The study from the University of Bath warns that freehand controls such as pinching, swiping and pressing virtual buttons – all gestures that are widely used in virtual reality (VR) and augmented reality (AR) programs – are often inaccessible, painful or fatiguing for people with even mild upper limb impairments.
Globally, an estimated 15 % of people aged 30 and older experience osteoarthritis (the most common form of arthritis) with millions more suffering from rheumatoid arthritis and an estimated 5 % of the world population experiencing carpal tunnel syndrome.
“These aren’t niche cases,” said Ms Pococke. “Ignoring them represents a fundamental design failure.”
The study’s findings were presented today at the International ACM SIGACCESS Conference (SIGACCESS 2025) in Denver, USA. SIGACCESS supports researchers applying computing and information technologies to empower individuals with disabilities and older adults.
VR (accessed through a headset) immerses a person in a fully digital world that can be explored and interacted with, while AR (typically accessed through smart glasses or mobile devices) enhances the real world by overlaying it with digital images and information.
Both technologies are expected to play an increasingly important role in areas such as gaming, education, retail and healthcare, where they promise to revolutionize everything from surgical training and physical rehabilitation to mental health therapy and patient care.
Testing the Cost of Common Gestures
The new study – supported by a number of disability charities and advocacy groups – involved trials with volunteers living with conditions that affect hand and arm movement.
Researchers assessed not just whether participants could complete the gestures, but also whether doing so caused pain, required additional effort or forced them to move in unnatural or unsustainable ways.
One of the most widely used gestures, ‘pinch to select’, was highlighted as particularly problematic because it relies heavily on the index finger – a joint frequently affected by arthritis. Current systems typically do not allow for alternative gestures or substitution with other fingers.
The researchers also noted that technology companies are increasingly favoring smaller and faster gestures in pursuit of efficiency but warned this trend risks locking out many users.
Accessible By Design
The team argues that accessibility needs to be built into VR/AR systems at the design stage rather than added as an afterthought. Their research highlights several solutions that could be standardized to make these technologies more inclusive – such as remapping gestures to suit different physical abilities, amplifying small or limited movements so they register as full commands, and stabilizing cursors to reduce unintended motion caused by tremors or lack of fine motor control.
“We want everyone to be able to use the next generation of technology the moment they take it out of the box,” said Dr Christopher Clarke, project supervisor and senior lecturer in Computer Science. “That means making accessibility a core part of design, not an optional extra. The key is ensuring solutions work for as many people as possible without creating new barriers.”
Mel Brooke, Patient and Public Involvement and Engagement consultant at the Bath Institute for Rheumatic Diseases (BIRD) said: “When virtual reality systems are designed without considering pain, fatigue or limited mobility, they can create new barriers instead of breaking them and risk excluding those who could benefit most.
“True innovation means designing with all bodies and accessibility needs in mind from the outset.”
Also involved in this research from the Department of Computer Science at the University of Bath: Dr Christof Lutteroth and Dr Crescent Jicol.
The work was supported by a wide range of organizations, including BIRD, the Stroke Association, spinal injury charity Aspire, Age UK Bath, the Psoriasis Association and the University of Bath Disability Action Group.