Background Serious games have been investigated for their use in multiple forms of rehabilitation for decades. The rising trend to use games for physical fitness in more recent years has also provided more options and garnered more interest for their use in physical rehabilitation and motor learning. In this study, we report the results of an opinion survey of serious games in upper limb prosthetic training. Objective This study investigates and contrasts the expectations and preferences for game-based prosthetic rehabilitation of people with limb difference and researchers. Methods Both participant groups answered open and closed questions as well as a questionnaire to assess their user types. The distribution of the user types was compared with a Pearson chi-square test against a sample population. The data were analyzed using the thematic framework method; answers fell within the themes of usability, training, and game design. Researchers shared their views on current challenges and what could be done to tackle these. Results A total of 14 people with limb difference and 12 researchers participated in this survey. The open questions resulted in an overview of the different views on prosthetic training games between the groups. The user types of people with limb difference and researchers were both significantly different from the sample population, with χ25=12.3 and χ25=26.5, respectively. Conclusions We found that the respondents not only showed a general willingness and tentative optimism toward the topic but also acknowledged hurdles limiting the adoption of these games by both clinics and users. The results indicate a noteworthy difference between researchers and people with limb difference in their game preferences, which could lead to design choices that do not represent the target audience. Furthermore, focus on long-term in-home experiments is expected to shed more light on the validity of games in upper limb prosthetic rehabilitation.

Serious games show a lot of potential for use in movement rehabilitation (eg, after a stroke, injury to the spinal cord, or limb loss). However, the nature of this research leads to diversity both in the background of the researchers and in the approaches of their investigation. Our close examination and categorization of virtual training software for upper limb prosthetic rehabilitation found that researchers typically followed one of two broad approaches: (1) focusing on the game design aspects to increase engagement and muscle training and (2) concentrating on an accurate representation of prosthetic training tasks, to induce task-specific skill transfer. Previous studies indicate muscle training alone does not lead to improved prosthetic control without a transfer-enabling task structure. However, the literature shows a recent surge in the number of game-based prosthetic training tools, which focus on engagement without heeding the importance of skill transfer. This influx appears to have been strongly influenced by the availability of both software and hardware, specifically the launch of a commercially available acquisition device and freely available high-profile game development engines. In this Viewpoint, we share our perspective on the current trends and progress of serious games for prosthetic training.

In virtual prosthetic training research, serious 1 games have been investigated for over 30 years. However, 2 few game design elements are used and assessed for their 3 effect on the voluntary adherence and repetition of the 4 performed task. We compared two game-based versions 5 of an established myoelectric-controlled virtual prosthetic 6 training task with an interface without game elements of 7 the same task [for video, see (Garske, 2022)]. Twelve limb-8 intact participants were sorted into three groups of com-9 parable ability and asked to perform the task as long as 10 they were motivated. Following the task, they completed a 11 questionnaire regarding their motivation and engagement 12 in the task. The investigation established that participants 13 in the game-based groups performed the task significantly 14 longer when more game design elements were implemented 15 in the task (medians of 6 vs. 9.5 vs. 14 blocks for groups 16 with increasing number of different game design elements).17The participants in the game-based versions were also more 18 likely to end the task out of fatigue than for reasons of 19 boredom or frustration, which was verified by a fatigue 20 analysis of the myoelectric signal. We demonstrated that the 21 utilization of game design methodically in virtual myoelec-22 tric training tasks can support adherence and duration of a 23 virtual training, in the short-term. Whether such short-term 24 enhanced engagement would lead to long-term adherence 25 remains an open question.

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Background: Serious games have been investigated for their use in multiple forms of rehabilitation for decades. The rising trend to use games for physical fitness in more recent years has also provided more options and garnered more interest for their use in physical rehabilitation and motor learning. In this paper, we report the results of an opinion survey of serious games in upper limb prosthetic training. Objective: This study investigates and contrasts the expectations and preferences for game based prosthetic rehabilitation of people with limb difference and researchers. Methods: Both participant groups answered open and closed questions as well as a questionnaire to assess their user types. The distribution of the user types was compared with a Pearson′s χ2 test against a sample population. The data was analysed with the thematic framework method; answers fell within the themes of usability, training, and game design. Researchers shared their views on current challenges and what could be done to tackle these. Results: A total of 14 people with limb difference and 12 researchers took part in this survey. The open questions resulted in an overview of the different views on prosthetic training games between the groups. The user types of people with limb difference and researchers were both significantly different from the sample population with χ2=12.31 and χ2=26.50, respectively. Conclusions: We found that the respondents show a general willingness and tentative optimism towards the topic, but also acknowledge hurdles limiting the adoption of these games by both clinics and users. Results indicate a noteworthy difference between researchers and limb different people in their game preferences, which could lead to design choices that do not represent the target audience. Furthermore, focus on long-term in-home experiments is expected to shed more light onto the validity of games in upper limb prosthetic rehabilitation.