Crossing the Bridge

Somewhere between a research lab and a hospital corridor, good ideas can get stuck. The technology works, the evidence is promising, the clinical need is real, and yet the gap between “this could help people” and “this is being used with patients” remains.

To understand why, a series of conversations were held with practitioners working at the intersection of XR technology, rehabilitation research, and commercial development. Participants came from Ireland, the Netherlands, and Spain, representing clinical research, industry, and positions that span both. All shared stories about what the bridge between academia and industry actually looks like and how it feels to be experienced firsthand.

This piece is a summary of their shared insight, as well as the questions they left for the community to contemplate further. Hopefully, it will also ignite conversation among the XR4REHAB community.

While participants spoke fondly of collaborations, they remarked that none were initiated through a formal process. One such collaboration began when a CEO at a company working in a similar space got in touch directly: are we competitors, or should we collaborate? With them promptly applying for a funding opportunity two weeks later. They took the leap, and it became a multi-year partnership. Another grew more organically, when a clinician who had been creating VR experiences in their spare time, eventually persuaded their medical institution that it was worth dedicating real time and resources to – helpfully meeting a company at a conference who were looking to have an MD on the team.

What all these collaborative beginnings have in common, is that they were personal before they were professional. A direct message, a side project, a casual conference conversation and a shared frustration with how things were being done. While the contracts and institutional sign-off came later, it was, in fact, the relationship which came first.

Ethics approval came up in every conversation. Protocols often rejected or needing revised because reviewers did not fully understand the technology. Templates designed for drug trials applied to a low-risk digital health study. As one founder put it, “understanding what we had to include in that template was a real challenge, and it came down to them not understanding what we were doing.”

Infrastructure was its own quiet barrier. Unreliable hospital Wi-Fi, the tedious steps to set up a headset, the absence of technical support, and underneath that, the more human problem of getting clinicians to trust the technology in the first place. “You cannot ask a group of clinicians who have never used XR to evaluate whether it’s feasible,” one interviewee noted. People need to put the headset on before they can judge it, and in a busy clinical setting that first try is hard to make time for. “Sometimes you can completely lose someone who could have been the hero of the project. The frustration is very damaging” – and through conversation it became clear that having your insider hero is vital to progress and innovate.

A different barrier appears later, once a collaboration is established. As a company grows and gains customers, what it wants to build and what the research side wants to study can quietly drift apart. “What the company sees for the future and what we see in research do not always align,” one researcher reflected. Neither side is wrong, but the research questions that felt central at the start of a collaboration are not always the ones a maturing company still needs answered.

Underneath all these sits something more basic. Namely, expectations that are never spoken out loud. “A lot of the past few years collaborating has to do with communication,” reflected one researcher. “Everyone has expectations, but if you don’t communicate them well, those are the times it goes wrong. We expected something to be finished by a certain point but never said so. Or they expected something from us and didn’t say that either.”

One of the most striking moments across these conversations was a quiet reversal of the usual story, and it happened mid-project, not just over the years. Academia is supposed to be the slow partner, whilst industry is the fast one. Partway through a study, the research team needed a change to the company’s product, something not working quite as the study required, and suddenly it was the researchers pushing for speed.

The explanation was structural rather than personal. The company had grown from five people to forty-five, organised into departments, with its own regulatory and development processes. “Everything seems to go slower, but also because it’s more professional,” the researcher noted. The speedboat had become a small oil tanker of its own.

This points to a broader challenge to the framing itself. The assumption that academia cares about rigour and industry cares about speed, as if these were permanently opposed, may be less fixed than it looks. Companies developing software as a medical device already face a regulatory pathway demanding clinical evaluation and evidence from planned studies – “there are more commonalities than people think.”

Across the conversations, one factor came up again and again: a single person who could move between worlds, understanding clinical value, research rigour, and technical possibility at once, and translating between teams when the language broke down.

One described it as a “hybrid profile.” Another held an explicit dual role, academic researcher one day, Chief Scientific Officer the next, to formalise that translator function. A third described a trusted clinical contact inside a hospital as irreplaceable: “In the hospital, they can go to people. We are outside and we don’t have the contacts.”

The clinical champion, a single trusted practitioner willing to navigate internal governance on the project’s behalf, emerged as a recurring theme. Not a formal role, but one person.

There was also a harder-won insight about design. Running a study in a specially arranged room produces clean results which can be difficult to replicate afterwards. “The pilot is going to be wonderful,” one interviewee said, “but the next day, if there’s no specific organisation for that usage, nobody is going to use it anymore.” The advice: design into the actual workflow from day one.

None of the collaborations described were without friction. But there was also genuine progress in products reaching patients, evidence being built, researchers developing skills no academic programme had prepared them for. “The academic world is a bit of a bubble,” reflected one researcher. “You have impact in the bubble that doesn’t sound like impact to the person working at the bakery. We should break that bubble.”

A few open threads feel worth reflecting on. What would it take to make communication about expectations and timelines part of how collaborations start, rather than something learned the hard way? When priorities drift apart as a company matures, whose job is it to notice, and what happens next? Is the academia-versus-industry framing itself sometimes the obstacle, when the friction is more specific — an ethics process not designed for digital health, or a company simply growing? How do we create more bridge people and clinical champions, rather than waiting for them to appear by chance? And in true design research style, I ask, how might we redesign our current systems to better fit such an innovative, impactful and fast-moving space?

The theme of the 2026 World Conference on Virtual Rehabilitation – “Business, Practice and Research, Better Together” – is an aspiration, not a description. The conversations behind this piece suggest it is also a genuinely open question, worth sitting with, together, in the same room.