# Enhancing Robotic-Assisted Lower Limb Rehabilitation Using Augmented Reality and Serious Gaming
Therefore, in recent years, in addition to robot-assisted therapy, physicians have increasingly adopted augmented reality (AR) technology to provide the patient with interactive exercises, personalized therapy, and, most importantly, motivation and adherence [16; 17]. In [18], the innovative use of augmented reality (AR) to improve data visualization and enhance human perception in healthcare is explored. The research includes studies from January 2018 to December 2021. Based on these findings, AR has the potential to improve orthopedic training and practice by providing a more human-centered clinical approach. However, there are still challenges such as hardware limitations, the lack of accurate registration and tracking systems, and the absence of security protocols. The authors of [19] studied the effectiveness of Augmented Reality in stroke rehabilitation, finding that AR significantly improves motor function in both upper and lower limbs after a stroke. The meta-analysis of 13 studies found that AR has a positive impact on rehabilitation outcomes, suggesting its potential to enhance traditional therapy and promote motor recovery. Another AR-based system, presented in [20], was designed to evaluate the clinical efficiency of a novel three-dimensional interactive augmented reality system (3D-ARS) for balance and mobility rehabilitation, which provides significant improvements for the beneficiaries. Given these benefits, AR is frequently integrated into robot-assisted rehabilitation in the form of serious gaming. Serious gaming, also known as serious games, refers to the use of game-based design, elements, and principles for purposes beyond pure entertainment [21]. These games are specifically designed to make rehabilitation more engaging, motivating, and effective. An interesting approach can be observed in [22], where the authors introduced AR-basedserious gaming in a rehabilitation platform for post-stroke spasticity. In [23], a rehabilitation system for the upper limb is presented, integrating a Kuka collaborative robot and a HoloLens device. The game is designed to support motor learning and improve the effectiveness of robotic arm training in neurorehabilitation. Another aspect in which serious gaming concepts can be integrated into the rehabilitation process is related to the assessment of the patient's functional state. In [24], the authors present an innovative solution to evaluate and validate the effectiveness of a low-cost robotic platform, designed for post-stroke upper-limb rehabilitation through serious games. While patients played the games, the platform named \"ArmAssist Assessment (AAA)\" continuously monitored and recorded key parameters of their upper-limb movements. This allowed the researchers to collect objective data on patient performance, which were then used for correlating with traditional clinical scales like the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT). However, the authors of these studies note that research on this topic remains limited. In response to the need for systems that support individuals with disabilities and promote their independent living, as well as the growing demand for patient-centered rehabilitation, this paper aims to develop a serious gaming-based system for lower limb robotic-assisted rehabilitation. By combining the benefits of AR and serious gaming, the proposed system aims to improve the effectiveness and engagement of robot-assisted therapies. Integrating serious gaming with a newly developed parallel robot and HoloLens 2 in lower limb rehabilitation significantly enhances patient engagement and effectiveness. Traditional therapy exercises often suffer from low adherence due to their repetitive nature, but gamification transforms these routines into engaging, goal-driven activities, motivating patients to stay consistent. HoloLens 2 adds an immersive mixed-reality layer, allowing patients to interact with both virtual and real environments, which enhances their focus and reduces pain perception.