The application of virtual reality (VR) and robotic devices in neuromotor rehabilitation has provided promising evidence in terms of efficacy, so far. Usability evaluations of these technologies have been conducted extensively, but no overviews on this topic have been reported yet.A systematic review of the studies on patients' and healthcare professionals' perspective through searching of PubMed, Medline, Scopus, Web of Science, CINAHL, and PsychINFO (2000 to 2021) was conducted. Descriptive data regarding the study design, participants, technological devices, interventions, and quantitative and qualitative usability evaluations were extracted and meta-synthetized.Sixty-eight studies were included. VR devices were perceived as having good usability and as a tool promoting patients' engagement and motivation during the treatment, as well as providing strong potential for customized rehabilitation sessions. By contrast, they suffered from the effect of learnability and were judged as potentially requiring more mental effort. Robotics implementation received positive feedback along with high satisfaction and perceived safety throughout the treatment. Robot-assisted rehabilitation was considered useful as it supported increased treatment intensity and contributed to improved patients' physical independence and psychosocial well-being. Technical and design-related issues may limit the applicability making the treatment difficult and physically straining. Moreover, cognitive and communication deficits were remarked as potential barriers.Overall, VR and robotic devices have been perceived usable so far, reflecting good acceptance in neuromotor rehabilitation programs. The limitations raised by the participants should be considered to further improve devices applicability and maximise technological rehabilitation effectiveness.PROSPERO registration ref. CRD42021224141 . 

https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-022-07821-w

A systematic review on the usability of robotic and virtual reality devices in neuromotor rehabilitation: patients’ and healthcare professionals’ perspective

Research trends in gamification have shown a significant diversity in various areas of e-health, particularly in addressing the issues of rehabilitation and physical activity. Rehabilitation requires better engaging tools that help to increase the patient’s motivation and engagement in particular forms of rehabilitation training. Adopting gamification in rehabilitation offers different treatment and care environments when implementing rehabilitation training. As gamification is increasingly being explored in rehabilitation, one might not realize that using various techniques in gamified applications yields a different effect on gameplay. To date, varied gamification techniques have been utilized to provide useful experiences from the perspective of health applications. However, a limited number of surveys have investigated the gamification of rehabilitation and the use of suitable game techniques for rehabilitation in the literature. The objective of this paper is to examine and analyze the existing gamification techniques for rehabilitation applications. A classification of rehabilitation gamification is developed based on the rehabilitation gamifying requirements and the gamification characteristics that are commonly applied in rehabilitation applications. This classification is the main contribution of this paper. It provides insight for researchers and practitioners into suitable techniques to design and apply gamification with increased motivation and sustainable engagement for rehabilitation treatment and care. In addition, different game elements, selection blocks, and gamification techniques are identified for application in rehabilitation. In conclusion, several challenges and research opportunities are discussed to improve gamification deployment in rehabilitation in the future.

https://www.mdpi.com/2078-2489/12/2/91/pdf

A survey on gamification for health rehabilitation care: applications, opportunities, and open challenges

In recent years, we have witnessed a growing adoption of serious games in telerehabilitation by taking advantage of advanced multimedia technologies such as motion capture and virtual reality devices. Current serious game solutions for telerehabilitation suffer form lack of personalization and adaptiveness to patients' needs and performance. This paper introduces "RehaBot", a framework for adaptive generation of personalized serious games in the context of remote rehabilitation, using 3D motion tracking and virtual reality environments. A personalized and versatile gaming platform with embedded virtual assistants, called "Rehab bots", is created. Utilizing these rehab bots, all workout session scenes will include a guide with various sets of motions to direct patients towards performing the prescribed exercises correctly. Furthermore, the rehab bots employ a robust technique to adjust the workout difficulty level in real-time to match the patients' performance. This technique correlates and matches the patterns of the precalculated motions with patients' motions to produce a highly engaging gamified workout experience. Moreover, multimodal insights are passed to the users pointing out the joints that did not perform as anticipated along with suggestions to improve the current performance. A clinical study was conducted on patients dealing with chronic neck pain to prove the usability and effectiveness of our adjunctive online physiotherapy solution. Ten participants used the serious gaming platform, while four participants performed the traditional procedure with an active program for neck pain relief, for two weeks (10 min, 10 sessions/2 weeks). Feasibility and user experience measures were collected, and the results of experiments show that patients found our game-based adaptive solution engaging and effective, and most of them could achieve high accuracy in performing the personalized prescribed therapies.

https://www.mdpi.com/1424-8220/20/24/7037/pdf

Adaptive Rehabilitation Bots in Serious Games.

A systematic review of intelligent assistants

Motor rehabilitation exercises require recurrent repetitions to enhance patients’ gestures. However, these repetitive gestures usually decrease the patients’ motivation and stress them. Virtual Reality (VR) exer-games (serious games in general) could be an alternative solution to address the problem. This innovative technology encourages patients to train different gestures with less effort since they are totally immersed in an easy to play exer-game. Despite this evolution, patients, with available exer-games, still suffer in performing their gestures correctly without pain. The developed applications do not consider the patients psychological states when playing an exer-game. Therefore, we believe that is necessary to develop personalized and adaptive exer-games that take into consideration the patients’ emotions during rehabilitation exercises. This paper proposed a VR-PEER adaptive exer-game system based on emotion recognition. The platform contain three main modules: (1) computing and interpretation module, (2) emotion recognition module, (3) adaptation module. Furthermore, a virtual reality-based serious game is developed as a case study, that uses updated facial expression data and provides dynamically the patient’s appropriate game to play during rehabilitation exercises. An experimental study has been conducted on fifteen subjects who expressed the usefulness of the proposed system in motor rehabilitation process.

/pdf/vr-peer-a-personalized-exer-game-platform-based-on-emotion-1rd1tltk.pdf

VR-PEER: A Personalized Exer-Game Platform Based on Emotion Recognition

This paper introduces 'RehaBot', a framework for building adaptive serious games in the context of telerehabilitation. RehaBot takes advantage of 3D motion tracking and virtual reality devices, to develop an immersive and gamified telerehabilitation environment. A personalized and adaptive gaming system is developed, which allows patients to perform exercises with the help of embedded virtual assistants, hereafter called 'rehab bots', that are dynamically displayed within scenes to guide the patient through the different sets of gestures required to complete the session. These rehab bots have the ability to learn and adapt to the best level of difficulty in real-time based on the user performance. An intelligent alerting and automatic correction technique is incorporated within our engine, so that pre-calculated gesture patterns are correlated and matched with patients' gestures. Consequently, the system estimates the perceived difficulty of gestures by the patient, and automatically adjusts the game behavior to ensure a highly engaging and adaptive gaming experience. Furthermore, multimodal instructions are conveyed to users with details on joints that are not performing as expected, and to guide them towards improving the current gesture. A pilot study has been conducted to prove the usability and effectiveness of our adaptive physiotherapy solution.

RehaBot: Gamified Virtual Assistants Towards Adaptive TeleRehabilitation

This paper introduces a framework for building adaptive serious games in the context of telerehabilitation. This framework takes advantage of 3D motion tracking and virtual reality devices, to present a personalized and adaptive gaming system, which allows patients to perform exercises as suggested by their physiotherapy experts, while being fully engaged in a gamified 3D scene. Virtual characters are dynamically displayed within scenes to guide users through the different set of required gestures. Virtual assistants have the ability to learn and adapt to the best level of difficulty in real-time based on the user performance. An intelligent alerting and automatic correction components are embedded in our engine, so that pre-calculated gesture patterns are correlated and matched with patients' gestures. Consequently, the system estimates the perceived difficulty of gestures by the patient, so that automatic adjustments are executed to ensure a highly engaging and adaptive serious game experience. A pilot study has been conducted to prove the usability and effectiveness of our gamified physiotherapy solution.

Towards an adaptive gaming framework for TeleRehabilitation

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Adaptive Rehabilitation Bots in Serious Games.

RehaBot: Gamified Virtual Assistants Towards Adaptive TeleRehabilitation

Towards an adaptive gaming framework for TeleRehabilitation