Posts Tagged Serious games

[Abstract+References] A Serious Games Platform for Cognitive Rehabilitation with Preliminary Evaluation


In recent years Serious Games have evolved substantially, solving problems in diverse areas. In particular, in Cognitive Rehabilitation, Serious Games assume a relevant role. Traditional cognitive therapies are often considered repetitive and discouraging for patients and Serious Games can be used to create more dynamic rehabilitation processes, holding patients’ attention throughout the process and motivating them during their road to recovery. This paper reviews Serious Games and user interfaces in rehabilitation area and details a Serious Games platform for Cognitive Rehabilitation that includes a set of features such as: natural and multimodal user interfaces and social features (competition, collaboration, and handicapping) which can contribute to augment the motivation of patients during the rehabilitation process. The web platform was tested with healthy subjects. Results of this preliminary evaluation show the motivation and the interest of the participants by playing the games.

Source: A Serious Games Platform for Cognitive Rehabilitation with Preliminary Evaluation | SpringerLink

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[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”.

Continue —> Sensors | Free Full-Text | New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments | HTML

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[ARTICLE] Modeling Based on Computational Intelligence for Physiotherapeutic Rehabilitation Games – Full Text PDF


Over the last years, the use of computational environments, like serious games, has been one of the strategies to improve commitment and motivation of patients undergoing rehabilitation. Beyond providing motivation, these systems are able to simulate life activities and provide means to automatically monitor users interactions, assuring that the patient is performing the exercises correctly, thus allowing the user to perform the exercises without the need of constant monitoring by a health professional. The aim of this work is to develop a modeling for construction of serious games, whose interaction is given by gestures performed by hand and wrist. The model includes an automatic continuous evaluation of rehabilitation exercises executed by the patient and dynamic game balancing using computational intelligence methods.

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[WEB SITE] NeuroRehabLab | Exploring the human brain through Virtual Environment interaction


The NeuroRehabLab is an interdisciplinary research group of the University of Madeira that investigates at the intersection of technology, neuroscience and clinical practice to find novel solutions to increase the quality of life of those with special needs. We capitalize on Virtual Reality, Serious Games, and Brain-Computer Interfaces to exploit specific brain mechanisms that relate to functional recovery to approach motor and cognitive rehabilitation by means of non-invasive and low-cost technologies.

more —> NeuroRehabLab | Exploring the human brain through Virtual Environment interaction

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[ARTICLE] Multi-User Virtual Reality Therapy for Post-Stroke Hand Rehabilitation at Home. – Full Text PDF


Our paper describes the development of a novel multi-user virtual reality (VR) system for post-stroke rehabilitation that can be used independently in the home to improve upper extremity motor function. This is the pre-clinical phase of an ongoing collaborative, interdisciplinary research project at the Rehabilitation Institute of Chicago involving a team of engineers, researchers, occupational therapists and artists. This system was designed for creative collaboration within a virtual environment to increase patients’ motivation, further engagement and to alleviate the impact of social isolation following stroke. This is a low-cost system adapted to everyday environments and designed to run on a personal computer that combines three VR environments with audio integration, wireless Kinect tracking and hand motion tracking sensors. Three different game exercises for this system were developed to encourage repetitive task practice, collaboration and competitive interaction. The system is currently being tested with 15 subjects in three settings: a multi-user VR, a single-user VR and at a tabletop with standard exercises to examine the level of engagement and to compare resulting functional performance across methods. We hypothesize that stroke survivors will become more engaged in therapy when training with a multi-user VR system and this will translate into greater gains.



Stroke is the leading cause of major, long-term disability in adults in the United States [1]. Every 40 seconds someone in
the U.S. has a stroke [2] and more than 700,000 people suffer a new or recurrent stroke each year. The majority of stroke survivors endure chronic impairment [1], which dramatically impacts their lives physically, psychologically and socially. Stroke incidence is even greater in low to middle income countries. Around 50% of all stroke survivors will have residual hemiparesis involving the upper extremity [4, 5], which can have a profound, adverse impact on self-care, employment, and overall quality of life. A number of studies [6, 7, 8, 9] have shown that upper extremity motor control can still be improved, even in stroke survivors with chronic hemiparesis subsequent to stroke. Many patients continue to be highly motivated to achieve further gains after standard rehabilitation has been completed, seeking out new methods, technologies and practices that can improve upper extremity motor control.

Repetitive movement practice proved to be crucial for maximizing therapeutic benefits [15]. The necessary repetition of rehabilitation exercises can be tedious, however [10, 11, 12] and many patients, including stroke survivors, discontinue treatment long before optimal results have been achieved. Lack of motivation, disengagement, and boredom contribute to impeded progress in rehabilitation [13]. Additionally, opportunities for task practice in the clinic are becoming increasingly limited due to shortened hospital stays [14] and a reduced number of allotted outpatient therapy sessions (Figure 1). Furthermore, lack of transportation can prevent outpatient stroke survivors from taking full advantage of the available therapy sessions.

Tele-rehabilitation seems a possible solution, but current telerehabilitation systems [7, 16] largely consist of teleconferencing between the therapist and the client. Therapist-client interaction is limited and quantitative measurement of performance is lacking. Instead, we propose a multi-user virtual reality environment (VRE) in which the therapist and client can interact with each other and with objects in the VRE.

An inexpensive motion capture system allows control of avatars, as well as collection of movement kinematics. Our system is innovative, because it brings the therapist and client together in the virtual space to work together in real-time. Alternatively, or additionally, the client can participate with a training partner, potentially another patient, providing additional motivation and encouragement. One study showed that impaired subjects prefer competitive/cooperative multi-user rehabilitation games compare to single-user rehabilitation games [17]. This system can mitigate issues related to transportation and limited clinical access by providing home-based training environment developed specifically for upper extremity rehabilitation.

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[Abstract] Surface Electromyography for Game-Based Hand Motor Rehabilitation.


Computer systems such as virtual environments and serious games are being used as a tool to enhance the process of user rehabilitation. These systems can help motivate and provide means to assess the user’s performance undertaking an exercise session. To do that, these systems incorporate motion tracking and gesture recognition devices, such as natural interaction devices like Kinect and Nintendo Wii. These devices, originally developed for the games market, allowed the development of low cost and minimally invasive rehabilitation systems, allowing the treatment to be taken to the patient’s residence. With the advent of natural interaction based on electromyography, devices that use electromyographic signals can also be used to construct these systems. The aim of this work is to show how electromyographic signals could be used as a tool to capture user gestures and incorporated into home-based rehabilitation systems by adopting a low-cost device to capture these gestures. The process of creation of a serious game to show some of these concepts is also present.

Source: IEEE Xplore Abstract – Surface Electromyography for Game-Based Hand Motor Rehabilitation

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[Abstract] Robot-Assisted Rehabilitation for Smart Assessment and Training – IEEE Xplore

Published in: Healthcare Informatics (ICHI), 2015 International Conference on

21-23 Oct. 2015


In the last two decades, robot-aided rehabilitation has become widespread, particularly for upper limb movement rehabilitation. In this Doctoral Consortium I present a system for physical and cognitive rehabilitation that uses a combination of Serious Games to allow the monitoring and progress tracking of a person during physical therapy. The system records physical and cognitive states through the interaction with the advance robotic arm in order to assess the users hand-eye coordination, response interaction, working memory and concentration rates.

Source: IEEE Xplore Abstract (Abstract) – Robot-Assisted Rehabilitation for Smart Assessment and Training


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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] Assessment-driven arm therapy at home using an IMU-based virtual reality system


Virtual reality therapy systems have the potential to increase the intensity and frequency of physical activity of stroke patients at home. This might help to increase the dose of rehabilitation, without the costs associated with clinic visits and therapist supervision.

We present a therapy game that continuously estimates the patient’s arm reachable three-dimensional (3D) workspace with a voxel-based model and selects targets to be reached accordingly, in order to increase challenge without causing frustration. This exercise is implemented on a novel, inertial measurement unit (IMU) based virtual reality system for the training of upper limb function. We present data from a pilot trial with 5 chronic stroke patients who trained for 6 weeks at home and without therapist supervision.

On average, the patients’ in-game assessed 3D workspace grew by 10.7% in volume and their score on the Fugl-Meyer Upper Extremity score improved by 5 points. The average self-selected therapy time, over the course of the therapy, was 16.8 h. These results suggest that the proposed assessment-driven target selection is viable for unsupervised home therapy and could form the basis for additional therapy games in the future.

Source: IEEE Xplore Abstract – Assessment-driven arm therapy at home using an IMU-based virtual reality system

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[ARTICLE] HeartHealth: A Cardiovascular Disease Home-based Rehabilitation System – Full Text PDF




The increasing pressure on medical institutions around the world requires health care professionals to be prescribing home- based exercise rehabilitation treatments to empower patients to self-monitor their rehabilitation journey. Home-based exercise rehabilitation has shown to be highly effective in treating conditions such as Cardiovascular Disease (CVD). However, adherence to home-based exercise rehabilitation remains low. Possible causes for this are that patients are not monitored, they cannot be con- fident that they are performing the exercise correctly or accurately and they receive no feedback.

This paper proposes HeartHealth, a novel patient-centric gamified exercise rehabilitation platform that can help address the issue of adherence to these programmes. The key functionality is the ability to record the patient movements and compare them against the exercises that have been prescribed in order to return feedback to the patient and to the health care professional, as well.

In order to synthesize a compact fully operational system able to work in real life scenarios, tools and services from FI-PPP projects, FIWARE 1 and FI-STAR 2, were exploited and a new FI-STAR component, Motion Evaluation Specific Enabler (SE), was designed and developed. The HeartHealth system brings together real-time cloud-based motion evaluation coupled with accurate low-cost motion capture, a personalised exercise rehabilitation programme and an intuitive and fun serious game interface, designed specifically with a Cardiac Rehabilitation population in mind.

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Source: HeartHealth: A Cardiovascular Disease Home-based Rehabilitation System

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