Virtual Reality-Powered Wrist Therapy: Developing a Therapist-Driven Exit-the-Room Serious Game with Hand Gesture Interactions  
[PERSON]  
1 Research Group for Industrial Software (INSO), TU Wien, 1040 Vienna, Austria  
[EMAIL_ADDRESS] (C.H.) [EMAIL_ADDRESS] (L.R.) christoph.aigner@uso.tuwien.acat (C.A.) [EMAIL_ADDRESS] (C.A.) [EMAIL_ADDRESS] (C.A.) kristoph.aigner@uso.tuwien.acat  
wrist injuries is crucial. Prolonged pain and limitations can significantly impede the quality of life and the use of hands in daily life and professional endeavors for those affected [6]. Wrist injuries, owing to their complexity and constant use, can lead to trauma if not properly rested, often necessitating surgical intervention. Subsequently, rehabilitation becomes crucial [7]. Rehabilitation primarily centers around mitigating the impact of a medical condition on an individual's daily life, improving their capabilities, and reducing the extent of impairment [8]. Traditionally, functional rehabilitation encompasses therapy counseling and participation in physical exercises or tasks, either under professional supervision or carried out independently [9]. Rehabilitation exercises, when required, often become monotonous, and the motivation and resilience of individuals tend to wane over time. Nevertheless, this challenge can be effectively tackled through the integration of serious games [10]. Patients' post-treatment or rehabilitation processes vary depending on the chosen treatment approach [11]. Serious games extend beyond simple entertainment, integrating interactive mechanics typical of video games to provide additional benefits to users [12]. [PERSON] et al. [13] conducted research on how serious games and wearable technology impact the rehabilitation of individuals with bone and soft tissue injuries. Their study involved an analysis of 12 relevant studies, revealing promising outcomes, particularly regarding therapy adherence. A study utilizing a wooden hand attached to an industrial robotic arm together with a Leap Motion Controller (LMC) has shown that such a setting is a viable and cost-effective solution for wrist rehabilitation [14]. [PERSON] et al. researched the effects of a virtual reality-based serious game aimed at upper-limb rehabilitation after a stroke. Their results showed that the game increased enjoyment and motivation for patients, encouraging them to participate in therapeutic exercises for rehabilitation [15]. Serious games have a wide and varied range of applications across multiple fields, including training and simulation, education, enhancing human performance, strategic communication, and healthcare [16]. A meta-analysis [17] highlighted and determined that the use of serious games and virtual reality can motivate patients to engage with their therapeutic needs, improve physical fitness, and reduce disease symptoms. Within the domain of serious games for health, various areas are covered, including their application in knee rehabilitation using smartphones, as shown in [18], or their use in stroke recovery as part of the rehabilitation process with the additional utilization of smartphone sensors, as demonstrated in [19]. Serious games are also employed in addressing cerebral dysfunction, as discussed in [20], cognitive impairments [21], and supporting nutritional education [22]. There are also multiple approaches to implementing serious games for enhancing sports activities [23; 24]. The Leap Motion Controller [25] is already being widely used for hand rehabilitation, with its optical hand-tracking module being utilized for capturing precise hand and finger movements [26]. Studies have shown its effectiveness in upper extremity mobility improvement through video game-based therapy, particularly in stroke rehabilitation [27]. Its relevance continues, with research demonstrating its impact on pinch grip in stroke patients [28] and its utility in other areas like Parkinson's disease.