"Patients can get so motivated that at some point we have to ask them to stop".

Whether it is rehabilitation after a heart attack or cognitive therapy for behavioral change: rehabilitation is an intensive process that requires a lot of energy. From the scientific program Medical Delta: Improving Mobility with Technology, Dr. ir. Bram Onneweer is linking pin between Rijndam, Delft University of Technology and Erasmus MC. In this role, he advises on technology and links research projects to therapists and patients at Rijndam, ultimately (helping to) develop products that can be used in practice.

This interview is the fourth in a series of interviews with Medical Delta-funded PhD students and postdoc researchers. Bram's postdoc position is funded from the Medical Delta scientific program: Improving Mobility with Technology.

What are you currently working on?

"I guide and support innovation projects in healthcare practice. I make sure that we address the right questions and that we do so with the right partners. For example, I am involved in developing the use of SenseGlove in hand rehabilitation. SenseGlove is a glove that makes it possible to interact with objects in a virtual environment. People rehabilitating after brain infarction or stroke can use the glove to practice hand movements in a safe and challenging way. This project was started based on a care request, but also to go through all the development steps and thus learn how innovation is done in the rehabilitation sector.

With CleVR, the company that designed the Virtual Reality environment for the SenseGlove project, I am working on cognitive behavioral therapy in VR. This includes role plays and situation-specific exercises. For example, they developed a virtual supermarket for people who find it scary to go to the store, so they can practice with it. This therapy is already used in mental health care. Together with CleVR, we now want to make that existing system suitable for people with non-congenital brain injuries. The therapist can make the environment as challenging as possible for the patient, for example by choosing in advance how many customers are walking around in the supermarket."

What does Medical Delta mean for your project?

"Part of the hours of my postdoctoral research is funded by Medical Delta, and that gives me the opportunity to go to conferences or other meetings. An important part of my work and for the projects is to engage with different partners. Therefore, I can seek and keep contact with people from different disciplines - from the technical field, but also experts in rehabilitation, for example. Over the years I have built up a valuable network this way."

With VR, you can do many more types of exercises, from frying eggs to sorting fruit.

How do your projects change by collaborating with people from different disciplines?

"To give an example, with the SenseGlove you can take measurements about the use of the glove. We started with the idea that we wanted to include those measurements, but in co-creation with the therapists it appeared that they don't have time to look at this data at all. Much rather, they wanted a user-friendly exercise system for patients. As a result, we decided to go for a certain type of gloves and stop storing the data, which also saved development costs. My "researcher head" and "practical head" sometimes clashed on this project. Coordination with healthcare providers is very important, so I can decide how far I can go with research data collection, without losing sight of the immediate interest of the patient.

In the end, we took the project in a different direction: the glove has now become primarily an exercise device, with which people undergoing rehabilitation can train movements. This ensures that this innovation has immediate value for patients and their therapists."

Martijn Nagtegaal, the previous interviewee in this series, is curious: what will remain of your research?

"Traditional rehabilitation therapy can be quite boring: patients have to attach a clothespin to a bar a hundred times, for example. With VR, you can do many more types of exercises, from frying eggs to sorting fruit. Because the patients practice in a VR environment, the therapists can give the other patients in the arm-hand rehabilitation group more attention. In addition, it saves a lot of cleanup time because the exercises are in VR.

Patients can also train more complex movements faster. That makes rehabilitation more fun. With VR, patients sometimes get so motivated that at one point we have to ask them to stop for a moment. That motivation is one of the most important results our VR environment produced: we can challenge patients at their own level. Ultimately, we want to use this to ensure that patients rehabilitate faster and easier."