IEEE Systems, Man and Cybernetics Magazine - October 2020 - 56

repetitive movements, rewards for successful task comrepurposed for older adults must take into account the
pletion should be provided to increase the patient's
physiological and psychological requirements of the
motivation and engagement.
patient. The development of an alert system that can
effectively detect risky situations and inform the patient
Methodology
and therapist would also be beneficial. At the same time,
The state of the art of rehabilitation systems lacks the folgame content must provide a captivating gameplay expelowing important functionalities: 1) the integration of
rience while seamlessly adapting itself to the user's
va lidated therapeutic methods
needs. In-game scores and perforinto game-based rehabilitation
mance should not be used as measystems, 2) the treatment of neusurements of actual functional
romotor and cognitive deficits
improvement; however, secondary
The current gamesimultaneously, 3) the development
physiological measurements should
based systems
of rehabilitation games that are as
be captured and analyzed.
designed for
enjoyable as commercial games, 4)
Hung et al. [14], conducted a
the need for integrated platforms
study to detect the features that
rehabilitation are less
with a variety of games and shared
patients and therapists find useentertaining than
motivational affordances, 5) the
ful and motivating of game-based
implementation of alert systems to
rehabi l it ation systems. T hei r
the games created
reduce and avoid compensatory
work focused on two categories:
for fun and used
strategies and risky situations for
game-based systems developed
for rehabilitation.
the patients, and 6) the monitoring
specifically for rehabilitation and
and evaluation of patients by using
existing games designed for fun
data analytics.
and employed for rehabilitation.
Based on the study of the previTheir main findings were that
ous research, this article presents a new approach for the
traditional in-home exercises are less effective than
rehabilitation of poststroke patients. This approach conwhen performed at the hospital. The current gamesists of using gamification to increase patients' motivation
based systems designed for rehabilitation are less
for and engagement with the rehabilitation program. It
entertaining than the games created for fun and used
includes virtual exercises based on methods validated at
for rehabilitation.
the hospital by physiotherapists and practiced by patients
Tamayo-Serrano et al. [15] carried out an analytical
at their homes. The approach integrates an intelligent
review of the existing rehabilitation systems. They identiadaptive system to tune the challenges to the actual indified future research directions, such as the importance of
vidual abilities of the patients. This approach allows the
developing integrated systems that can address neuromotherapist to remotely monitor the patients and tailor the
tor and cognitive rehabilitation needs simultaneously. Furrehabilitation program as necessary.
ther, the inclusion of visual analytics to allow patient
To test the approach, a game-based rehabilitation sysmonitoring by therapists and the online monitoring of
tem was developed following user-centered design methpatients' engagement and emotion recognition to adapt the
odology [17], [18]. To capture the users' needs, at the
in-game content to the patient's ability can also augment
beginning of each development cycle, observations of
the experience. Alert systems in case of risk situations as
rehabilitation sessions and interviews with the therapists
well as the use of social interactions and novel features to
and the patients were conducted at the hospital. The colfoster motivation through cooperative and/or competitive
lected data were related to the execution of the rehabiliscenarios are also key methods.
Omar et al. [16] proposed a conceptual model based
tation exercises and the therapeutic tests used to assess
on the persuasive system design model for the developthe patients' performance. At the end of each development of games targeted to poststroke patients. They
ment cycle, the system was tested by the therapists to
identified four important persuasive features for postevaluate and improve the user interfaces and evaluate
stroke rehabilitation games: reduction, tailoring, selfthe acceptance of the system and the usefulness of the
monitoring, and reward. Reduction is simplifying
implemented virtual exercises. After the tests, discuscomplex ta sks into ta sk-specific movements that
sions took place, and the collected feedback was used to
require the use of a small number of body joints. Tailorfurther improve the system. In addition, these improveing refers to the placing of in-game virtual objects so
ments marked the end of the current iteration and the
that they can be reached by the patient regardless of
start of a new one.
his/her degree of impairment. Self-monitoring lets the
patient follow his/her progress and enables the therapist
Requirements
to assess the patient's improvement. Because therapy
The identified requirements were grouped into two categorequires the patient to execute a large number of
ries: 1) patients' therapy objectives and limitations and 2)
56

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IEEE Systems, Man and Cybernetics Magazine - October 2020

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