Gamified In-Home Rehabilitation for Stroke Survivors: Analytical Review

Abstract

A stroke is a life-changing event that may end up as a disability, with repercussions on the patient’s quality of life. Stroke rehabilitation therapies are helpful to regain some of the patient’s lost functionality. However, in practice stroke patients may suffer from a gradual loss of motivation. Gamified systems are used to increase user motivation, hence, gamified elements have been implemented into stroke rehabilitation therapies in order to improve patients’ engagement and adherence. This review work focuses on selecting and analyzing developed and validated gamified stroke rehabilitation systems published between 2009 and 2017 to identify the most important features of these systems. After extensive research, 32 articles have met the selection criteria, resulting in a total of 28 unique works. The works were analyzed and a total of 20 features were identified. The features are explained, making emphasis on the works that implement them extensively. Finally, a classification of features based on objectives is proposed, which was used to identify the relationships between features and implementation gaps. It was found that there is a tendency to develop low-cost solutions as in-home therapy systems and provide a variety of games. This review allowed the definition of the opportunities for future research direction such as systems addressing the three rehabilitation areas; data analytics to make decisions; motivational content identification based on automatic engagement detection and emotion recognition; and alert systems for patient´s safety.

Using Both Hands

“…The impairments are significant, especially in terms of grip and fine motor control [37]. Due to this, a large body of previous research on interactive stroke rehabilitation systems are implemented using gestural input devices without the need to grip [49]. For example, Alankus et al [2] suggested removing the need to hold anything in a hand as one design guideline for stroke rehabilitation games.…”

“…However, opportunities for exercising are very different in homes than they are at hospitals (or other rehabilitation centres) as the "clinical" looking devices with significant dedicated space are infeasible in home environments [4]. Despite the differences between home and rehabilitation centres, most evaluations with stroke survivors have been conducted in lab settings with such [7,49]. There is a clear need for low-cost and effective stroke rehabilitation devices [7] that "fit-in" to the home and are not abandoned [4].…”

“…Our results agree with Alankus et al [2], who found that customisation is highly important when designing rehabilitation games for stroke survivors. However in their approach, as well as in many other studies, the games were developed first, and only customised following these developments, depending on the stroke survivors' rehabilitation requirements (see a review in [49]). Having determined what games to implement beforehand does not take into account that stroke survivors may have diverse interests for games that ought to be considered when customising them to home environments [18].…”

Development of a Hardware/Software System for Proprioception Exergaming

“…A survey performed on 15 quantitative exergame studies to define a general set of elements that make exergames effective from a physical standpoint was presented in [24]. In addition, [25] found, through selecting and analyzing developed gamified systems, that there exists a tendency to develop low-cost solutions for in-home exercising with various games [8] [26]. In [27], the methodology was to use data collected during SG exercises for later analysis in order to monitor the long-term evolution of patients.…”

Social Information as a Means to Enhance Engagement in Citizen Science‐Based Telerehabilitation

“…Adherence to rehabilitation regimens can be enhanced by incorporating gaming elements into the exercises (Barrett, Swain, Gatzidis, & Mecheraoui, 2016;Flores et al, 2008;Lange, Flynn, & Rizzo, 2009;Tamayo-Serrano, Garbaya, & Blazevic, 2018;Webster & Celik, 2014). For example, commercial entertainment games are reported to improve motor function in stroke patients (Saposnik et al, 2010).…”