# Developing a Serious Video Game to Engage the Upper Limb Post-Stroke Rehabilitation
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Notable examples include games that involve lifting weights [13], grabbing and throwing balls at designated targets [10], or reaching specific positions when certain areas are activated (e.g., turning green) [12]. Specifically concerning Kinect-based applications, some studies were identified; however, to the best of the authors' knowledge, none of these studies involved games created to be focused on upper limb stroke rehabilitation using Kinect. Existing examples primarily address the use of Kinect V2 for lower limb stroke rehabilitation [17] or the use of Kinect Xbox 360 for upper body applications related to cerebral palsy [19]. Some studies explored the use of Xbox 360 Kinect for upper limb stroke rehabilitation, but they primarily utilized existing commercial games that are not specifically designed for this purpose. [PERSON] et al. [20] incorporated games such as \"Tennis Player,\" \"Joy Riding,\" and \"Rally Ball\" from the Kinect Adventure Package and Kinect Sports Package, which are not health focused. [PERSON] et al. [21] involved games like \"Mouse Mayhem,\" \"Traffic Control,\" \"Balloon Buster,\" and \"Mathercising\" from Dr. [PERSON]'s Body and Brain Exercises package. While these games are health related, they are not primarily intended for upper limb stroke rehabilitation, which might not consider certain critical aspects, such as the correctness of movements (if the movements involve reaching for objects that are beyond the patient's reach, the user will inevitably need to engage their body, extending beyond the use of their arms alone, to reach them), the handling of errors or failures within the game, or the design of the interface to accommodate individuals facing greater challenges, whether in executing the movements or in utilizing the technologies. The primary objective was to develop an upper limb stroke rehabilitation system that integrates key gamification features to enhance user motivation and adaptability through adjustable difficulty, real-time feedback, and interactive gameplay features. The game emphasizes simplicity and is specifically designed to support individuals with low/moderate stroke impairment (cognitive and physical) in improving their motor function recovery. The system was developed with the primary objective of supporting stroke survivors who exhibit mild to moderate impairments in the upper limbs and possess sufficient cognitive and physical abilities to interact with motion-based gamified environments. At this stage, individuals with severe motor deficits or those requiring full assistance were not included in the system's target group. Healthy participants were recruited to assess usability and motivation in a controlled environment prior to proceeding with clinical trials involving stroke patients. The remainder of the article is structured as follows. Section 2 provides a comprehensive discussion of the methodologies employed, including detailed justifications for the choices made regarding hardware, software, and game logic. The game implementation section outlines the implementation processes required for the development of the application, encompassing the database structure, techniques utilized, and the final outcomes related to the application and gameplay. Section 3 presents the results obtained from various tests conducted on the application. Lastly, Section 4 concludes the article by summarizing the work undertaken and proposing future tasks necessary for further improvement.