Serious Gaming Technology in Upper Extremity Rehabilitation: Scoping Review

Abstract

Background: Serious gaming has increasingly gained attention as a potential new component in clinical practice. Specifically, its use in the rehabilitation of motor dysfunctions has been intensively researched during the past three decades.

Objective: The aim of this scoping review was to evaluate the current role of serious games in upper extremity rehabilitation, and to identify common methods and practice as well as technology patterns. This objective was approached via the exploration of published research efforts over time.

Methods: The literature search, using the PubMed and Scopus databases, included articles published from 1999 to 2019. The eligibility criteria were (i) any form of game-based arm rehabilitation; (ii) published in a peer-reviewed journal or conference; (iii) introduce a game in an electronic format; (iv) published in English; and (v) not a review, meta-analysis, or conference abstract. The search strategy identified 169 relevant articles.

Results: The results indicated an increasing research trend in the domain of serious gaming deployment in upper extremity rehabilitation. Furthermore, differences regarding the number of publications and the game approach were noted between studies that used commercial devices in their rehabilitation systems and those that proposed a custom-made robotic arm, glove, or other devices for the connection and interaction with the game platform. A particularly relevant observation concerns the evaluation of the introduced systems. Although one-third of the studies evaluated their implementations with patients, in most cases, there is the need for a larger number of participants and better testing of the rehabilitation scheme efficiency over time. Most of the studies that included some form of assessment for the introduced rehabilitation game mentioned user experience as one of the factors considered for evaluation of the system. Besides user experience assessment, the most common evaluation method involving patients was the use of standard medical tests. Finally, a few studies attempted to extract game features to introduce quantitative measurements for the evaluation of patient improvement.

Conclusions: This paper presents an overview of a significant research topic and highlights the current state of the field. Despite extensive attempts for the development of gamified rehabilitation systems, there is no definite answer as to whether a serious game is a favorable means for upper extremity functionality improvement; however, this certainly constitutes a supplementary means for motivation. The development of a unified performance quantification framework and more extensive experiments could generate richer evidence and contribute toward this direction.

Keywords: gamification; rehabilitation; serious gaming; upper extremity; upper limb.

Figure 1

PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) [16] flow diagram of the literature search and final included studies.

Figure 2

Distribution of the publications over time. The “Commercial Sensors” category refers to studies using commercial sensors or any combination of commercial devices for the rehabilitation scenario, and the “Hardware Development” category refers to studies that created any type of robotic arm, glove, or other device for the connection with the game platform.

Figure 3

Comparison between the two device development categories regarding the game type. The ratio of virtual reality (VR), augmented reality (AR), video games, and electronic board games between the commercial sensors and hardware development categories is shown.

Figure 4

Overview of the devices used in the included studies. The green nodes indicate the sensors included in the commercial sensor category, while the orange nodes are those included in the hardware development category. The dark green nodes represent sensors that have been used individually or in combination with one of the sensors represented by the light green nodes.

Figure 5

Summary of devices reported in the literature over time. Groups of sensors used for studies of upper limb rehabilitation are presented in a timeline. The groups include devices from both the hardware development and commercial sensors categories.