Serious game design and clinical improvement in physical rehabilitation: a systematic review


JMIR Serious Games. September 23, 2021; 9 (3): e20066. doi: 10.2196 / 20066.


BACKGROUND: Serious video games have now been used and evaluated in clinical protocols, with several studies reporting improvement and patient engagement with this type of therapy. Even though some reviews of the literature have approached this topic from a gaming perspective and presented a broad overview of the types of video games that have been used in this context, there is still a need to better understand how different gaming characteristics and strategies are played. development can have an impact and relate to clinical outcomes.

OBJECTIVE: This review evaluated the relationship between the characteristics of serious games (SG) and their relationship to the clinical results of studies that use this type of therapy in the rehabilitation of motor impairment in patients with stroke, multiple sclerosis or cerebral palsy. The aim was to take a closer look at the design features of video games described in the literature (game genre [GG], nature of play [GN], and game development strategy [GDS]) and assess how they can help improve health outcomes. Additionally, this review attempted to bring together medical and game development perspectives to facilitate communication between clinicians and game developers, thereby facilitating the process of choosing which video games to use for physical rehabilitation.

METHODS: We analyzed the main features of OS design to achieve significant clinical results when applied to the physical rehabilitation of patients recovering from motor impairments resulting from stroke, multiple sclerosis and of cerebral palsy. We implemented an electronic search strategy adjusted to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) database for the PubMed, IEEE Xplore and Cochrane databases.

RESULTS: We screened 623 related articles from 2010 to 2021 and identified 12 that presented results consistent with our inclusion criteria. A total of 512 participants with stroke (8 studies, 417 participants), cerebral palsy (1 study, 8 participants) and multiple sclerosis (2 studies, 46 participants) were included; 1 study targeting the elderly (41 participants) was also included. All of the studies assessed motor, sensory, and functional functions, while some also measured general health outcomes. Interventions with games have been used for motor rehabilitation of the upper limbs. Of the 12 studies, 8 showed significant improvements in at least one clinical measure, of which 6 presented casual GG games, 1 combined casual, simulation and exercise GGs, and 2 combined sport and simulation GGs.

CONCLUSIONS: Among the possible combinations of game design features (GG, GN, and GDS) described, bespoke casual games that use first-person perspective, do not feature a visible player character, are played in single-player mode , and use non-immersive virtual reality to achieve the best results in terms of positive clinical outcomes. Additionally, the use of bespoke games over commercial commercial games tends to yield better clinical outcomes, although the latter are perceived to be more motivating and engaging.

PMID: 34554102 | DOI: 10.2196 / 20066

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