A digital rehabilitation session begins before the game starts. The therapist needs to decide what the person is working towards, what part of that goal the task can address and which observations will help guide the next decision.
“Use the tablet today” describes equipment. “Practise choosing the objects needed for a familiar outing” describes an activity. That distinction helps organise the session around the person's priorities, while keeping the technology in a clearly defined supporting role.
The following framework is a practical planning aid, not a validated treatment protocol. It does not prescribe a fixed session length, exercise dose or progression threshold.
1. Define what the session should help you understand
Start with an activity the person wants or needs to do. Clarify the usual context, what currently makes it difficult and what support is available. Then identify a manageable question for this session.
For example: can the person select the objects needed for a familiar outing using an agreed visual checklist? This is more informative than a general aim such as “work on cognition.” It also allows the therapist to distinguish choosing the correct object from understanding instructions, reaching the display or remembering the task rule.
For adults after stroke, NICE recommends meaningful goals focused on activity and participation, with sessions linked to those goals and adapted to individual needs. These recommendations are specific to stroke rehabilitation; they do not validate the framework proposed here. [1]
2. Check readiness and access before measuring performance
Discuss how the person feels and confirm their agreement to the activity. Review relevant pain, fatigue, attention, communication and sensory needs. Establish how they will ask for help or a pause.
Check the seating, display position, input method and clarity of instructions. If a headset is involved, follow the device and application guidance and assess whether it is appropriate in the clinical context. A screen-based alternative may be useful when available.
Allow familiarisation before treating the recorded attempts as task performance. Difficulty operating a device can otherwise be mistaken for difficulty with the intended activity. Note any change of input or assistance rather than treating all attempts as equivalent.
3. Write down a starting configuration
Select the simplest setup that still presents the demand you want to observe. Record the actual settings supported by the software. Do not assume that target size, timing, prompts or input methods are adjustable on every system.
For the outing example, the therapist might use a small set of recognisable object images, a familiar destination and a visible checklist. Whether a time limit or distracting items are useful depends on the objective. They should not be added simply because the software offers them.
A worked planning example
This fictional example concerns an adult in an individual, therapist-led rehabilitation session. Suitability depends on assessment. It does not describe a confirmed Remotion exercise module.
| Planning element | Illustrative choice |
|---|---|
| Functional objective | Participate in preparing selected objects for a familiar outing, using agreed support. |
| Session question | Can the person identify the relevant objects with a visual checklist, and what assistance is needed? |
| Patient-facing task | Choose the objects you would take for this familiar outing. |
| Starting configuration | Recognisable images, limited choices, accessible display and input, checklist available; no time pressure unless clinically justified. |
| Recorded events | Selected objects, incorrect selections, omissions and completion time, only where actually recorded by the tool. |
| Therapist observations | Understanding, help provided, search strategy, unintended inputs, comfort and reasons for pauses. |
| Easier version | Reduce choices, demonstrate the rule or present one step at a time, while documenting the changed demand. |
| Possible progression | Change one relevant demand, such as reducing a prompt or adding a choice, when justified by observation and the person's agreement. |
| Cautions | Stop or pause for concerning symptoms, distress or loss of safe positioning; reassess before continuing. |
| Follow-up activity | Observe the corresponding selection using real objects when appropriate, without assuming the digital result predicts independence. |
4. Observe a short attempt, then make a decision
Give a clear instruction and observe how the person approaches the task. Avoid adding several new rules while trying to interpret the same attempt. If the instruction is misunderstood, clarify it and document the help provided.
After an attempt, choose whether to continue, simplify, modify the setup or stop. Changing one relevant variable at a time can make the reason for a change easier to interpret, although immediate comfort and safety needs take priority over keeping conditions comparable.
A mistake is information to examine. It may reflect an unfamiliar symbol, accidental input, misunderstanding, fatigue or another factor. The game result alone cannot identify the cause.
5. Review the session with the person
Ask what felt useful, difficult or tiring. Reconnect the exercise to the chosen activity. If appropriate, examine a related task with real objects, remembering that different materials and environments introduce different demands.
Decide together what should happen next: repeat a comparable task, adjust the support, try another activity or reconsider whether the digital exercise serves the goal. Ending the digital activity can be an appropriate clinical decision.
6. Document enough to explain the next step
A useful note separates the conditions, recorded results, clinical observations and interpretation. For example: “Fictional teaching example: person selected items for a familiar outing with a checklist available. The therapist repeated the instruction and pointed to the checklist. One unintended screen contact occurred. Real-object preparation was not assessed. Next session: review input access and observe a comparable selection task.”
This note does not claim that daily independence improved. If the system provides a score, include the configuration and assistance needed to interpret it. A game score should not be presented as a validated clinical outcome without evidence for that specific use.
Keep the plan adaptable
The session plan should make the purpose clear while leaving room for the person's response. W3C's XR accessibility note highlights the importance of interaction alternatives and personalisation; it is a design resource rather than a clinical protocol or product certification. [2]
For therapist-led care, the practical endpoint is a reasoned next decision: what was observed, what remains uncertain and what should be tried or assessed next. The session can be useful even when it shows that another approach is needed.
Discuss your activity goals and clinical setting with the Remotion team through the website contact page. Confirm which settings and accessibility options are available in the specific configuration being considered.
References
- National Institute for Health and Care Excellence. Stroke rehabilitation in adults. NG236. 2023.
- W3C. XR Accessibility User Requirements. Working Group Note, 25 August 2021.