© 2024 SURF
Goal:
Investigate the inconsistent use of Serious Games (SGs) in physical rehabilitation therapy and
define guidelines to tackle this.
Methodology
We conducted a small state-of-the-art review, two focus groups with 13 physiotherapists (roughly
half of them with no SGs experience), and 3 interviews with rehabilitation SG development
companies. Sessions were recorded, transcribed, and data was clustered using the NASSS
framework as a rough guideline, which was used to define SG guidelines. Afterwards, a 4-day game
jam was organized to assess the SG design guidelines in terms of clarity, applicability, and
usefulness. Eleven game design students participated in creating rehabilitation games for dynamic
balance while using the guidelines, as well as 2 provided personas and a video library of
rehabilitation exercises. This led to the creation of 2 game prototypes.
Results
Guidelines: A list of enablers/barriers for the adoption of SGs in rehabilitation has been composed.
Based on this, two serious game guidelines were defined. The design guidelines include technical
and game design challenges from the perspective of therapists (difficult setup, limited
personalization) and game developers (alignment between tasks & activities of daily living, no one
size fits all). The implementation guidelines cover organizational problems for both therapists and
developers (lack of availability/time, limited technical support), in addition to business-related
barriers (lack of clear business case, focus on publications).
Game jam: Two dynamic balance SG prototypes were developed. One of them makes use of
procedural generation to tackle the problems of personalization, customization, and replay value.
Medical practitioners were very enthusiastic about this concept, which has currently being turned
into a RAAK Publiek project proposal.
Conclusion
The guidelines provides a solid foundation to encourage discussions about designing SGs that are
beneficial and usable for patients and therapists, and a valuable investment for both companies
and medical institutions.
Physical rehabilitation programs revolve around the repetitive execution of exercises since it has been proven to lead to better rehabilitation results. Although beginning the motor (re)learning process early is paramount to obtain good recovery outcomes, patients do not normally see/experience any short-term improvement, which has a toll on their motivation. Therefore, patients find it difficult to stay engaged in seemingly mundane exercises, not only in terms of adhering to the rehabilitation program, but also in terms of proper execution of the movements.
One way in which this motivation problem has been tackled is to employ games in the rehabilitation process. These games are designed to reward patients for performing the exercises correctly or regularly. The rewards can take many forms, for instance providing an experience that is engaging (fun), one that is aesthetically pleasing (appealing visual and aural feedback), or one that employs gamification elements such as points, badges, or achievements.
However, even though some of these serious game systems are designed together with physiotherapists and with the patients’ needs in mind, many of them end up not being used consistently during physical rehabilitation past the first few sessions (i.e. novelty effect). Thus, in this project, we aim to 1) Identify, by means of literature reviews, focus groups, and interviews with the involved stakeholders, why this is happening, 2) Develop a set of guidelines for the successful deployment of serious games for rehabilitation, and 3) Develop an initial implementation process and ideas for potential serious games.
In a follow-up application, we intend to build on this knowledge and apply it in the design of a (set of) serious game for rehabilitation to be deployed at one of the partners centers and conduct a longitudinal evaluation to measure the success of the application of the deployment guidelines.