To help children overcome disabilities, Digireha (Digital Interactive Rehabilitation System) provides a rehabilitation tool that combines digital art and sensors. Leveraging the power of digital design, they have realized a new approach where rehabilitation happens while children are concentrated on playing. With an estimated 15% of the world’s population facing disabilities, what kind of rehabilitation approach are they envisioning?

Kanako Nakamura | General Manager / Physical Therapist at Digireha

After working as a physical therapist at a university hospital, pediatric facilities, and NICU, Kanako was in Guatemala as a JICA overseas cooperation volunteer. She joined Digireha in 2018 after working as a development consultant and in after-school and daycare services. She pursued a master’s degree in Disability Studies at the University of Leeds to learn about the social model of disability. She has been in her current position since 2020 and currently works remotely from the UK.

Transforming rehabilitation more fun and proactive

── First of all, could you tell us about Digireha?

Kanako: Digireha is a rehabilitation tool that utilizes digital art and sensors, providing various applications (content) as a platform.

Kanako: For example, some of the apps include “Shiny Explosions” where users can rehabilitate their upper limbs by moving their hands up, down, left, and right to launch fireworks, and “Water Prank” where users can play pranks on waiting people with a digital water gun that detects slight movements. Currently, 34 apps are available, allowing users to choose according to their needs.

── What are the problems with the traditional rehabilitation system?

Kanako: One of the issues is the strong artistic aspect and subjectivity involved. Many people think of rehabilitation as part of medical treatment, but in reality, it doesn’t have clear-cut answers like medicine. While standardized treatment methods exist, they rely heavily on the therapist’s skills and judgment when performing stretches. Despite efforts in the industry to standardize, the lack of reproducibility is a significant challenge.

Moreover, there are many children with severe disabilities who cannot speak, making it difficult to obtain reliable data. In the current situation, even if you say, “Squeeze tightly for the grip test,” it’s uncertain if the message is understood or if they are genuinely exerting force. Furthermore, the assessment of rehabilitation effectiveness may only be possible years later, after the child has grown up, perhaps even a decade later. With no precise data available and the inability to immediately confirm results, it is challenging to establish systematic treatment methods based on evidence, leading to the persistence of outdated training methods attributed to unscientific beliefs. Acquiring and accumulating data through sensors and utilizing them to address these challenges is a crucial role of Digireha.

Discarding conventions and efficiency and adapting to as many children as possible

── What are the key features of Digireha’s apps?

Kanako: There are three main features: Utilization of Gamification, Integration with a Variety of Sensors, and Customization Function.

At Digireha, it is crucial for children to have fun above all else. Therefore, when planning our apps, we incorporate the perspective of gamification to ensure that the movements during play contribute to rehabilitation.

Regarding sensors, we collaborate with five different types, each capable of unique functions. It’s honestly quite challenging to cater to multiple sensors, but we aim to provide a wide range of options so that every child can find the perfect app.

Kanako: Some sensors have as many as 7 apps compatible, which means more workload and development costs. However, we didn’t want any child to miss out on Digireha by narrowing down the options. Even if it sacrifices work efficiency, our goal is to reach as many children as possible, hence we take this approach.

── It’s common for startups to specialize in one area for initial resource allocation, but you’ve taken a different approach, haven’t you?

Kanako: To be honest, this may not be the best business decision for a startup. However, the reason we’ve chosen this approach is that many of our team members, including myself, have professional backgrounds or personal experiences related to disabilities.

Digireha was originally born for very personal reasons. Initially established as the NPO Ubdobe to make medical and welfare services more accessible through regular events, the founders, Okamoto and Kato, who have a daughter with muscular dystrophy, were inspired to create something useful after witnessing children enjoying digital art music events. 

Especially for Kato, seeing her daughter struggle with hating rehabilitation was a painful experience. For young children, having rehabilitation constantly around them is understandably not enjoyable.

Kanako: As a physical therapist myself, and with all team members having extensive knowledge about disabilities, our core belief is wanting to solve the immediate problems faced by these children. This is why when we think about focusing on one thing, the faces of children who wouldn’t be able to use Digireha if we did so come to mind. We cannot overlook the fact that while we specialize in something, there are children in need of fun and support, spending years with disabilities unresolved. It’s because we have a much deeper understanding of disabilities and children with disabilities than others that we cannot give up.

The customization feature also embodies the intention of ensuring as many children as possible can enjoy it. Disabilities vary greatly in individuality, so while increasing the number of apps is essential, individual optimization is necessary to create something that fits each child perfectly.

── What aspects can be customized in the app?

Kanako: We allow for detailed adjustments such as object size, color, background on/off, movement speed, interval between movements, sensor sensitivity, and more within the app. Additionally, since the abilities can differ even with the same disability, we have created an Easy Mode. This ensures that children with severe disabilities can enjoy the app according to the severity of their disability while maintaining the level of difficulty to extend their current abilities.

── By accommodating a variety of sensors and offering a range of apps, you are expanding the degree of disabilities that can be covered through customization, while catering to a wide range of conditions.

Kanako: That’s right. When it comes to customization, there are many things we want to do in the future. One of them is image replacement. If users can have their own hand-drawn characters or favorite characters appear in the app, they should be even more engaged.

We are also exploring voice switching. In fact, children with disabilities often respond differently depending on the person speaking, showing significant reactions to their mother’s voice, for example. Instead of providing instructions with mechanical voices, we believe that being able to ask questions in the voice of a familiar person could make the activities more enjoyable and engaging.

A child’s reaction is the best guide. Getting closer to the ideal through updates

── When designing services for children with disabilities, are there any specific considerations you keep in mind?

Kanako: Earlier, I mentioned gamification, and we are careful not to make the gameplay too complex. Children with intellectual disabilities find it challenging to understand many rules and complex elements, so it is important to keep things simple. For example, in “KIRAKIRA Jewelry,” jewels fall when you move your hands or feet, and in “Flying High,” touching animals or cars makes them move.

Kanako: We also pay attention to the amount of stimulation. We minimize on-screen decorations to avoid distractions and make it easier for children to concentrate. There is a significant percentage of individuals with epilepsy, and just like the “Polygon episode” in the Pokémon anime where strong flashing lights triggered seizures, we are cautious about the level of stimulation. To ensure safety, we undergo a hardening check by an authentication company (analytical diagnosis aimed at reducing the risk of photosensitive seizures).

── How do you ensure the effectiveness of a rehabilitation tool?

Kanako: We have a team that guarantees both the rehabilitation and design perspectives, with individuals holding therapist qualifications involved in directing production and development. By aligning the non-negotiable aspects and requirements from each perspective, we can maintain quality in development without time loss.

Things don’t always go as planned, so we update while observing the children’s reactions.

For example, in the app “Ninja Touch!” where you touch ninjas like playing whack-a-mole. Initially, we set the ninjas to appear slowly to make it enjoyable for everyone, but it turned out that children who could move their bodies were playing a lot, causing a mismatch in speed and everyone waiting for the ninjas to appear. Therefore, we made it possible to customize the speed of ninja appearances to adjust and ensure that the app remains enjoyable for a diverse range of users without compromising its original intent.

Making rehabilitation accessible anywhere, for anyone, equally

── With the progress in visualizing data, which was a significant initial challenge, have there been any changes for those using Digireha?

Kanako: Various changes and developments have emerged. One is that it has become easier to capture the changes in children. In Digireha, we calculate a play score based on data acquired from sensors and make it publicly available for customers to view. Changes in children are often difficult to notice for those close by. By quantitatively showing improvements like “it was 10 points last month, but now it’s 15 points,” it has led to increased motivation for parents, and facility staff, and has become a trigger for the individual to feel hopeful.

Another aspect is that it also functions as a common understanding among staff. When different staff members take turns observing a child, there used to be no clear indicators for sharing the child’s condition. Now, we can share specific numerical values like “when we tried Water Prank at sensitivity level 8, the response was just right.” This enables all staff members to respond uniformly, making communication easier and bringing various benefits.

── It seems that there are cases where you collaborate with children in planning within the app development process.

Kanako: Through a project called Digireha LAB, we conduct workshops with children. We brainstorm together on what kind of apps would be good, actually create them, and sometimes have engineers develop them on the spot. Recently, we collaborated with the pediatric department of Hokkaido University Hospital. Apps on the Digireha website that credit individual names as Planners, such as “Mazeruto Kawaru (meaning Mix and Change),” were born through planning with children in this way.

Kanako: Indeed, Digireha is a service for children. What is enjoyable should not be arbitrarily decided by adults, and it should not become about adult ego. I believe that we must involve the children, who are the stakeholders, in creating together, and I also hope that through this process, the children will become a team with each other. Rather than treating them as children who need to be helped, I want to assist them in becoming a team as companions who created an app together. I believe that contributing in this way to the next generation’s society ultimately contributes to the quality of the app itself.

── What would you like to achieve with Digireha in the future?

Kanako: Beyond the current customization efforts, I aim to create a system where anyone can easily create the app they need. It involves providing a certain framework and allowing the intuitive combination of necessary elements based on the individual’s rehabilitation situation, similar to a no-code tool.

Additionally, we are exploring mechanisms to provide real-time feedback based on data obtained from sensors. We are conducting collaborative research with experts on methods to monitor physiological indicators and evaluate stress levels and levels of interest based on heart rate variability.

Currently, individuals rely on someone to adjust the system as they cannot customize it themselves. However, with an app equipped with an adaptive system, therapists would be able to create an optimal environment for each individual without the need for their presence. Ultimately, I want to create an environment where rehabilitation tailored to each child is provided, regardless of whether it is in a hospital with cutting-edge therapists or in a village in a developing country without doctors.

Related Links
Digireha, Inc.