Lessons learned from developing serious games for upper-limb rehabilitation in children

Virtual reality (VR), augmented reality (AR), and serious games have demonstrated growing potential in physical therapy, exergaming, and the promotion of physical activity across diverse patient populations. However, the development of therapeutic games, particularly for rehabilitation in children, still lacks consolidated guidelines and structured frameworks.

This study aims to document the design and development process of two gamified upper-limb rehabilitation systems for children, developed in collaboration with physical therapists, and to derive preliminary clinician-informed design recommendations.

An iterative development process was carried out in close collaboration with clinicians. Feedback and observations from therapy sessions were collected and analyzed. These findings were contextualized through a targeted narrative review of relevant literature to examine their relationship with existing research.

The comparative analysis produced actionable design recommendations regarding game mechanics, reward structures, adaptive difficulty, and feature extraction strategies. Key findings highlight the need to tailor gameplay to children's abilities through simplified narratives, therapeutic mechanics, consistent feedback, and adaptive difficulty.

The results highlight the unique challenges and opportunities involved in designing serious games for therapy for children. It advocates for the development of preliminary clinician-informed design principles to support the creation of engaging, usable, and clinically grounded rehabilitation games for children.