# Developing a Serious Video Game to Engage the Upper Limb Post-Stroke Rehabilitation
## 4 Discussion  
This project successfully integrated essential features into a rehabilitation game specifically designed for upper limb stroke recovery, showcasing its potential to enhance patient motivation. Increased motivation is a key factor in improving patient engagement in therapeutic exercises, which may significantly contribute to a more complete and efficient recovery process. The game utilizes a humanoid avatar capable of replicating the user's movements, detected solely through a camera, within an immersive and interactive environment. A points-based reward system encourages patient participation--by simply moving their arm to interact with on-screen objects, users can earn points, making the experience more engaging. The use of camera systems, such as Kinect V2, offers a cost-effective and practical alternative to VR headsets, particularly benefiting older patients who may find VR technology challenging. This approach still delivers an experience that closely resembles virtual reality without the complexity or cost associated with wearable devices. One of the foundational principles of this project is its use of gamified rehabilitation to enhance patient motivation, as opposed to relying solely on traditional physical therapy methods [7; 8; 9; 10]. The game leverages a Kinect camera, enabling patients to interact with the system using natural body movements without the need for physically attached devices that may cause discomfort, such as VR headsets [10; 11; 12; 13] or body-worn sensors [15] or gloves [10]. This approach also reduces the burden on healthcare professionals, as it eliminates the need for cleaning shared equipment between patients [19]. The system features an automatic difficulty adjustment mechanism, supervised by healthcare professionals, to ensure that each patient engages with levels that are appropriately challenging. This prevents users from becoming unmotivated due to tasks being too easy or overly difficult. The involvement of clinicians helps ensure that the difficulty level does not spike unexpectedly, preserving the continuity of the rehabilitation process [13]. Furthermore, the game design emphasizes exclusively positive feedback, as negative feedback can be detrimental to user motivation, particularly in a rehabilitation context, such as sounds associated with unsuccessful attempts [13]. Despite promising results, the testing phase was limited to healthy individuals, with a small sample size providing initial feedback. Participants generally found the game motivating and well balanced in terms of challenge, although they noted that the aesthetic design could benefit from future improvements. Suggestions for enhancing user engagement include introducing a customizable avatar to reflect the patient's physical characteristics, thereby increasing immersion. Incorporating personalized motion data (e.g., lateral arm lift, elbow flexion, and circular motions) upon account creation could allow therapists to better tailor exercises to individual needs. The tests conducted with healthy participants, rather than directly involving poststroke patients, played a crucial role in several respects. Firstly, they allowed for verification of usability, ensuring that the game is easy to understand and play, functions reliably from a technical standpoint, and is free of major issues. Secondly, these tests supported refinement of game mechanics, such as adjusting difficulty levels, identifying design flaws, and assessing whether the proposed tasks are meaningful and appropriate. Additionally, this stage served to validate the game's concept before engaging patients, representing an important ethical and methodological step. It helped to prevent exposing individuals with impairments to a system that may not yet be fully suitable or prepared. It also demonstrated the game's potential for real rehabilitation use. Early testing enabled the collection of initial feedback, such as identifying unclear elements, observing user motivation, and gauging engagement levels.