The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation

Abstract

Upper limb exercise is often neglected during post-stroke rehabilitation. Video games have been shown to be useful in providing environments in which patients can practise repetitive, functionally meaningful movements, and in inducing neuroplasticity. The design of video games is often focused upon a number of fundamental principles, such as reward, goals, challenge and the concept of meaningful play, and these same principles are important in the design of games for rehabilitation. Further to this, there have been several attempts for the strengthening of the relationship between commercial game design and rehabilitative game design, the former providing insight into factors that can increase motivation and engagement with the latter. In this article, we present an overview of various game design principles and the theoretical grounding behind their presence, in addition to attempts made to utilise these principles in the creation of upper limb stroke rehabilitation systems and the outcomes of their use. We also present research aiming to move the collaborative efforts of designers and therapists towards a model for the structured design of these games and the various steps taken concerning the theoretical classification and mapping of game design concepts with intended cognitive and motor outcomes.

Exercising with Baxter: preliminary support for assistive social-physical human-robot interaction

“…Feedback throughout iterative design steps with these experts helped us to instill the games with clear social cues by Baxter, adaptive cognitive and physical difficulty levels, and fitting musical premises. These ideas are well supported by past work on designing effective exercise games for therapeutic interactions [39][40][41]. Throughout the games, the maximum hand-to-hand span of the robot was limited to the user's height.…”

Serious Games for Stroke Telerehabilitation of Upper Limb - A Review for Future Research

“…Cost: Video games have been applied to upper limb rehabilitation since the 1980s. With the advent of less expensive and higher-fidelity technology, acceptance and clinical validity of games for serious purposes have been increasing ( Barrett et al, 2016 ; James et al, 2018). Non-immersive or mobile VR do not require high-level graphic performance or expensive hardware, making them good candidates for providing low-cost, ubiquitous, and interesting treatment programs ( Choi & Paik, 2018 ).…”

“…Another mechanism is Motor Imagery Therapy, where the imagination of executing a movement of a segment promotes stimulation of the respective cortical area ( Vourganas et al, 2019 ). VR-based serious games can activate the nucleus accumbens , with the release of dopamine, which is associated with reward-based learning, feelings of pleasure and motivation to perform specific behavior ( Barrett et al, 2016 ).…”

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).…”