### Novelty of the Solution  
The solution described here offers novel approaches for the development of a serious game that supports hand rehabilitation exercises utilizing a MetaQuest VR headset [45]. The proposed solution offers a new game type (escape room setting) not yet used within a rehabilitation setting, which also includes concurrent gameplay without considering different levels or mini-games. Our solution can, therefore, be extended horizontally (new riddles and interaction within the current rooms) or vertically (new rooms or places). Different movements are included in this setting compared to other solutions where specific movements are tied to a mini-game or level. In addition, many previous solutions also lack definitions/descriptions of requirements or movements and their projections within a serious game. Our solution offers an overview of these exercises and their alignment with specific in-game interactions. In addition, using a \"MetaQuest\" VR headset with built-in sensors is also new. It demonstrates the technical feasibility of using such a hand and wrist rehabilitation solution. Other projects use sensors like the LMC, built-in smartphone sensors, or even proprietary self-built hardware. Additionally, current solutions often focus on a specific disease or pathology and do not explicitly address hand or wrist rehabilitation in general. Thus, the research presented here should be viewed as a potential foundation for creating a serious game focused on hand and wrist rehabilitation. This leads to the research question: Can a serious game developed using a \"MetaQuest\" headset (or any VR serious game) fulfill the requirements specified by therapists? Table 1 summarizes the solutions in the related works and also highlights the differences between these solutions and the serious game presented here.  
\begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline
**Author** & **Reference** & **Sensor** & **Focus on** & **Game Type** & **Req. Defined Explicitly** & **VR** & **Gaming Context** \\ \hline [PERSON] et al. & [34] & LMC & Upper-limb & Cooking & No & No & Game/Room \\ [PERSON] et al. & [35] & LMC & Stroke rehabilitation & Fruit Nina & No & No & Level-Based \\ [PERSON] et al. & [36] & LMC & Stroke rehabilitation & Jump and Run & Yes & No & Level-Based \\ [PERSON] et al. & [37] & Smartphone & Wrist rehabilitation & Various & Yes & No & Mini-Games \\ [PERSON] et al. & [38] & Smartphone & Wrist rehabilitation & N/A & No & No & N/A \\ [PERSON] et al. & [59] & Data Glove & Hand rehabilitation & N/A & N/A & No & N/A \\ [PERSON] et al. & [40] & OR, LMC, Own device & & & & & \\ [PERSON] et al. & [41] & Mark1 & Stroke walking & Walking & No & Yes & Levels \\ [PERSON] et al. & [42] & Myo & Hand and wrist & Various & No & No & Mini-Games \\ [PERSON] et al. & [43] & LMC & JIA Wrist & Various & Partly & No & Mini-Games \\ [PERSON] et al. & [44] & Webcam & Wrist rehabilitation & Maze runner & No & No & Levels \\ [PERSON] et al. & [30] & Gear VR & Cerebral Paly & Catching Fruits & No & Yes & Mini-Game \\ [PERSON] et al. & This publication & MetaQuest & Hand and wrist & Exit the Room & Yes & Yes & Game \\  & & & rehabilitation & & & & \\ \end{tabular}
\end{table}
Table 1: Comparison and overview of state-of-the-art solutions, including the work presented here.