Control to Chaos: Design and Evaluation of a Mixed-Reality Exergame Scenario for Sports Rehabilitation (Preprint)
Authors: Haas Michelle C. , Wild Larissa , Schneeberger Leander , Graf Eveline S. , Martin-Niedecken Anna Lisa 
Published: November 2024

BACKGROUND

Exergaming, involving physically active play, provides a means for motivating and functional training. It may also offer an innovative solution for rehabilitation after sports injuries like an anterior cruciate ligament (ACL) injury. The rehabilitation phase after such injury is lengthy and only partially prepares athletes for the demands of sports. As a result, only 65% of athletes return to the same performance level as before the injury.
Exergames specific for ACL-rehabilitation are missing. Their unique combination of both physical and cognitive challenge may contribute to the preparation of patients (PAT) for their return to sports. The collaboration of sport scientists, game designers, and physiotherapists enables a comprehensive and user-centered development of an innovative training concept incorporating the needs of both PAT and therapists along with scientific evidence.

OBJECTIVE

The aim of this project was to develop a specific Exergame for sports rehabilitation after ACL injuries thereby following a user-centered approach. The project was structured into four parts: 1) assessment of motor performance during a fitness exergame, 2) establishing user requirement for rehabilitative exergames, 3) development of a new exergame, 4) validation of the new exergame.

METHODS

Assessment of motor performance: lower extremity kinematics during gameplay of a fitness exergame in the ExerCube was assessed in 24 athletes (6 after ACL injury).
User requirements: focus groups with physiotherapists and PAT were performed.
Development of new exergame: results from the kinematic analysis and user requirements informed an iterative and interdisciplinary design process for a functional movement concept and a new game scenario specific for the ExerCube.
Validation: developed game scenarios were recurrently evaluated with patient and therapist focus groups and eventually transformed into a final exergame scenario, now in use in numerous facilities.

RESULTS

Biomechanical risk factors during the fitness exergames were determined by comparing the kinematic results to current literature on risk factors for knee injuries. Focus groups revealed that PAT want to return to sports as quickly as possible but have concerns about the sensory overload during training. Physiotherapists desire a device that allows additional independent training with new therapeutic stimuli. Accordingly, the movement concept for the new exergame includes strength and balance exercises, as well as a mini-game for endurance, reaction, and skill training. Three difficulty levels allow for varying complexity and speed.

CONCLUSIONS

The interdisciplinary and evidence-based approach facilitated a systematic development of requirements for an exergame for rehabilitation, ensuring user-centered implementation. A final evaluation confirmed the gaming experience, potential effects, and the applicability of the new exergame in sports rehabilitation, leading to its deployment at all ExerCube locations.