Case Study
REAL™ Immersive System

Virtual rehab with REAL results

Any type of physical rehabilitation is difficult. That’s especially true when recovering from a brain injury. Progress is typically slow and it’s easy to become discouraged and depressed. The CDC reports that less than a third of discharged stroke patients receive any rehab, and, of those who do, frequency of use is low despite clear evidence that it’s effective.

The REAL™ Immersive System is a radically different approach to stroke rehab that’s designed to be accessible, effective, and fun. It’s the first virtual reality (VR) system that is purpose-built from the ground up for rehabilitation in a healthcare environment. In a REAL therapy session, the patient sees their avatar moving like it’s their own body, which encourages development of new neural pathways. The therapist uses an app on a tablet to see what the patient sees and can customize activities to meet patient needs.


The inspiration for the REAL System came from a mutual friend of the CEOs of Penumbra, which specializes in solutions in the neuro and vascular interventional space, and Sixense, a company focused on enterprise use of VR hardware and software.

Their friend’s neighbor, Deb, experienced a stroke and was coming into Sixense’s offices to play VR games with her therapist. Watching her joy at interacting in this virtual environment, the companies saw the opportunity to create a life-changing technology for people recovering from strokes. Deb remained the team’s muse throughout the development process.

Neither company had experience providing solutions in the rehab environment. That’s where Delve came into the picture. Our engineers and designers went into the field to interview and observe physical therapists. Their goal was to help adapt Sixense’s immersive VR technology to easily work in a variety of rehab settings including the gym, bedside, and mobile facilities. Throughout the process, we focused on the needs of two users – physical therapists and patients.

Photo of REAL system

There were many technical requirements to be addressed. Highly accurate electromagnetic sensors are used rather than the typical optical sensors used in gaming systems, which require “line of sight” tracking. Electromagnetic tracking allows the therapist to be wherever they need to be around their patient without disrupting position tracking, creating a more stable and consistent user experience. These sensors required careful placement of a sensing coil and battery inside a compact package.

We designed the organic form of REAL’s sensors to mimic the curves of the human body, with a little valley in the center to hold a band securely and provide necessary separation of the components. Sensors are attached with soft neoprene bands that are easy for the therapist to place on the patient. The bands come in a set that is assigned to the patient for the duration of therapy for sanitation reasons.

The headset was engineered from existing technology, which limited customization. We focused on achieving well-balanced weight distribution, making it more comfortable.

Photo of tech strapping sensors on patient
Photo of patient using REAL system
It takes about two minutes for the therapist to set up and start a REAL session.

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