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Games Health J. 2013 Apr;2(2):81-88.

Computational Intelligence and Game Design for Effective At-Home Stroke Rehabilitation.

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Department of Computer Science, University of Milan , Milan, Italy .
Department of Computer Science, University of Milan , Milan, Italy . ; Dipartimento di Elettronica, Informazione e Bioingegneria - Politecnico di Milano , Milan, Italy .
Dipartimento di Elettronica, Informazione e Bioingegneria - Politecnico di Milano , Milan, Italy .
Institute of Human Movement Sciences and Sport , Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland .



The aim of this article is to describe a game engine that has all the characteristics needed to support rehabilitation at home. The low-cost tracking devices recently introduced in the entertainment market allow measuring reliably at home, in real time, players' motion with a hands-free approach. Such systems have also become a source of inspiration for researchers working in rehabilitation. Computer games appear suited to guide rehabilitation because of their ability to engage the users. However, commercial videogames and game engines lack the peculiar functionalities required in rehabilitation: Games should be adapted to each patient's functional status, and monitoring the patient's motion is mandatory to avoid maladaptation. Feedback on performance and progression of the exercises should be provided. Lastly, several tracking devices should be considered, according to the patient's pathology and rehabilitation aims.


We have analyzed the needs of the clinicians and of the patients associated in performing rehabilitation at home, identifying the characteristics that the game engine should have.


The result of this analysis has led us to develop the Intelligent Game Engine for Rehabilitation (IGER) system, which combines the principles upon which commercial games are designed with the needs of rehabilitation. IGER is heavily based on computational intelligence: Adaptation of the difficulty level of the exercise is carried out through a Bayesian framework from the observation of the patient's success rate. Monitoring is implemented in fuzzy systems and based on rules defined for the exercises by clinicians. Several devices can be attached to IGER through an input abstraction layer, like the Nintendo® (Kyoto, Japan) Wii™ Balance Board™, the Microsoft® (Redmond, WA) Kinect, the Falcon from Novint Technologies (Albuquerque, NM), or the Tyromotion (Graz, Austria) Timo® plate balance board. IGER is complemented with videogames embedded in a specific taxonomy developed to support rehabilitation progression through time.


A few games aimed at postural rehabilitation have been designed and developed to test the functionalities of the IGER system. The preliminary results of tests on normal elderly people and patients with the supervision of clinicians have shown that the IGER system indeed does feature the characteristics required to support rehabilitation at home and that it is ready for clinical pilot testing at patients' homes.

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