Posts Tagged Exergames

[ARTICLE] New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments – Full Text


The work presented here suggests new ways to tackle exergames for physical rehabilitation and to improve the players’ immersion and involvement. The primary (but not exclusive) purpose is to increase the motivation of children and adolescents with severe physical impairments, for doing their required exercises while playing. The proposed gaming environment is based on the Kinect sensor and the Blender Game Engine. A middleware has been implemented that efficiently transmits the data from the sensor to the game. Inside the game, different newly proposed mechanisms have been developed to distinguish pure exercise-gestures from other movements used to control the game (e.g., opening a menu). The main contribution is the amplification of weak movements, which allows the physically impaired to have similar gaming experiences as the average population. To test the feasibility of the proposed methods, four mini-games were implemented and tested by a group of 11 volunteers with different disabilities, most of them bound to a wheelchair. Their performance has also been compared to that of a healthy control group. Results are generally positive and motivating, although there is much to do to improve the functionalities. There is a major demand for applications that help to include disabled people in society and to improve their life conditions. This work will contribute towards providing them with more fun during exercise.

1. Introduction

For a number of years, the possibility of applying serious games for rehabilitation purposes has been thoroughly investigated [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]. It is often claimed that serious games reduce health system costs and efforts as they enable in-home rehabilitation without loss of medical monitoring, and in so doing provide an additional fun factor for patients [22,23,24]. Multiple reviews have summarized the very powerful contributions and reveal that the systems are generally evaluated as feasible, but no state of general applicability has yet been reached [2,3,5,7,11,13].
Most studies are quite specialised and tend to cover the same groups of largely elderly patients (e.g., stroke and Parkinson’s), which do not constitute a credible target group per se for gaming among the population. In addition, the impression is that the same functionalities are being tested repeatedly, without any evolution. Above all, other groups like children and adolescents with chronic diseases are rarely addressed, even though they are an excellent target group and would probably benefit greatly from using exergames as they need to move like any other child but are mostly limited to performing their exercises with a physiotherapist. This is generally boring, time-consuming and prevents them from playing with friends during this time. If instead they could play games involving physical exercises, without it feeling like rehabilitation, due to proper immersion and motivation, they would possibly need fewer sessions with the therapist, which may in turn improve their social life. Commercially available games would be good enough for many children with physical disabilities, if only they were configurable and adaptive to their potential and needs. Remote controls (RC) are typically not sufficiently configurable (button functions cannot be changed or the RC cannot be used with one hand) and are only made for hands (why not for feet or the mouth?) Some RCs are not sufficiently precise in detection, and so the user ends up tired and loses motivation. Motion capture devices like the Kinect sensor seem to provide better prerequisites for exergaming purposes but feature important limitations too, (e.g., detection of fine movements and rotations) such that the needs of many people are still not be covered by commercial solutions.
However, this is not due to the sensors, but rather the software, which lacks configurability for special needs, such as simple adjustments of level difficulties or the option of playing while seated. For the latter, some Kinect games are available [29], but those are hardly the most liked ones, as has been stated by affected users [30]. Therefore, more complex solutions are required to adapt a game to problems like muscle weaknesses (most games require wide or fast movements), spasticity (“strange” movements are not recognized) or the available limbs (for instance configuring a game to be controlled with the feet for players without full hand use).
To fill these gaps, the authors of the work presented here are pursuing the overall aim (as part of a long-term project) of creating an entertaining exergaming environment for adventure games that immerses the players into a virtual world and makes them forget their physical impairments. Knowledge of the gaming industry is applied to create motivating challenges that the users have to solve, which are sufficiently addictive to make the exercises pass to an unconscious plane. The gaming environment is configurable to the user’s potential and requirements. Challenges will be programmable by a therapist and will also adapt themselves to the players automatically real-time, by observing their fatigue or emotional state (lowering the difficulty or switching to more relaxing exercises when needed)…

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Figure 8. Different scenes while the volunteers were playing. (a) “The Paper-Bird”, (b) “The Ladder”, (c) “The Boat” and (d) “Whack-a-Mole”.

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[ARTICLE] “FIND Technology”: investigating the feasibility, efficacy and safety of controller-free interactive digital rehabilitation technology in an inpatient stroke population: study protocol for a randomized controlled trial – Full Text HTML



Stroke results in significant disability, which can be reduced by physical rehabilitation. High levels of repetition and activity are required in rehabilitation, but patients are typically sedentary. Using clinically relevant and fun computer games may be one way to achieve increased activity in rehabilitation.


A single-blind randomized controlled trial will be conducted to evaluate the feasibility, efficacy and safety of novel stroke-specific rehabilitation software. This software uses controller-free client interaction and inertial motion sensors. Elements of feasibility include recruitment into the trial, ongoing participation (adherence and dropout), perceived benefit, enjoyment and ease of use of the games. Efficacy will be determined by measuring activity and using upper-limb tasks as well as measures of balance and mobility. The hypothesis that the intervention group will have increased levels of physical activity within rehabilitation and improved physical outcomes compared with the control group will be tested.


Results from this study will provide a basis for discussion of feasibility of this interactive video technological solution in an inpatient situation. Differences in activity levels between groups will be the primary measure of efficacy. It will also provide data on measures of upper-limb function, balance and mobility.


In the US alone, one person per minute has a stroke, and although death rates have declined over the last decade, the burden of disease remains high [13]. Physical rehabilitation has the potential to positively impact functional outcomes and improve this burden; however, this requires a high dose of therapy. A significant factor limiting rehabilitation outcomes is low levels of patient activity [10]. Observational studies in different countries have found that patients after stroke in rehabilitation are surprisingly inactive for the vast majority of the waking day. For example, only 13 % of a stroke unit patient’s day is typically spent in activities related to functional outcome, such as active therapy or walking practice [2]. Many rehabilitation activities, aimed at stimulating neuroplasticity, are by their very nature repetitive and tend to be tedious [19]. One method by which engagement with rehabilitation programs and levels of activity could be improved involves the use of fun and engaging video games.

Commercial, off-the-shelf devices such as the Microsoft Xbox Kinect (Microsoft Corporation, Redmond, WA, USA) are relatively inexpensive and use motion capture and feedback technologies with potential for use in rehabilitation. Interactive video games increase adherence to and enjoyment of exercise in the general population [1] and have the potential to increase the dose of repetitive exercise completed by people with reduced mobility. Exercise-based video games could be used to increase exercise dose during therapy and to enable exercise outside of therapy hours. This is true both in inpatient and outpatient rehabilitation settings as well as at home after discharge from hospital.

In particular, the Kinect for Xbox 360, or simply Kinect, is a “controller-free gaming and entertainment experience” by Microsoft for the Xbox 360 video-game platform and is now also supported by PCs via Windows 8. It enables users to control and interact with the Xbox 360 without the need to touch a game controller, through a user interface using gestures and spoken commands. Kinect enables full-body depth-based three-dimensional motion-capture, facial recognition and voice recognition capabilities. This differentiates it from previous generations of interactive technologies that have been used in rehabilitation.

Despite the promise of such low-cost, consumer-based technologies, many, if not all, off-the-shelf video-game solutions are inappropriate for individuals with functional impairment [16]. There is an opportunity for purpose-built, clinically relevant video game-based rehabilitation to add significant value to current rehabilitation practice. Jintronix, a Montreal-based company, has recently launched a Kinect-based rehabilitation system, Jintronix Rehabilitation System (JRS), which provides an easy-to-use software solution (JRS WAVE) for patients to use. The software solution has been designed in collaboration with physical and occupational therapists and draws upon the motor relearning recommendations by Carr and Shepard [5]. As such, upper limb, sitting balance, standing balance and stepping rehabilitation tasks have been programmed in the JRS WAVE as fun and engaging video games that can be played at a number of different levels of complexity and speed. The system is also capable of automatically measuring changes in the range, speed and quality of motion to give patients instant feedback on their progress.

A second feature of the JRS WAVE is a cloud-based client management telehealth system for clinicians to recommend rehabilitation tasks and track and record performance of those tasks (JRS PORTAL). The PORTAL allows clinicians to provide patients regular updates and information on what has happened to them with daily, weekly or monthly progress reports on their rehabilitation, either face-to-face or remotely.

The proposed project will evaluate the feasibility, efficacy and safety of the JRS WAVE for use in an Australian stroke inpatient rehabilitation context. Elements of feasibility include recruitment into the trial, ongoing participation (adherence and dropout), perceived benefit, and enjoyment and ease of use of the games. Efficacy will be determined by measuring physical activity (using an accelerometer) and using upper-limb tasks as well as measuring changes in balance and mobility over time between the two groups. Adverse events will be monitored and changes in pain and fatigue with the interventions will be used to determine safety of the system. We will test the hypothesis that the intervention group will have increased levels of physical activity within rehabilitation and improved physical outcomes compared with the control group.

Continue —> “FIND Technology”: investigating the feasibility, efficacy and safety of controller-free interactive digital rehabilitation technology in an inpatient stroke population: study protocol for a randomized controlled trial | Trials | Full Text


Fig. 1 Feasibility Interactive Digital (FIND) technology protocol flow diagram

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[ARTICLE] Exergaming and rehabilitation: A methodology for the design of effective and safe therapeutic exergames


We present here a comprehensive definition of therapeutic exergames from which a methodology to create safe exergames for real therapy pathways is derived. Three main steps are identified.

  1. A clear identification of all the exercise requirements, not only in terms of goals of the therapy, but also in terms of additional constraints. Characteristic parameters for determining the challenge level and to assess progression are also defined in this phase.
  2. The exercise is transformed into a Virtual Exercise, in which all the exercise elements are implemented inside a simple virtual environment. In this step the discussion between clinical and ICT teams allows maximizing the effectiveness of exergames implementation.
  3. The final exergame is realized by introducing on top of the exercise all the game elements suggested by good game design to maximize entertainment.

A clear line between exercises and games is drawn here. We illustrate the methodology with exergames designed for

  1. balance and posture and
  2. neglect rehabilitation, implemented and tested with post-stroke patients training autonomously at home.

The methodology can have a broader impact as it can be applied also in other gaming fields in which the requirements go beyond entertainment.

Source: Exergaming and rehabilitation: A methodology for the design of effective and safe therapeutic exergames

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[ARTICLE] A Novel Study on Natural Robotic Rehabilitation Exergames using the unaffected Arm of Stroke Patients – Full Text PDF


It is well known that home exercise is as good as rehab center. However, people with severe stroke typically lack the ability to move their affected arm, and hence they need a very special rehabilitation program that usually available in hospitals or professional centers. Therapists train the affected hand of those patients by using robotic-assisted therapy devices, or sometimes by holding the affected arms of the patients and stretching it for them.

However, such robotic devices and professional therapists are not available at home. In this study, we design and implement a low-cost rehabilitation glove to meet the needs of those patients who have paralysis in their affect hand. The novelty of this glove is that it is to be worn on the unaffected hand which acts as a natural robotic arm during the rehabilitation session. The glove is equipped with FSR sensors that measure the forces exerted by the affected hand on the unaffected hand.

A virtual reality rehabilitation game is developed using Microsoft Kinect to facilitate the exercises and motivate the patients. The system is tested on three patients for six weeks. Objective measurements showed that patients have significantly improved over the study period. Moreover, the patients themselves gave a positive feedback about the whole system; wearing the glove on the unaffected hand made their life easier and let them enjoyed the rehabilitation sessions.

Full Text PDF

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[WEB SITE] ableX Offers Suite of Computer-Based Games to Enhance Stroke Recovery

The ableX system features therapy games and a handheld controller, built to accelerate rehabilitation of the arms and hands following stroke. According to the company of the same name, the technology can be set up on a computer and is intended to help stroke survivors transition from acute care to self-care at home. Users who are able to recognize simple shapes on a TV or computer screen and can sit while supported may benefit from using ableX, the company’s website says.

The site notes that the ableX software and control devices are built to work together, providing high intensity task-based rehabilitation for stroke-affected arms and hands. The therapy games are designed to be fun and easy to play on any Windows computer and are built to provide progressive recovery for an injured brain. The ableX system aims to stimulate neural plasticity and encourage long-term recovery habits, the site adds.

While no Internet connection is required, the ableX Pro requires a desktop or laptop computer with the Windows 7 operating system or better. The ableX is engineered to allow users to include arm and hand recovery as part of their daily routine, allowing for up to 1,000 repetitions per session.

Additionally, the ableX Pathway service for health professionals is intended to provide users prescription support and tailored training routines based upon routine observation and patient goals.

For more information, visit

Goto –> ableX Offers Suite of Computer-Based Games to Enhance Stroke Recovery.

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[BROCHURE] BITS – Bioness Intergrated Therapy System



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[REVIEW] Virtual reality using games for improving physical functioning in older adults. – Full Text PDF


The use of virtual reality through exergames or active video game, i.e. a new form of interactive gaming, as a complementary tool in rehabilitation has been a frequent focus in research and clinical practice in the last few years. However, evidence of their effectiveness is scarce in the older population.

This review aim to provide a summary of the effects of exergames in improving physical functioning in older adults. A search for randomized controlled trials was performed in the databases EMBASE, MEDLINE, PsyInfo, Cochrane data base, PEDro and ISI Web of Knowledge. Results from the included studies were analyzed through a critical review and methodological quality by the PEDro scale. Thirteen studies were included in the review.

The most common apparatus for exergames intervention was the Nintendo Wii gaming console (8 studies), followed by computers games, Dance video game with pad (two studies each) and only one study with the Balance Rehabilitation Unit. The Timed Up and Go was the most frequently used instrument to assess physical functioning (7 studies). According to the PEDro scale, most of the studies presented methodological problems, with a high proportion of scores below 5 points (8 studies). The exergames protocols and their duration varied widely, and the benefits for physical function in older people remain inconclusive. However, a consensus between studies is the positive motivational aspect that the use of exergames provides. Further studies are needed in order to achieve better methodological quality, external validity and provide stronger scientific evidence.



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[Wikipedia] Exergaming

Fitness game,[1] Exergaming or exer-gaming (a portmanteau of “exercise” and “gaming”)[2] is a term used for video games that are also a form of exercise.[3] Exergaming relies on technology that tracks body movement or reaction. The genre has been credited with upending the stereotype of gaming as a sedentary activity, and promoting an active lifestyle.[4][5] However, research indicates that exergames do not actually promote a more active lifestyle.[6] Exergames are seen as evolving from technology changes aimed at making video games more fun.[7]…

more–> Exergaming – Wikipedia, the free encyclopedia.


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[WEB SITE] OSU team designs river running video game to help stroke patients get stronger

The patient pictured above is playing a game on Microsoft Kinect where she’s paddling and steering down a river, swatting bats inside a cave, grabbing things out of the river and catching parachutes of supplies. She’s had a stroke and, as a result, has impaired motor function in her right hand.

The game she’s playing was developed by a team of clinicians, computer scientists, an electrical engineer and a biomechanist at Ohio State University as a way to bring costly constraint-induced movement therapy into a stroke survivor’s home.

more–>  OSU team designs river running video game to help stroke patients get stronger.

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[WEB SITE] Stroke Recovery with Kinect – Microsoft Research

…Stroke Recovery with Kinect is an interactive rehabilitation system prototype that helps stroke patients improve their upper-limb motor functioning in the comfort of their own home. By using Microsoft Kinect technology, this prototype system recognizes and interprets the user’s gestures, assesses their rehabilitation progress, and adjusts the level of difficulty for subsequent therapy sessions…


via Stroke Recovery with Kinect – Microsoft Research.

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