A marriage of virtual reality and physical therapy: Immergo Labs emerges from its UCSC roots

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The COVID-19 pandemic has changed a lot of things about everyday life — but for UC Santa Cruz Baskin School of Engineering alumni Aviv Elor, Ash Robbins and Michael Powell, it’s presented an opportunity: to bring physical therapy to telehealth.

Their company, Immergo Labs, is a virtual reality telehealth platform that allows physical therapy patients to continue their treatment from anywhere with internet connectivity. With the technology, now intended for a trial run in January, patients who have achieved a certain level of recovery in person can dial in to sessions with their physical therapists from the comfort of their living rooms — making continuing treatment easier and more equitable, the creators say.

It’s a novel idea that sits at the nexus of two emerging industries: telehealth, which due to a pandemic-related boom could soon be worth upward of $250 billion in the United States alone; and virtual reality, long the tech industry’s proverbial “what’s next?” The team, comprised of Elor, Robbins and Powell plus four regular technical advisors and two interns, plans to release the platform by the end of next year, and is now conducting a small trial with a select group of physical therapists throughout the U.S. They’ve raised about $411,000 through a combination of grants and an ongoing StartEngine investment crowdfunding campaign.

The first inklings of their concept came when Powell and his two business partners were researching “medical deserts” at UCSC. In less-urban areas, medical specialists can be hard to find — with physical therapists being particularly difficult.

“There are a lot of areas in the country where it’s really difficult for anyone to get to a physical therapy clinic,” Powell said. “It’s mainly because of distance, but it can also be because of disability too, right?”

With Immergo VR, physical therapists are able to dial in to live exercise sessions with their patients where, using sensors and gyroscopic remotes, both patient and therapist are able to see almost exactly how each other is moving within a 3D environment. The platform records data points — like the range of motion of a patient’s limbs — which are useful for tracking their recovery over time.

The Immergo VR team.

(Via Immergo VR)

Elor, Robbins and Powell met while working in the engineering labs at UCSC. The three hail from different disciplines: Elor specializes in virtual reality and user experience, Robbins in artificial intelligence and biologically inspired robots and Powell in biomechanics.

And given the problem their company is trying to solve, it’s no coincidence that all three are athletes, and have all undergone some form of physical therapy at one point in their lives: Elor does judo, Robbins is a rock climber and Powell was once a gym trainer.

Currently, the team is fielding an early version of Immergo with eight physical therapists throughout the country, and will soon begin a user study involving 100 physical therapists with Houston’s veterans affairs department. The team aims to release the platform by January to what it says is a large waitlist, followed by a full release by the end of 2023.

Sean Wells, one of the physical therapists participating in Immergo’s small user trial, said the platform has already been useful in tracking his patients’ progress — especially when either he or they travel.

“With a patient, what I can do is say, ‘Hey, do your exercises in VR, and I’ll monitor your progress until the next time we meet,’” Wells said. “[Immergo] will give me all sorts of information: Is he getting stronger? Is his torque and range of motion getting better?”

This interview has been edited for clarity.

Lookout: What problem are you trying to solve?

Michael Powell: We’re a virtual reality telehealth platform for physical therapists, and the key part really is the telehealth. A big problem at physical therapy clinics are no-shows. We’ve heard that 20-30% of patients a day don’t show, and that’s lost revenue for a clinic. So just by using telehealth, they increase their revenue, because people show up to telehealth appointments. They’re much more convenient.

Also, a lot of patients have a hard time getting to a clinic two, three times a week; there’s work, family, immobility, distance — lots of reasons. But having a telehealth component that supplements some of the care increases accessibility.

The idea is that we aren’t trying to replace physical therapists or in-person care — the idea is to help supplement it.

Lookout: Is that 20-30% figure new — as in pandemic-related? Or is this a consistent pattern?

Powell: The way we heard about this phenomenon is that we received a NSF Small Business Innovation Research (SBIR) grant, and through this process, we had to go through I-Corps and Beat-the-Odds bootcamps — which are customer discovery bootcamps, meaning we had to do over 100 interviews for one program and 70 for the other. And basically we spent that time interviewing physical therapists, occupational therapists, insurance workers, policymakers — anyone and everyone we could think of in this space — to really understand what the big, shark-bite problems are. We weren’t trying to pitch virtual reality; we weren’t trying to pitch telehealth. It was just like, “What’s going on? What do you guys need?”

And it always came back to telehealth. That’s when we started to learn about no-shows, and those were the numbers we were hearing the most: between 20 and 30%, even as high as 50% for large clinics, which is crazy.

The first round of interviews we did was in the summer of 2020 — right when everything was shutting down — and obviously telehealth was a huge concern. And we knew that interviewing physical therapists at that time would be very different than what it might be like now. When we did the Beat-the-Odds bootcamp, that was like eight or nine months ago, when everything had opened back up. So the landscape — we caught it at a huge shift, and then caught it as it was “going back to normal.”

But what the pandemic did for telehealth is it accelerated everything by five to 10 years. That’s what we kept hearing from physical therapists: That prior to COVID, no one — no physical therapists or patients — wanted telehealth. But now after being forced to do it, and realizing there are benefits to it, but that it’s just not good enough yet — now that it’s out there — PTs really want it.

Lookout: What’s Immergo like to use? What do you do in it?

Powell: So the idea is, a patient at home throws on a virtual reality headset, and a therapist throws on a virtual reality headset, and the patient and therapist meet in the same 3D, virtual room. They can walk around each other, see metrics for range of motion, joint torques and balance assessment.

The idea is, you can move around each other, see full-body movements, and [your PT] can correct your exercises; guide you through them. And what those exercises actually look like, that really depends on whether you’ve had surgery, or if it’s just aches and pains, or whatever it might be — an old injury or something. Some components [of PT] are very hands-on with the manipulation, but as you’re progressing through the phases of recovery, you should be becoming more independent, and that’s when telehealth starts to make more sense.

Lookout: You guys worked on a game together, right?

Powell: Yeah, that’s how we got started on this. We’ve all gone through physical therapy ourselves, so we all know first-hand that adherence is a big issue. A common thing in physical therapy is that patients do well with their in-person sessions, when they’re meeting with their therapist — and as soon as those in-person sessions stop, pretty much everyone stops doing their exercises. So we thought, “Let’s gamify the exercise and make it more fun, so people actually stay on top of them.”

So when we did I-Core, we thought the problem we were trying to address was adherence — but that wasn’t. The issue was telehealth and connectedness. So it was a pivot from game experiences that give valuable metrics to live sessions that give these metrics.

Lookout: It sounds like the game portion is coming back in the form of the asynchronous feature you’re adding.

Powell: Definitely. So it’s really cool, and the idea is that PTs can record themselves in the virtual reality environment doing the exercises, and record audio while they’re doing it. Like, “Hey, here’s your exercise program, I want you to do 10 reps of this, five reps of that.” So when the patient opens it up on their end, they can see exactly what the therapist was doing, and they can record themselves doing it all and then send it back to them. The big plus here is that, if internet connection is limited, people can still do their exercises without having to be live.

And we do have a plan for continued care in the future. Recovery isn’t, “eight sessions and ultimately, magically, you’re 100% better.” It’s a continuum. Like, you should be maintaining your exercises.

So the idea is, when a therapist feels like their patient is ready to be on their own, but they do need to continue their exercises, we’ll have a continued care subscription that has these exercise games that will continue to log their data, and still keep them connected to their physical therapists.

Lookout: What’s your perspective on UCSC as a place where startups like Immergo can get off the ground? It’s cool that you guys met there.

Powell: Yeah, it’s really cool. UCSC has had some spinouts, but it’s still relatively new at this compared to like Stanford or Berkeley, which are cranking out a lot of companies and have a lot of experience in this. I think UCSC is still trying to figure out how to encourage that same environment among their students — to do research and then bring it out of the lab into the real world and have an impact. We really appreciate UCSC’s support in that, and we have a lot of lab friends who are working on really great things, and it would be great if they can figure out ways to bring them out.