Digital Games and Engagement in Patient Rehabilitation: A Systematic Literature Review
Abstract
This article presents a systematic literature review on the use of digital games in rehabilitation and telerehabilitation, focusing on engagement strategies and interaction modalities. Searches were conducted in the IEEE and Scopus databases, resulting in the inclusion of 16 studies. The analysis revealed a predominance of game mechanics such as rewards and feedback, progression and challenge, and exercise gamification, along with narrative, personalization, competition, and collaboration elements. In terms of interaction, the studies highlighted the use of motion-based controls with sensors, virtual and augmented reality, biofeedback, and traditional interfaces, often combined in hybrid configurations.
Keywords:
Digital games, rehabilitation, serious games, Human-Computer Interaction, engagement
References
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Bae, S. and Park, H.-S. (2023). Development of immersive virtual reality-based hand rehabilitation system using a gesture-controlled rhythm game with vibrotactile feedback: An fnirs pilot study. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 31:3732–3743.
Baranyi, R., Hirber, C., Roehrling, L., Aigner, C., et al. (2024). Virtual reality-powered wrist therapy: Developing a therapist-driven exit-the-room serious game with hand gesture interactions. Applied Sciences, 14(11).
Burke, J. W., McNeill, M. D. J., Charles, D. K., Morrow, P. J., et al. (2009). Optimising engagement for stroke rehabilitation using serious games. The Visual Computer, 25(12):1085–1099.
Camardella, C., Chiaradia, D., Bortone, I., Frisoli, A., et al. (2023). Introducing wearable haptics for rendering velocity feedback in vr serious games for neuro-rehabilitation of children. Frontiers in Virtual Reality, Volume 3 - 2022.
García-Ramón, R. D., Rechy-Ramirez, E. J., Alonso-Valerdi, L. M., and Marin-Hernandez, A. (2024). Engagement analysis using electroencephalography signals in games for hand rehabilitation with dynamic and random difficulty adjustments. Applied Sciences, 14(18).
Gray, H. and Howe, T. (2013). Physiotherapists’ assessment and management of psychosocial factors (yellow and blue flags) in individuals with back pain. Physical Therapy Reviews, 18(5):379–394.
Ibrahim, Z., Cahyadi, B. N., Aziz, A., and Shamil, A. (2024). Enhancing upper limb stroke rehabilitation with electromyography-monitored virtual reality–based games. Journal of Robotics, 2024:Article ID 8945325, 14 pages.
Kitchenham, B. (2007). Guidelines for performing systematic literature reviews in software engineering. EBSE Technical Report EBSE-2007-01, Keele University and University of Durham.
Lakshminarayanan, K., Ramu, V., Shah, R., Haque Sunny, M. S., et al. (2024). Developing a tablet-based brain-computer interface and robotic prototype for upper limb rehabilitation. PeerJ Computer Science, 10:e2174.
Masmoudi, M., Zenati, N., Izountar, Y., Benbelkacem, S., et al. (2024a). Assessing the effectiveness of virtual reality serious games in post-stroke rehabilitation: a novel evaluation method. Multimedia Tools and Applications, 83(12):36175–36202.
Masmoudi, M., Zenati, N., Izountar, Y., et al. (2024b). Assessing the effectiveness of virtual reality serious games in post-stroke rehabilitation: a novel evaluation method. Multimedia Tools and Applications, 83:36175–36202.
Moreira, M., Vilhena, E., Carvalho, V., and Duque, D. (2024). A virtual reality game-based approach for shoulder rehabilitation. Multimodal Technologies and Interaction, 8(10).
Panagiotopoulos, N., Lampropoulou, S., Avouris, N., and Skodras, A. (2024). Design of exergaming platform for upper limb rehabilitation using surface electromyography. Applied Sciences, 14(16).
Pruitt, D. T., Duong-Nguyen, Y. N., Meyers, E. C., Epperson, J. D., et al. (2023). Usage of replay as a take-home system to support high-repetition motor rehabilitation after neurological injury. Games for Health Journal, 12(1):73–85. Epub 2022 Oct 31.
Rodríguez, A., Chover, M., and Boada, I. (2023). Gamification and virtual reality for tongue rehabilitation. IEEE Access, 11:124975–124984.
Sardi, L., Idri, A., and Fernández-Alemán, J. L. (2017). A systematic review of gamification in e-health. Journal of Biomedical Informatics, 71:31–48.
Shah, S. H. H., Karlsen, A. S. T., Solberg, M., et al. (2023). A social vr-based collaborative exergame for rehabilitation: codesign, development and user study. Virtual Reality, 27:3403–3420.
Silva, E., Lopes, R., and Reis, L. P. (2023). Cognichallenge: multiplayer serious games’ platform for cognitive and psychosocial rehabilitation. International Journal of Serious Games, 10(4):3–14.
Souza, C. H., Oliveira, D., Berreta, L., and Carvalho, S. (2021). Jogos digitais e engajamento na reabilitação de pacientes: Uma revisão sistemática da literatura. In Anais do XXI Simpósio Brasileiro de Computação Aplicada à Saúde, pages 25–36, Porto Alegre, RS, Brasil. SBC.
Sánchez San Blas, H., Filipe Sales Mendes, A., Pérez Robledo, F., Villarrubia González, G., and de Paz Santana, J. F. (2024). A multi-agent system approach for balance disorder treatment: Integrating computer vision and gamification. IEEE Access, 12:118649–118664.
Vaida, C., Rus, G., Tucan, P., Machado, J., Pisla, A., Zima, I., Birlescu, I., and Pisla, D. (2024). Enhancing robotic-assisted lower limb rehabilitation using augmented reality and serious gaming. Applied Sciences, 14(24).
Bae, S. and Park, H.-S. (2023). Development of immersive virtual reality-based hand rehabilitation system using a gesture-controlled rhythm game with vibrotactile feedback: An fnirs pilot study. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 31:3732–3743.
Baranyi, R., Hirber, C., Roehrling, L., Aigner, C., et al. (2024). Virtual reality-powered wrist therapy: Developing a therapist-driven exit-the-room serious game with hand gesture interactions. Applied Sciences, 14(11).
Burke, J. W., McNeill, M. D. J., Charles, D. K., Morrow, P. J., et al. (2009). Optimising engagement for stroke rehabilitation using serious games. The Visual Computer, 25(12):1085–1099.
Camardella, C., Chiaradia, D., Bortone, I., Frisoli, A., et al. (2023). Introducing wearable haptics for rendering velocity feedback in vr serious games for neuro-rehabilitation of children. Frontiers in Virtual Reality, Volume 3 - 2022.
García-Ramón, R. D., Rechy-Ramirez, E. J., Alonso-Valerdi, L. M., and Marin-Hernandez, A. (2024). Engagement analysis using electroencephalography signals in games for hand rehabilitation with dynamic and random difficulty adjustments. Applied Sciences, 14(18).
Gray, H. and Howe, T. (2013). Physiotherapists’ assessment and management of psychosocial factors (yellow and blue flags) in individuals with back pain. Physical Therapy Reviews, 18(5):379–394.
Ibrahim, Z., Cahyadi, B. N., Aziz, A., and Shamil, A. (2024). Enhancing upper limb stroke rehabilitation with electromyography-monitored virtual reality–based games. Journal of Robotics, 2024:Article ID 8945325, 14 pages.
Kitchenham, B. (2007). Guidelines for performing systematic literature reviews in software engineering. EBSE Technical Report EBSE-2007-01, Keele University and University of Durham.
Lakshminarayanan, K., Ramu, V., Shah, R., Haque Sunny, M. S., et al. (2024). Developing a tablet-based brain-computer interface and robotic prototype for upper limb rehabilitation. PeerJ Computer Science, 10:e2174.
Masmoudi, M., Zenati, N., Izountar, Y., Benbelkacem, S., et al. (2024a). Assessing the effectiveness of virtual reality serious games in post-stroke rehabilitation: a novel evaluation method. Multimedia Tools and Applications, 83(12):36175–36202.
Masmoudi, M., Zenati, N., Izountar, Y., et al. (2024b). Assessing the effectiveness of virtual reality serious games in post-stroke rehabilitation: a novel evaluation method. Multimedia Tools and Applications, 83:36175–36202.
Moreira, M., Vilhena, E., Carvalho, V., and Duque, D. (2024). A virtual reality game-based approach for shoulder rehabilitation. Multimodal Technologies and Interaction, 8(10).
Panagiotopoulos, N., Lampropoulou, S., Avouris, N., and Skodras, A. (2024). Design of exergaming platform for upper limb rehabilitation using surface electromyography. Applied Sciences, 14(16).
Pruitt, D. T., Duong-Nguyen, Y. N., Meyers, E. C., Epperson, J. D., et al. (2023). Usage of replay as a take-home system to support high-repetition motor rehabilitation after neurological injury. Games for Health Journal, 12(1):73–85. Epub 2022 Oct 31.
Rodríguez, A., Chover, M., and Boada, I. (2023). Gamification and virtual reality for tongue rehabilitation. IEEE Access, 11:124975–124984.
Sardi, L., Idri, A., and Fernández-Alemán, J. L. (2017). A systematic review of gamification in e-health. Journal of Biomedical Informatics, 71:31–48.
Shah, S. H. H., Karlsen, A. S. T., Solberg, M., et al. (2023). A social vr-based collaborative exergame for rehabilitation: codesign, development and user study. Virtual Reality, 27:3403–3420.
Silva, E., Lopes, R., and Reis, L. P. (2023). Cognichallenge: multiplayer serious games’ platform for cognitive and psychosocial rehabilitation. International Journal of Serious Games, 10(4):3–14.
Souza, C. H., Oliveira, D., Berreta, L., and Carvalho, S. (2021). Jogos digitais e engajamento na reabilitação de pacientes: Uma revisão sistemática da literatura. In Anais do XXI Simpósio Brasileiro de Computação Aplicada à Saúde, pages 25–36, Porto Alegre, RS, Brasil. SBC.
Sánchez San Blas, H., Filipe Sales Mendes, A., Pérez Robledo, F., Villarrubia González, G., and de Paz Santana, J. F. (2024). A multi-agent system approach for balance disorder treatment: Integrating computer vision and gamification. IEEE Access, 12:118649–118664.
Vaida, C., Rus, G., Tucan, P., Machado, J., Pisla, A., Zima, I., Birlescu, I., and Pisla, D. (2024). Enhancing robotic-assisted lower limb rehabilitation using augmented reality and serious gaming. Applied Sciences, 14(24).
Published
2025-11-12
How to Cite
SILVA, Isadora Bastos N.; STARKE, Rhafael da Cruz; BARBOZA, Gustavo Santana de; BEZERRA, João Pedro M.; RIBEIRO, Karen da Silva Figueiredo Medeiros.
Digital Games and Engagement in Patient Rehabilitation: A Systematic Literature Review. In: REGIONAL SCHOOL ON INFORMATICS OF MATO GROSSO (ERI-MT), 14. , 2025, Pontes e Lacerda/MT.
Anais [...].
Porto Alegre: Sociedade Brasileira de Computação,
2025
.
p. 199-208.
ISSN 2447-5386.
DOI: https://doi.org/10.5753/eri-mt.2025.17182.
