# Design of Exergaming Platform for Upper Limb Rehabilitation Using Surface Electromyography
###### Abstract  
This study explores the development and pilot testing of an exergame designed for the rehabilitation of individuals with upper limb deficits. While traditional physiotherapy is effective, it often fails to fully engage patients due to its repetitive nature. This research integrates a novel exergame into physiotherapy regimens, aiming to enhance patient motivation through a gaming experience that complements conventional sessions. The exergame is structured around a narrative-driven adventure, with exercises embedded in gameplay that mirror adjustable physiotherapy routines. It utilizes the Myo armband, a wearable electromyography device, to capture muscle activity and movement. The system, part of a web-based platform, is easily deployable in various settings, including home environments. Comprehensive evaluations with health professionals and neurological patients indicate that the exergame significantly improves patient engagement. This study not only demonstrates the potential of exergames in enhancing traditional therapy but also underscores the importance of patient-centered therapeutic tools. exergaming; serious games; rehabilitation; surface electromyography (sEMG); physical therapy; Myo armband; human-computer interaction Article Design of Exergaming Platform for Upper Limb Rehabilitation Using Surface Electromyography  
[PERSON], 1  
1 Department of Electrical and Computer Engineering, University of Patras, 26504 Patras, Greece; [EMAIL_ADDRESS] (N.P. ); [EMAIL_ADDRESS] (N.A.) 2 Department of Physiotherapy, University of Patras, 26504 Patras, Greece; [EMAIL_ADDRESS] (N.A. )to utilize built-in sensors, employing smartphone cameras for 3D pose estimation [10], and integrating inertial measurement units with smartphones for data collection [11]. The literature further investigates tools to improve the performance and monitoring of physical activity. This involves the use of artificial intelligence to ensure precise exercise execution [12], adaptive difficulty settings via interaction classification [13] or decision-making with fuzzy logic [14], and personalized exercise routines recommendations based on user history [15]. Game design has also been a matter of study, as researchers have examined the impact of allowing specialized users to customize exercises [16], the role of narrative in boosting engagement [17], the effectiveness of specific frameworks like Persuasive System Design [18], and the application of general design principles to exergaming [19]. Additionally, significant attention has been given to understanding user reactions to various game attributes. This encompasses studies on the influence of game elements on virtual exercise experiences [20], the integration of psychoeducational content [21], the effects of collaborative play through shared mechanisms [22] or parallel side-by-side actions [23], the incorporation of cognitive challenges [24], and strategies for sustaining long-term engagement [25]. Nevertheless, despite extensive research, there is still a need for experimentation and research in this area. Accessibility is paramount, necessitating innovations such as controller-free interaction to support individuals with physical limitations, as demonstrated in [26; 27], and the creation of games that more closely mirror conventional physical therapy sessions. Moreover, the potential for biofeedback through, for example, heart rate [28] and muscle activity monitoring [29] remains underutilized. Finally, exergames often lack cohesive narratives, overly relying on disjointed minigames. This study aims to address these gaps by developing an exergame that is playable via affordable and easy-to-use technology, capable of providing measurements of physiological parameters, inclusive of gameplay taking into account a protocol of physiotherapy exercises, and has been designed as an actual game rather than a gamified application.