# Gamification of Upper Limb Rehabilitation in Mixed-Reality Environment
## 5 Experiments and Results
Once these estimations were made, finding the ROMs of the shoulder and elbow was simple and relied on mathematical algorithms similar to those used for determining the finger and wrist joints' DoFs' ROM. Gamified approach to UE rehabilitation is evaluated from both objective and subjective perspectives. Objective measures include comparable in-game performances through task completion, level achievements, badge collection, milestone crossing, and the number of hours spent playing the game in a timeframe. The subjective measures are surveys among the participants about their post-game experience and feedback from the OT. \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Range of** & \begin{tabular}{c} **Shoulder** \\ **Abduction/** \\ **Adduction** \\ \end{tabular} & \begin{tabular}{c} **Shoulder** \\ **Flexion/** \\ **Extension** \\ \end{tabular} & \
\begin{tabular}{c} **Shoulder** \\ **Internal/** \\ **External** \\ **Rotation** \\ \end{tabular} &
\begin{tabular}{c} **Elbow Flexion/** \\ **Extension** \\ \end{tabular} \\ \hline \hline \(p\)-Value & 0.82 & 0.25 & 0.19 & 0.14 \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Example of the average p-values calculated using 1-sample T-test for all ten subjects as recorded from their data when playing the level shown in Figure 1(a). The subjects were part of the control testing cohort to assess the precision of MR-game. \begin{table}
\begin{tabular}{c l l l} \hline \hline
**Item** & **Criteria** & **Questions** &
\begin{tabular}{c} **Avg. Score** \\ **(\(n\) = 12)** \\ \end{tabular} \\ \hline
1 & \
\begin{tabular}{c} Usability \\ 2 \\ \end{tabular} &
\begin{tabular}{c} I think the MR Game is easy to use. \\ I think the functionalities of the MR Game are well \\ integrated \\ \end{tabular} & 4.64 \\
3 & \
\begin{tabular}{c} Learnability \\ 3 \\ 4 \\ 5 \\ 6 \\ 7 \\ \end{tabular} &
\begin{tabular}{c} I think the most users can quickly learn to use the \\ MR Game \\ \end{tabular} & 4.57 \\
4 & \
\begin{tabular}{c} Motivation \\ 5 \\ 6 \\ \end{tabular} &
\begin{tabular}{c} I am confident when using the MR Game \\ I would like to use the MR Game on a daily basis \\ How do you rate the MR game? \\ \end{tabular} & 4.68 \\
7 & \begin{tabular}{c} OT Assessment \\ \end{tabular} & \begin{tabular}{c} (i) How do you rate the comfort of using the MR \\ Game? \\ (ii) How do you rate the accuracy of the MR \\ Game’s capabilities for measuring the shoulder’s \\ flexion/extension ROM? \\ \end{tabular} & 4.83 \\  & \
\begin{tabular}{c} (iii) How do you rate the accuracy of the MR \\ Game’s capabilities for measuring the shoulder’s \\ abduction/adduction ROM? \\ \end{tabular} & 4.89 \\  &
\begin{tabular}{c} (iv) How do you rate the accuracy of the MR \\ Game’s capabilities for measuring the shoulder’s \\ internal/external rotation ROM? \\ \end{tabular} & 4.60 \\ \hline \hline \end{tabular}  
* Scale ranging from 1 to 5 is used for items (1–6) where 1 = strongly disagree, 2 = disagree, 3 = somewhat agree, 4 = agree, 5 = strongly agree. Another scale ranging from 0 to 5 is used for item 7 where 0 = minimum and 5 = maximum.  
\end{table} 
Table 3: Evaluation and OT assessment of the proposed MR-based gamified rehabilitation system, \(n\) = 12 (10 Healthy participants and 2 OTs). Traditional games provide engagement to the players by offering several in-game achievements, depicting the status of the player. Among them, task completion is a primary criterion to measure success. Some tasks are the virtual representations of ADLs performed by the in-game avatar, such as cleaning dishes, brushing teeth, combing hair, moving objects, etc. Tasks for a UE patient may include different movements of joints such as shoulder abduction-adduction, elbow flexion-extension, and forearm pronation-supination to make changes to the in-game virtual objects. Though the binary interpretation of task completion can be recorded as successful or unsuccessful, scaling them on a predetermined scale helps analyze the data for suggesting improvements.