IEEE Systems, Man and Cybernetics Magazine - October 2020 - 58

Patient's Interface
The patient's interface is the component of the system
that is present at the patient's home. It is composed of
five modules.
The natural user interface (NUI) module is the group
of sensors that allow the patient to interact with the system. Poststroke patients should use their time in rehabilitation as productively as possible and not spend it
learning how to use complex technologies. NUIs enable
the patients to use their bodies or other natural means of
communication to easily interact with the system.
The game-based rehabilitation module is the main module of the patient's interface. Interactions with this module
are achieved though the NUI module. To keep the patient
motivated, therapeutic exercises should be presented as
serious games with elements of gamification. The games
must be designed in a way that, to complete them, the
patient should, at the same time, perform the exercises
that are a part of the therapy.
The data capture module acquires and processes the
patients' data. The two main sources of data are the sensors and the data coming from the therapist's interface.
The data include the patients' demographic data, afterstroke conditions and disabilities, and the in-game data
related to patients' performance.
The adaptation module automatically modifies the ingame parameters to keep the challenge within the current
level of the patient's abilities. For poststroke patients, two
types of adaptation are necessary: adaptation related to
the difficulty of the task, regardless of whether the
patients have any disability or not, and ROM adaptation
related to the physical impairments that the patients present as a result of the stroke.
The communication module was included to establish a
bidirectional channel of information exchange between
the patient's and the therapist's interface. The therapist's
interface provides the patient's interface with the relevant
data to adjust the games to the specific needs of each
patient. The data are updated in real time while the patient
interacts with the system, and they are transmitted to the
therapist's interface. Additionally, data security and anonymization are performed by the system.

20
2,085

Log Out
Figure 2. The main menu of the patient's interface.
58

IEEE SYSTEMS, MAN, & CYBERNETICS MAGAZINE O ctober 2020

Therapist's Interface
The therapist's interface is the component of the system
that allows the therapist to monitor and tailor the patients'
sessions. This interface is composed of four modules.
◆ The communication module has the same functionalities as its counterpart on the patient's interface.
◆ The data storage module is a repository for saving significant patient data. Security concerns about privacy,
data access, and records retention must be resolved
according to appropriate practices, ethics, and national/international laws.
◆ The knowledge extraction and data analytics module
is in charge of analyzing the data contained in the data
storage module to create valuable information. Thanks
to data analytics, information can be shown to the
therapist in a meaningful and easy-to-understand way.
This supports the therapist in making a well-informed
decision about the future course of the therapeutic
rehabilitation program.
◆ The user interface is the entry point of interaction
between the therapist and the system. This module
provides the patient's demographic and health data,
creates his/her user account, and configures the ingame parameters and menus.
Developed System
Following the proposed approach and architecture, a
game-based computer system was developed.
Patient's Interface
The patient's interface enables interaction with the
system through NUIs. In the developed system, two
NUIs are used: Microsoft's Kinect, which is the main
interaction interface, and Thalmic Lab's Myo, which
has a supportive role. Kinect is used to capture the 3D
position of the patient's joints, whereas Myo is used to
capture the electrical activity of the muscles of the
patient's forearm.
NUI calibration occurs at least once per day, which is
required if the system detects that it has not been calibrated
in a given day (daily calibration). The calibration of Myo is
used to create a baseline of the patient's handgrip, and
Kinect's calibration is used to create the patient's current
working space.
The main menu of the patient's interface (see Figure 2),
is divided into a grid of four columns by three rows. In the
upper row, the first column contains information about
the gamified profile of the patient. The lower row of the
first column contains the button to log out. The upper
row's second column contains the button to recalibrate
the NUIs. The middle row includes the button to access
the rewards menu. Finally, columns three and four
include the games.
Six games were developed following two design
approaches. The first design approach, A1, consists of
selecting games or ludic activities and adapting them to

IEEE Systems, Man and Cybernetics Magazine - October 2020

Table of Contents for the Digital Edition of IEEE Systems, Man and Cybernetics Magazine - October 2020