Strokes affect nearly 800,000 people per year in the United States alone. While most people survive a stroke, they are often left with life-changing neuromotor disabilities. Two classic examples of this are hemiparesis (weakness on one side of the body) and hemipelagia (paralysis of one side of the body).

These two conditions create obvious daily challenges for patients and severely affect their quality of life.

Fortunately, both conditions can be improved with regular therapeutic exercise. As patients practice these exercises, their brains re-establish proper control over their affected limbs, eventually allowing many patients to live independent lives.

Unfortunately, rehab exercises are often dull, demotivating, and extremely challenging. As a result, many patients don’t exercise enough, and their recovery slows or stops.


CogniviveVR was a virtual reality experience designed to help solve the problem of compliance with ideas borrowed from the gaming world. As Cognivive’s Chief Creative Officer, I was responsible for the entire product’s design and user experience.

Throughout the experience, our patient-players would regularly perform rehabilitation exercises disguised as game actions. By re-contextualizing the various exercise motions we removed the first two barriers to compliance: that the exercises were dull and unmotivating. CogniviveVR also featured a proprietary “Therapeutic Adaptive Difficulty System” which could learn about the patient’s cognitive abilities, and adjust the experience to fit. This system allowed CogniviveVR to always challenge the patient in an appropriate, therapeutically effective way, removing the third barrier to compliance. The entire CogniviveVR experience would be delivered to patients’ homes as a simple system of a VR headset, hand controllers, and a companion tablet. By making it an at-home therapeutic tool, we hoped to lower two more barriers to compliance: the cost and availability of quality therapists.

The finished demo of CogniviveVR featured 3 therapeutic activities designed by myself and our software engineer Joey Salisbury. After donning their headset, patients could switch amongst the 3 activities, or explore Crystal Cove Resort, the experience’s narrative setting which I designed. Patients also had the ability to visit Ronnie, the resort’s personal trainer, for a routine assessment of their physical abilities. The entire experience was also predicated by an interactive “Welcome to VR” sequence that allowed patients to become comfortable with VR before starting to use it regularly.

Design Principles

As the creative lead for CogniviveVR, I developed a list of “Design Do’s and Don’t’s” to guide our design process. At the core of the list were two key design principles for any therapeutic activity in CogniviveVR: “Hide The Exercise” and “You Can’t Lose At Therapy”

“Hide the Exercise” meant that we should never ask the player to specifically do a therapeutic exercise. Since nearly all of the therapeutic exercises we covered in CogniviveVR involved the patient moving their hands in particular ways, that also meant we couldn’t ask the player to move their hand somewhere simply for the sake of it. We always needed to give the player a higher order task, such as hitting a ball or rotating a laser cannon with a joystick.

“You Can’t Lose At Therapy” reminded us to design game activities where the player’s success was as independent of their rehabilitation goals as possible. For example, an activity might challenge the player to remember ingredients for a recipe. This would have been appropriate since that kind of cognitive challenge was not a part of the player’s rehabilitation goals. Failing to complete the recipe challenge would not mean players failed their rehabilitation goals.

The idea behind these principles was simple: we wanted players to feel empowered beyond their disabilities. This would keep them motivated and excited to continue engaging with CogniviveVR’s activities much longer than if we tied their rehabilitation progress to any notion of “game progress”.