# What Children with Neuromotor Disabilities Need to Play with Technological Games
## 1 Introduction
Therefore, even though they are not specifically meant for rehabilitation, they can act as serious games for therapeutic and rehabilitative uses [12]. In the literature, there are plenty of studies that report the use of serious AVGs for rehabilitation purposes [9; 12; 13; 14; 15; 16; 17; 18; 19; 20]. Usually, these interventions consist of sessions of commercial videogames played with commercial consoles such asMicrosoft Kinect, Sony PlayStation2 EyeToy, PlayStation Move, Nintendo Wii, Nintendo Wii Fit, GestureTech IREX, and GestureXtreme [9; 12; 14; 15; 16; 17; 18; 20]. However, most of the AVGs have been specifically developed for individuals without disabilities to motivate them to increase physical activities by proposing fitness-like exercises [14]. Therefore, they could not be easily accessible in terms of understanding and playability for children with neuromotor limitations. To overcome this situation, during recent years, some research groups have investigated the design principles of videogames to enhance [21; 22] or evaluate [23] engagement during rehabilitation. [PERSON] et al. [21] identified several key factors in videogame design to increase motivation and engagement during rehabilitation. These key factors are:  
* Reward: gameplay is motivated by rewarding experiences, regardless of the type of rewards, or the conditions that trigger rewards across games or gamers;
* Difficulty/Challenge: to avoid boredom or frustration, players should be kept at the upper limit of their ability by modulating the challenge and difficulty levels;
* Feedback: to evaluate the effectiveness of the game session, it is helpful to have feedback for improving motor learning, increasing at the same time the motivation;
* Choice/Interactivity: the player can interact with the play and choose among different options (e.g., different mini-games), increasing their connection with the virtual environment;
* Clear goals: goal-directed tasks lead to a higher chance of acceptance of assistive devices, and their lack could have a significant negative impact on the motivation of patients;
* Socialization: to increase motivation, engagement, and learning, since it allows for cooperation and competition with a partner who is a valuable source of feedback and encouragement. The \"socialization\" aspect was investigated also by [PERSON] et al. [23], who evaluated the impact of competitive, co-active, and collaborative multi-user games on engagement and social involvement. What they found is that collaborative game modes promote more social involvement when compared to competitive and co-active modes. In accordance with [PERSON], [PERSON] concluded that feedback, challenge, and rewards are promising mechanisms by which exergames could become more enjoyable [22]. In parallel to the identification of a suitable game design, several researchers developed videogames specifically designed for the rehabilitation of disabled individuals in order to increase the motivation of the patients or support activity participation [11; 14; 24; 25; 26; 27; 28; 29; 30; 31]. These games are played on computers [24; 25; 26; 28; 29; 30; 32] or different commercial consoles (i.e., Nintendo Wii--Nintendo, Kyoto, Japan; \(\mathbf{\chi}\)box 360--Microsoft, Redmond, WA, USA; PlayStation--Sony Interactive Entertainment LLC, San Mateo, CA, USA) [14; 29; 33; 34; 35; 36], in some cases using commercial controllers (i.e., Nintendo Wii Balance Board, Wii Motion Plus--Nintendo, Kyoto, Japan; Microsoft Kinect--Microsoft, Redmond, United States; Novint Falcon--Novint Technologies, Albuquerque, United States; 5 DT 5 Ultra Glove-Fifth Dimension Technologies, Navin Mumbai, India; EyeToy--Sony Interactive Entertainment LLC, San Mateo, CA, USA) [14; 28; 29; 30; 33; 34; 35; 36]. On the other hand, several authors preferred to design and hoc controllers to simplify the gaming activity or to train a specific body district. For example, [PERSON] et al. developed a sensorized hat to allow the users to control the cursor of the computer with movements of their heads [11]. [PERSON] et al.