Scenario description:

The aim of this Pilot is to demonstrate the transformative potential of Extended Reality (XR) technologies in the rehabilitation of patients with orthopedic, neurological, and oncological conditions. the pilot’s central ambition is to enhance patient motivation, engagement, and recovery outcomes by blending immersive digital environments with real-time physiological monitoring and feedback. Physiotherapy after orthopaedic surgery and other kinds of upper limb motor impairment such as “frozen shoulder” or severe hand arthritis is crucial for complete rehabilitation but is often repetitive, tedious and time-consuming. Actually, in order to achieve a motor recovery a very long physiotherapy treatment, sometimes more than 50 sessions, is needed.

The pilot evolved around a novel XR-based rehabilitation platform, integrating motion and electromyographic (EMG) sensors, wearable haptic actuators, and AI-driven feedback mechanisms. These components create a supervised yet personalized environment, where both patient and therapist can monitor performance and adapt therapy dynamically. The platform was applied to two clinical use cases: upper limb rehabilitation (focusing on shoulder pathologies and lymphedema following breast cancer treatment) and lower limb rehabilitation, targeting post-surgical knee recovery.

In the upper limb scenario, patients wore an augmented reality headset (HoloLens 2) and interacted with 3D virtual objects in a “pick-and-place” exercise framed as a serious game. Guided by an avatar demonstrating correct movements, patients practiced repetitive goal-oriented tasks with real-time visual and haptic feedback that indicated errors or compensatory movements. The lower limb scenario adopted a more autonomous setup, where patients followed their mirrored 3D avatar performing squats, seated extensions, and walking exercises, receiving immediate feedback on posture and accuracy.

The first validation phase, conducted at Versilia Hospital, involved healthy volunteers to test system usability, comfort, and functionality. Results confirmed strong engagement and ease of use, though users highlighted areas for improvement such as glove fit and avatar accuracy. These insights guided system refinements before advancing to clinical testing.

The final validation phase involved six real patients undergoing upper or lower limb rehabilitation. Clinical assessments, including the DASH, Oxford Knee Score, and WOMAC scales, were administered alongside physiological measurements. Patients reported high satisfaction, comfort, and motivation, appreciating the immersive feedback and interactive exercises. Clinically, modest but measurable improvements were observed in upper limb function and lymphedema reduction. Although lower limb results showed no immediate functional gains consistent with the longer recovery time of such conditions the system was well accepted by patients and clinicians alike.

Overall, Pilot 20 successfully demonstrated the feasibility and therapeutic value of XR in clinical rehabilitation. It showed that immersive, sensor-driven environments can increase patient engagement, personalize recovery pathways, and strengthen the therapeutic alliance between clinician and patient. The evolution from prototype to clinical validation marks a significant step toward integrating XR technologies into standard rehabilitation practice offering a vision of future care that is both technologically advanced and deeply human-centered.

On YouTube SUN channel you can watch a video showing the validation performed in Versilia Hospital.