Exergaming System Research Articles

Exergaming interventions for older adults: The effect of game characteristics on gameplay

PurposeExergames can be used to train physical and cognitive abilities and have been shown to be effective in reducing the risk of falls in older adults. However, there is limited evidence about how people play exergames and how gameplay is affected by game settings and, thus, the potential training effects. The aim of this study was to investigate the impact of repeated exergaming sessions over 4 weeks and two game settings (difficulty level and game speed) on gameplay (performance, physical activity and perceived exertion) in older adults over a four-week exergaming intervention. Methods28 independently living older adults (mean age 74.47 years; 14 females) played two different exergames (Puzzle and Fox) at two difficulty levels 3× per week for 4 weeks. Physical activity measures from an accelerometer at the lower back, performance as game scores from the exergaming system, and self-reported measures of physical and cognitive exertion were collected at sessions 1,2,3,6,9 and 12. ResultsFor the Puzzle game, performance and physical activity increased significantly across the 12 training sessions. For the Fox game, an increased game speed was associated with increased performance, physical activity, and exertion across the exergaming sessions. Across all exergaming sessions, increasing difficulty by adding cognitive elements decreased the performance and amount of physical activity. ConclusionGame characteristics significantly influence how the exergames are played during a 4-week exergaming intervention. Hence, individual tailoring of the difficulty level and game speed is important. This study highlights the importance of understanding the interplay between game characteristics and gameplay during an exergaming intervention, thereby adding critical information for interpreting intervention effects – or the lack thereof.

A Study of Exergame System Using Hand Gestures for Wrist Flexibility Improvement for Tenosynovitis Prevention

Currently, as an increasing number of people have been addicted to using cellular phones, smartphone tenosynovitis has become common from long-term use of fingers for their operations. Hand exercise while playing video games, which is called exergame, can be a good solution to provide enjoyable daily exercise opportunities for its prevention, particularly, for young people. In this paper, we implemented a simple exergame system with a hand gesture recognition program made in Python using the Mediapipe library. We designed three sets of hand gestures to control the key operations to play the games as different exercises useful for tenosynovitis prevention. For evaluations, we prepared five video games running on a web browser and asked 10 students from Okayama and Hiroshima Universities, Japan, to play them and answer 10 questions in the questionnaire. Their playing results and System Usability Scale (SUS) scores confirmed the usability of the proposal, although we improved one gesture set to reduce its complexity. Moreover, by measuring the angles for maximum wrist movements, we found that the wrist flexibility was improved by playing the games, which verifies the effectiveness of the proposal.

Brain modulation after exergaming training in advanced forms of Parkinson’s disease: a randomized controlled study

BackgroundPhysical activity combined with virtual reality and exergaming has emerged as a new technique to improve engagement and provide clinical benefit for gait and balance disorders in people with Parkinson’s disease (PD).ObjectiveTo investigate the effects of a training protocol using a home-based exergaming system on brain volume and resting-state functional connectivity (rs-FC) in persons with PD.MethodsA single blind randomized controlled trial was conducted in people with PD with gait and/or balance disorders. The experimental (active) group performed 18 training sessions at home by playing a custom-designed exergame with full body movements, standing in front of a RGB-D Kinect® motion sensor, while the control group played using the computer keyboard. Both groups received the same training program. Clinical scales, gait recordings, and brain MRI were performed before and after training. We assessed the effects of both training on both the grey matter volumes (GVM) and rs-FC, within and between groups.ResultsTwenty-three patients were enrolled and randomly assigned to either the active (n = 11) or control (n = 12) training groups. Comparing pre- to post-training, the active group showed significant improvements in gait and balance disorders, with decreased rs-FC between the sensorimotor, attentional and basal ganglia networks, but with an increase between the cerebellar and basal ganglia networks. In contrast, the control group showed no significant changes, and rs-FC significantly decreased in the mesolimbic and visuospatial cerebellar and basal ganglia networks. Post-training, the rs-FC was greater in the active relative to the control group between the basal ganglia, motor cortical and cerebellar areas, and bilaterally between the insula and the inferior temporal lobe. Conversely, rs FC was lower in the active relative to the control group between the pedunculopontine nucleus and cerebellar areas, between the temporal inferior lobes and the right thalamus, between the left putamen and dorsolateral prefrontal cortex, and within the default mode network.ConclusionsFull-body movement training using a customized exergame induced brain rs-FC changes within the sensorimotor, attentional and cerebellar networks in people with PD. Further research is needed to comprehensively understand the neurophysiological effects of such training approaches.Trial registration ClinicalTrials.gov NCT03560089.

Balance Board or Motion Capture? A Meta-Analysis Exploring the Effectiveness of Commercially Available Virtual Reality Exergaming in Enhancing Balance and Functional Mobility Among the Elderly.

Force platforms and motion capture are commonly used as feedback mechanisms in exergaming; nevertheless, their therapeutic effectiveness may vary. Therefore, the primary objective of this study was to evaluate the effectiveness of commercially available virtual reality (VR) exergaming systems on balance and functional mobility, with a supplementary analysis considering the administered dose of exergaming. The search was conducted in five databases. Commercially available exergaming platforms were classified into two categories: VR exergaming with a balance board (including Wii Balance Board) and motion capture (including Xbox Kinect). Two categories of control interventions (treatment as usual [TAU] and no treatment [NT]) were extracted. The meta-analysis was performed separately for static, dynamic, and proactive balance outcomes and for the aggregated results of all included outcomes with subgroup analysis of lower, moderate, and higher doses. In total, 28 studies with 1457 participants were included. Both exergaming systems were particularly effective in improving the single leg stance outcome. VR exergaming with motion capture was found to be more effective than TAU with a standardized mean difference (SMD) of 0.48 (P = 0.006) and NT (SMD = 0.86; P = 0.02). In conclusion, commercially available VR exergaming with a motion capture feedback mechanism has demonstrated effectiveness as an intervention for balance training when compared with NT. Specifically, high doses (above 134 minutes per week) appear to be more beneficial for healthy older adults. Moreover, the findings provide some weak evidence supporting the effectiveness of VR exergaming with a balance board for improving functional mobility, particularly when compared with NT.

Effects of home-based exergaming on cardio-metabolic and cognitive health in physically inactive individuals.

To examine the effects of a home-based exergame training over 6 weeks on cardio-metabolic and cognitive health, as well as training adherence, in physically inactive individuals. Twenty participants were equipped with an exergame system specifically designed for use at home. Each participant performed at least three weekly exercise sessions at ≥80% of their individual maximum heart rate, over 6 weeks. Exercise duration increased biweekly until 75 min of vigorous exercise were performed in Weeks 5 and 6. Maximum oxygen uptake (VO2max), cardio-metabolic profiling, and neuro-cognitive tests were performed at baseline and study end. Additionally, training adherence was assessed via training diaries. After 6 weeks of home-based exergaming, VO2max increased significantly, while there was a significant decrease in heart rate (resting and maximum), blood pressure (systolic, diastolic and mean), and low-density lipoprotein cholesterol. Dynamic balance and reaction time improved after 6 weeks of exergaming. Training adherence was 88.4%. Home-based exergaming induced a clinically relevant increase in VO2max, a determinant of cardiovascular health, accompanied by further improvements in cardiovascular, metabolic and neuro-cognitive parameters. Exergaming may, therefore, offer an innovative approach to increasing regular physical activity, improving metabolic risk profile, and preventing chronic diseases.

Design of an exergame system for knee osteoarthritis rehabilitation based on the exercise prescription

Design of an exergame system for knee osteoarthritis rehabilitation based on the exercise prescription

Fit Islands: Designing a Multifunctional Virtual Urban Community to Promote Healthy Aging for Chinese Older Adults

Within the context of an aging global population, the demographic structure of emerging economies is undergoing a dramatic transformation. Emerging economies have a large population base and rapid economic development, but they are ill-prepared to deal with population aging. Limited resources force many older adults to face health issues such as chronic diseases and loss of physical independence, exacerbating the burden of traditional family and societal elderly care. Uncontrollable events such as the COVID-19 pandemic and regional conflicts have exacerbated the plight of older adults. Improving the quality of life and health of older adults has become a development priority in emerging economies in the face of a rapidly aging population. The development of smart cities has brought with it many available digital technologies, and the consequent development of smart aging offers endless possibilities for improving the quality of life and health of older people, making cities more inclusive of older people. Researchers from developed economies have attempted to address the health issues of older adults through a technology that combines physical exercise and digital technology called Exergame. However, existing projects are not suitable for older adults in emerging economies due to differences in national conditions. The aim of this project is therefore to propose a universal approach to designing a health-promoting Exergame system in the format of a virtual urban community to help emerging economies cope with aging populations, making cities more inclusive. To verify the feasibility of this approach, the authors designed an expandable Exergame called “Fit Islands”, using China as a case study. Based on the initial demonstration, the authors conducted functional tests. The result is that Fit Islands can meet the development objective of motivating Chinese older people to increase their physical activity, providing initial evidence of the feasibility of an Exergame system to promote healthy aging in emerging economies. The application of Fit Islands demonstrates the feasibility of the universal Exergame development method, which can, in principle, provide comprehensive and practical guidance for other countries.

Effects of home-based interventions using exergames on physical and cognitive functions in community-dwelling older adults: a PRISMA-P-compliant protocol for a systematic review.

Physical activity and exercise are crucial to counteract physical and cognitive decline in old age. Home-based exergame training can be a solution to overcome physical inactivity. This systematic review aims to provide a comprehensive overview of home-based exergame interventions and evaluate their effectiveness in improving cognitive and physical functions through physical activity enhancement in older adults. We are conducting a systematic literature search including studies examining (1) community-dwelling older adults aged 60 years and older without any specific disease, (2) exergame-based exercise programs that take place at least partially in a home setting, and (3) intervention-related physical and/or cognitive outcomes. We will include randomized controlled trials and any other type of pre-post study published in English. There are no restrictions in terms of control group type and publication date. A search string was created and used in PubMed, Web of Science, Embase, Scopus and CINAHL. In addition, a hand search is carried out. This involves checking the references of the included studies and searching Google Scholar for further studies. The included studies will be summarized and, if homogeneity is sufficient, a random-effects meta-analysis will be performed. We will assess the risk of bias using RoB 2.0 and ROBINS-I. The findings of this systematic review will help to define the most suitable exergame programs to counteract cognitive and physical decline in older adults. Additionally, they will inform the development of effective home-based exergame systems and point to future pathways of digital rehabilitation in older adults. Prospero (ID: CRD42023374234).

Effectiveness of two different exergaming systems in addition to conventional treatment for physical therapy in patients with multiple sclerosis: A study protocol for a multicenter, assessor-blind, 24-week, randomized controlled trial.

The main aim is to evaluate and compare the effectiveness of two specific exergaming systems in addition to conventional treatment on improving physical functional capacity, balance, muscle strength, spasticity in lower limbs, and quality of life in patients with multiple sclerosis. The secondary aim is to compare the effectiveness of each exergaming system to isolated conventional treatment. A multicenter, assessor-blind, 24-week, randomized controlled trial. 39 patients diagnosed with multiple sclerosis will be allocated to three groups. A control group will perform a conventional treatment based on daily routine activities and/or combined training, whereas the experimental groups will be randomly divided to develop an active videogame-based exercise program through Nintendo Ring Fit Adventure© or Nintendo Wii Fit©, in addition to the conventional treatment. Study outcomes will be assessed at baseline and at 12 and 24 weeks. One-way ANOVA or Kruskal-Wallis tests will be used to analyze differences between groups at baseline and mixed ANOVA for differences between-within groups over time. The findings from this evidence-based trial, which includes both Nintendo© active videogames, could potentially establish exergame training as a valuable and reliable therapeutic tool for neurorehabilitation. It is essential to consider the customization, specifically in our case, on each multiple sclerosis condition, and ensure patients' adherence to the treatment.

Development and feasibility of a virtual reality-based exergaming program to enhance cardiopulmonary fitness in children with developmental coordination disorder.

Developmental coordination disorder (DCD) is a neurodevelopmental disorder characterized by motor skill deficits. Such deficits often limit children's participation in physical activities, further affecting their overall health, including through reduced cardiopulmonary fitness. Because virtual reality (VR) devices offer interactive games and activities that require various movements and coordination, they can serve as motivating and enjoyable means for children to perform physical exercise. In this study, we developed a VR-based exergaming system and tested its ability to enhance the cardiopulmonary fitness of children with DCD. A total of 13 children with DCD and 10 young adults were recruited in phase I to examine the test-retest reliability and concurrent validity of our system (including a custom-made heart rate monitor) with a commercial heart rate device. In phase II, we included an additional 13 children with DCD to test the feasibility of the system. We tested the outcomes using the enjoyment rating scale, intrinsic motivation inventory (IMI), and 20-m shuttle run test (20mSRT). In phase I, test-retest reliability was good to excellent in the static task and moderate to good in the dynamic task. Concurrent validity was excellent in both tasks. In phase II, more than half of the children (18 out of 26) assigned the maximum rating for their enjoyment of the game; they also had high average scores on the IMI. Furthermore, after the 8-week training using the VR program, the average running distance of the 26 children in the 20mSRT had increased significantly from 129.23 m to 176.92 m (p < 0.001). Our VR-based exergaming program can serve as an alternative intervention for enhancing cardiopulmonary fitness in children with DCD.

A computerized assessment tool for the upper extremities motor performance in individuals with Parkinson's disease

ObjectiveComputerized assessment of Parkinson's disease (PD) patients' motor performance can pave the way to subject-specific design of the rehabilitative interventions. The objective is to propose a computerized assessment tool for upper extremities motor performance in PD. It is based on kinematic indices and a virtual reality exergaming system. The reliability, construct and discriminative validity of the proposed tool were investigated. MethodsA set of virtual tasks was designed and integrated to the therapeutic programs of the participants including uni/bimanual, in-phase/anti-phase hand movements on the less/more affected sides. 33 persons with PD participated in a test re-test study to determine the reliability, discriminative validity on the medication states, and validity of the kinematic indices. Clinical assessments, including Box and Block Test, 9-Hole Peg Test, Movement Disorders Society motor section of the Unified PD Rating Scale (MDS-UPDRS III), were performed for validity assessment. ResultsTask type has a significant impact on the validity of the indices. Reaching tasks were shown to be superior. Besides, it was demonstrated that a minimum of 3 repeats is needed for reliable results in the proposed setting. Jerk indices, curvature, and spectral speed metrics lack either reliability or validity. Temporal speed metrics have superior reliability (Intraclass Correlation Coefficient ICC ≥ 0.9) and validity (Pearson ≥ 0.6) in reaching tasks. ConclusionTemporal speed metrics and point reaching virtual tasks were shown to have high potentials for objective assessment of upper extremity (UE) motor performance in PD in the context of a virtual reality exergaming rehab program.

Feasibility, usability, and acceptance of "Brain-IT"-A newly developed exergame-based training concept for the secondary prevention of mild neurocognitive disorder: a pilot randomized controlled trial.

Exergames provide a promising new approach to implement simultaneous motor-cognitive training, which may support preventing the decline in cognitive functioning in older adults who have a mild neurocognitive disorder (mNCD). To evaluate feasibility, system usability, and acceptance of "Brain-IT", a newly developed training concept combining exergame-based motor-cognitive training and heart rate variability (HRV) guided resonance breathing for the secondary prevention of mNCD. A pilot randomized controlled trial (RCT) with an allocation ratio of 2:1 (i.e., intervention:control) was conducted. The control group proceeded with usual care. The intervention group performed a 12-week training according to the "Brain-IT" training concept implemented with the "Senso Flex" (Dividat AG) exergaming system in addition to usual care. Feasibility and usability outcomes were analyzed using descriptive statistics. User acceptance was analyzed qualitatively and using Friedman analysis of variance (ANOVA), as well as Wilcoxon signed-rank tests. Eighteen participants (77.3 ± 9.8 years; 44.4% females) were included. On average, we recruited 2.2 participants per month, and 35.3% of the individuals contacted were included. The intervention group had an attrition rate of 20% and mean adherence and compliance rates of 85.0 and 84.1%, respectively. The mean system usability score, measured with the system usability scale, was 71.7. High levels of exergame enjoyment, an increase in exergame enjoyment, and internalization of training motivation with large effect sizes (p = 0.03, r = 0.75 and p = 0.03, r = 0.74, respectively), as well as acceptable perceived usefulness, were observed. Preliminary data on the effects of the "Brain-IT" training are promising. The feasibility and usability of the "Brain-IT" training are acceptable. However, frequent occurrences of technical problems and difficulties in using the exergame training system were identified as barriers to performing the "Brain-IT" training. To optimize feasibility, either improvements or alternative solutions are required in the hardware and software of the exergame used to implement the "Brain-IT" training. The "Brain-IT" training itself was well-accepted by older adults who have mNCD. Therefore, the effectiveness of the "Brain-IT" training concept should be investigated in future studies. clinicaltrials.gov/ct2/show/NCT04996654.

Measuring Brain Activation Patterns from Raw Single-Channel EEG during Exergaming: A Pilot Study

Physical and cognitive rehabilitation is deemed crucial to attenuate symptoms and to improve the quality of life in people with neurodegenerative disorders, such as Parkinson’s Disease. Among rehabilitation strategies, a novel and popular approach relies on exergaming: the patient performs a motor or cognitive task within an interactive videogame in a virtual environment. These strategies may widely benefit from being tailored to the patient’s needs and engagement patterns. In this pilot study, we investigated the ability of a low-cost BCI based on single-channel EEG to measure the user’s engagement during an exergame. As a first step, healthy subjects were recruited to assess the system’s capability to distinguish between (1) rest and gaming conditions and (2) gaming at different complexity levels, through Machine Learning supervised models. Both EEG and eye-blink features were employed. The results indicate the ability of the exergame to stimulate engagement and the capability of the supervised classification models to distinguish resting stage from game-play (accuracy &gt; 95%). Finally, different clusters of subject responses throughout the game were identified, which could help define models of engagement trends. This result is a starting point in developing an effectively subject-tailored exergaming system.

Development of a Novel Home-Based Exergame With On-Body Feedback: Usability Study.

With more than 1.4 billion adults worldwide classified as physically inactive, physical inactivity is a public health crisis leading to an increased risk of cardiometabolic diseases. Motivating and engaging training strategies are needed to tackle this public health crisis. Studies have shown that exergames, games controlled by active body movements, are potentially usable, attractive, and effective tools for home-based training. The ExerCube (by Sphery Ltd) has been developed as a physically immersive and adaptive functional fitness game. The development of a home-based version of the ExerCube could increase accessibility, reduce barriers to exercise, and provide an attractive solution to improve physical and cognitive health. The aim was threefold: (1) to develop a usable home-based exergame system, (2) to evaluate the usability and training experience of the home-based exergame and its early-stage on-body feedback system, and (3) to identify avenues for further user-centered design iterations of the system. A total of 15 healthy participants (mean age 25, SD 3 years) completed 2 laboratory visits consisting of four 5-minute exergame sessions. In each session, the on-body feedback system provided a different feedback modality (auditory, haptic, and visual feedback) to the participant. Following the second visit, participants completed a range of assessments, including the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), the Flow Short Scale (FSS), the Immersive Experience Questionnaire (IEQ), and a rating of perceived exertions (RPEs) both physically and cognitively. Participants answered questions regarding the on-body feedback system and completed a semistructured interview. Usability was rated as acceptable, with a SUS score of 70.5 (SD 12). The questionnaires revealed medium-to-high values for the training experience (FSS: 5.3, SD 1; PACES: 5.3, SD 1.1; IEQ: 4.7, SD 0.9. Physical (mean 4.8, SD 1.6) and cognitive (mean 3.9, SD 1.4) RPEs were moderate. Interviews about the on-body feedback system revealed that the majority of participants liked the haptic feedback and the combination of haptic and auditory feedback the best. Participants enjoyed the distinct perceptibility, processing, and integration of the exergame and its supportive and motivating effect. The visual feedback was perceived less positively by participants but was still classified as "potentially" helpful. The auditory feedback was rated well but highlighted an area for further improvement. Participants enjoyed the training experience and described it as motivating, interactive, immersive, something new, interesting, self-explanatory, as well as physically and cognitively challenging. Moreover, 67% (n=10) of the participants could imagine exercising at home and continuing to play the exergame in the future. The home-based exergame and its early-stage on-body feedback system were rated as usable and an enjoyable training experience by a young healthy population. Promising avenues emerged for future design iterations.

Design and evaluation of an exergame system to assist knee disorders patients' rehabilitation based on gesture interaction.

The online version contains supplementary material available at 10.1007/s13755-022-00189-5.

Integration of persuasive elements into exergames: Application in the development of a novel gait rehabilitation system for children with musculoskeletal conditions

The main contribution of this paper is the application of the Persuasive System Design (PSD) model for the analysis and development of exergame systems to stimulate pediatric patients to adhere to short-term gait rehabilitation. It resulted in a novel therapy consisting of a video gaming and virtual reality (VG/VR) biofeedback system for treadmill gait rehabilitation, including a method for progressing the rehabilitation settings. During gait rehabilitation (GR) sessions, therapy settings need to be adjusted by physiotherapists, based on their clinical experience, to address the deficiencies of individuals while maximizing their motor functioning and maintaining their motivation. The system integrates persuasive elements, adjusted when physiotherapists progress the therapeutic settings, such as the treadmill speed, auditory feedback, and game challenges. We followed a scenario-based design method to develop the system, which comprised an observational study of conventional GR sessions and evaluations with 6 and 9 rehabilitation specialists who provided feedback about the system design. They perceived that the proposed method was valuable for physiotherapists to adapt the rehabilitation based on the children’s performance. Also, they remarked that the system’s visual and auditory stimulus would help engage the children in the therapy.

Design and Evaluation of an Exergaming System for Children With Autism Spectrum Disorder: The Children’s and Families’ Perspective

Children with autism spectrum disorder (ASD) have lower levels of physical activity than their typically developing peers. Barriers to participation include deficits in motor function and in social interaction, both of which reduce opportunities to engage in leisure activities that incorporate physical exertion. Because children with ASD also have higher than average levels of media use, exergames—video games that require bodily interaction to play—are a promising form of exercise. While studies have examined exergaming interventions for children with ASD, to date there has been little research on exergames that have been specifically designed for children with neurodevelopmental disorders, or qualitative analysis of players’ and families’ experience with exergaming programs. In this paper we present Liberi, an exergaming system involving kinaesthetic interaction within a virtual world, and designed explicitly for children with neurodevelopmental disorders. We report the results of a 6-week study where Liberi was played from the home by five children with ASD. The paper describes those aspects of the design that were successful and unsuccessful; how children and parents viewed the exergames; how the games were incorporated into the children’s lives; and how parents envisaged exergames could be best deployed for children with ASD.

Personalized Touch-Based Exergame System for Unilateral and Bilateral Rehabilitation Training.

Background: Natural and intuitive interfaces that monitor and promote upper limb task-specific training need to be developed. This article presents the development and testing of a touch-based game system for training and assessment of unilateral (ULR) and bilateral (BLR) reaching movements. Interaction becomes intuitive and simple by introducing in-game touch and pressure onto virtual targets projected on a custom-made large touch panel. Materials and Methods: A custom-made App integrates exergames and a biomechanical model with advanced algorithms for movement analysis. It processes and manages data from a motion-tracking sensor and a large touch panel equipped with 1222 (26 × 47) piezoresistive sensors, including high-speed readout electronics and algorithms to measure touch points and contact forces during fingertip interaction. An experiment was conducted to evaluate the experience, motivation, and movements of healthy and stroke subjects when interacting with the proposed system. The panel height, dispersion of virtual targets, and required contact force were customized based on motor skills of each group of subjects. Results: Both groups of subjects showed high level of motivation and user experience when interacting with the virtual environments. Stroke subjects performed the task slower and traveled a similar path length than healthy subjects, but with shorter range of motion. The mechanical work and potential energy profiles of both groups are consistent with those achieved when reaching real objects. Conclusions: The proposed contact-based exergames are a feasible solution for performing natural and intuitive therapeutic ULR and BLR exercises. They elicit appropriate reaching movements and contact forces in healthy and stroke subjects. The spatial and temporal attributes of the proposed solution can be customized to influence the movement and energy expenditure of specific joints.

VR-PEER: A Personalized Exer-Game Platform Based on Emotion Recognition

Motor rehabilitation exercises require recurrent repetitions to enhance patients’ gestures. However, these repetitive gestures usually decrease the patients’ motivation and stress them. Virtual Reality (VR) exer-games (serious games in general) could be an alternative solution to address the problem. This innovative technology encourages patients to train different gestures with less effort since they are totally immersed in an easy to play exer-game. Despite this evolution, patients, with available exer-games, still suffer in performing their gestures correctly without pain. The developed applications do not consider the patients psychological states when playing an exer-game. Therefore, we believe that is necessary to develop personalized and adaptive exer-games that take into consideration the patients’ emotions during rehabilitation exercises. This paper proposed a VR-PEER adaptive exer-game system based on emotion recognition. The platform contain three main modules: (1) computing and interpretation module, (2) emotion recognition module, (3) adaptation module. Furthermore, a virtual reality-based serious game is developed as a case study, that uses updated facial expression data and provides dynamically the patient’s appropriate game to play during rehabilitation exercises. An experimental study has been conducted on fifteen subjects who expressed the usefulness of the proposed system in motor rehabilitation process.

Feasibility of Cognitive-Motor Exergames in Geriatric Inpatient Rehabilitation: A Pilot Randomized Controlled Study.

Objective: The aim of this pilot randomized clinical trial was to test the feasibility and efficacy of an exergame-based cognitive-motor training program in geriatric inpatients.Methods: The study participants were randomly allocated to either the exergame intervention group or the control group. The control group received the standard rehabilitation treatment offered in the clinic. In addition to the standard rehabilitation program, the intervention group conducted supervised exergame training on 5 days per week using the Dividat Senso, an exergame system specifically designed for older adults. The primary outcome was feasibility, as measured by e.g., adherence rate, attrition rate, occurrence of adverse events, System Usability Scale (SUS) and NASA-TLX score. Secondary outcomes included measures of physical and cognitive functioning such as comfortable walking speed, maximal walking speed, dual task walking speed, Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), Color-Word Interference test (D-KEFS), Trail Making test A and B (TMT), Go/No-Go test and Step Reaction Time test (SRTT). All secondary outcome measures were assessed pre- and post-intervention.Results: Thirty-nine persons were included in the study. Average adherence rate was 99%, there were no intervention-related dropouts and no adverse events. The mean System Usability Scale (SUS) score was 83.6 and the mean NASA-TLX score 45.5. Significant time-group interaction effects were found for the dual task walking speed, the Go/No-Go test and Step Reaction Time test (SRTT).Conclusion: Exergaming is a feasible, safe and effective cognitive-motor training approach in inpatient rehabilitation of geriatric patients. Incorporating exergaming in the rehabilitation program of geriatric patients offers potential to reduce fall risk factors and to increase patients’ exercise motivation and rehabilitation success.