# Design of Exergaming Platform for Upper Limb Rehabilitation Using Surface Electromyography
## 5 Results
### Exergame
#### 5.2.1 Observations from User Study with Patients  
Patient evaluations of the exergame provided interesting findings, based on key observations from the game sessions. One critical issue identified was the significant impact of involuntary spasmodic movements on gameplay. Specifically, users with increased spasticity, corresponding to a score of 2 on the MAS, often required more than twice as many attempts to successfully complete an exercise set. The challenge arose because the Myo armband interpreted brief spasms as an end to and restart of movement, generating excess events. This resulted in the game prematurely terminating the current attempt due to its immediate response to the receipt of the pose end event and then promptly restarting the attempt upon receipt of the pose start event. This instantaneous nature, without the presence of a threshold for accepting a state for the current gesture, highlights the sensitivity of the game's logic in relation to unintentional movements. As a result, the user had to repeat the exercise repetition, which adversely affected engagement.  
An additional observation was the unintended effect of one patient's behavior during play, as shown in Figure 5. After completing an exercise repetition, the patient instinctively clenched her hand, moving directly from finger abduction to finger flexion, bypassing the neutral rest position. This caused the game, due to its method of processing input data, to incorrectly register the closing of the hand as a completed exercise action. This misrecognition, although rare, highlights a flaw in the game's accuracy in tracking intended exercise movements.  
\begin{table}
\begin{tabular}{c c c c c c} \hline \hline \multicolumn{1}{c}{\multirow{2}{*}{**Wrist Flexion**}} & \multicolumn{1}{c}{\multirow{2}{*}{\begin{tabular}{c} **Wrist Extension** \\ \end{tabular} }} & \multicolumn{1}{c}{\multirow{2}{*}{\begin{tabular}{c} **Finger Flexion** \\ \end{tabular} }} & \multicolumn{1}{c}{\multirow{2}{*}{\
\begin{tabular}{c} **Finger Abduction** \\ \end{tabular} }} & \multirow{2}{*}{
\begin{tabular}{c} **Finger** \\ \end{tabular} } \\  & & & & & \\ \hline Sets & 2 & 2 & 1 & 2 & 2 \\ Repetitions & 3 & 3 & 3 & 3 & 5 \\ Hold time (s) & 10 & 15 & 15 & 15 & 5 \\ \hline \multicolumn{5}{c}{Between Sets} & Between Repetitions \\ \hline Rest time (s) & & 1 & & 15 \\ \hline \hline \end{tabular}
\end{table}
Table 3: Exercise routine followed in the game testing.  
Another observation focused on the overall player experience was that players occasionally did not respond quickly or correctly to feedback from the game. For instance, they frequently kept their hand in position long after subtle signs suggested that the necessary time had elapsed. Furthermore, players sometimes attempted actions without realizing that certain cues meant their movements had no effect, such as being out of range of an enemy. These examples highlight the importance of providing clearer feedback within the game, as unnecessary effort due to such misinterpretations can adversely affect the patient's performance by causing undue muscle strain.