# Probe: A Framework for Serious Games in Telecrabilitation
## 1 Introduction  
Telecrabilitation (TR) can be defined as delivering rehabilitation services to the patient's home through a remote connection with the therapist, possibly enhanced by additional multimedia technologies [1; 2; 3]. TR can be provided using a variety of technological tools and modalities, for example, real-time visits with audio, video, or both; asynchronous e-visits, telephone assessments; closed-circuit television to video conferences; internet-based communication software (e.g., teleconference platform) with headsets, web-cams, speakers, handheld cameras, microphones, and internet; serious games; or remote evaluations of recorded videos or images [1].  
Several systematic reviews have argued that TR is an effective tool for patients with different disabilities, from musculoskeletal conditions, multiple sclerosis, neurological disorders, and stroke to autism and genetic syndromes [4; 5; 6; 7; 8; 9]. Moreover, it was found that TR services are effective both for children and adults with disabilities, and professionals have also reported high levels of satisfaction and acceptance of TR services [5; 10; 11; 12]. However, it is expected that advancements in technology can increase the usability and effectiveness of TR, but current TR systems do not usually allow for therapists to customize or adapt these systems to the characteristics of the patient and setting, and they are limited to specific patient conditions [13; 14; 15; 16; 17; 18]. This can be due to different factors such as the complexity of the process, the technical aspects of TR service development, and the heterogeneity of patients with disabilities. Thus, it is necessary to develop and test the suitability and safety of TR modalities that can be customized by the therapist across subgroups of patients.  
The last year, which has been deeply impacted by the COVID-19 pandemic, has led to a significant increase in the use of remotely guided rehabilitation and therapy interventions [19; 20; 21; 22; 23]. However, patient conditions vary significantly, and the need for a framework to define customized TR systems that can improve the engagement of the involved patients arises, with the aim of facing the enormous variability in patient specificity and needs. Moreover, such a framework should have a modular structure, such that a therapist can add support for specific hardware devices (i.e., eye trackers) or software capabilities (i.e., computer vision, machine learning) which would be useful in allowing the patients interact with the system and to acquire data for further analyses. Consequently, the implementation of TR leads to a double challenge: motivating patients and ensuring an effective system [24; 25; 26].  
In this scenario, we propose Proteo, a framework designed to give therapists and researchers without specific skills in software development the capability of defining TR service customization and developing rehabilitation-oriented serious games, starting from game templates. Moreover, the framework can be applied in rehabilitation centers that could easily develop suites of remotely administered serious games, focusing only on a simplified game implementation, exploiting the framework modules for client/server communication, user management, human-computer interaction, or deep learning techniques.  
This framework aims at: (a) the creation of personalized serious games for TR systems; (b) monitoring of the therapeutic goals of the rehabilitation process; (c) simplifying the interaction schemes between the patients and serious games. Moreover, Proteo is open-source and cross-platform, and it is distributed under the MIT license.  
In the next sections, after presenting Proteo, we discuss two use cases to analyze the practicability of the serious games creation process and to discuss user satisfaction. In this paper, we present experiments involving therapists and researchers, while we plan to apply Proteo in telerehabilitation programs involving people with disabilities as part of future work.