and might need to be left out. The Vicon system, for us, wasthe key to get that information that we needed—the detailed three dimensional kinematics of the lower extremities.”

“The data we gained from the biomechanical analysis really topped expectations, because we were able to very accurately see exactly which movements are better or worse for inclusion in the training concepts we’ve developed,” says Martin-Niedecken. “It was really vital to have this Vicon system at the very beginning of the project to allow us to include the right movements for the training concept we were developing for the new exergame concept.”

The system that the interdisciplinary R&D-team  used consisted of mixed Vantage cameras, Vero cameras and video reference cameras. “It was a real advantage to be able to combine all those different products and make one system,” says Graf.

The story doesn’t stop there, to read the full case study, you can download it below.


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