A Serious Games and Game Elements Based Approach for Patient Telerehabilitation Contexts





Serious Games, Rehabilitation, Telerehabilitation, Game Elements, Engagement


There are several factors involved in telerehabilitation therapy, such as the patient’s engagement in the activity. In this context, the therapist’s active participation is compromised and, on the other hand, the exercises performed are often repetitive and boring, decreasing the patient’s engagement and motivation, directly impacting the results of the sessions. Considering this, this paper aims to present an approach based on an exergame (a serious game that aims to encourage physical exercise) with a distributed architecture. It was developed to assist in conducting telerehabilitation sessions that involve a cycle ergometer as a device – a bedside bicycle used in rehabilitation sessions for patients with motor disorders. In order to validate the effectiveness of this approach, the construction of an exergame prototype was undertaken, followed by two validation steps done by 16 physiotherapists from the Clinical Hospital of the Universidade Federal de Goiás - UFG (based on the Delphi Method). About 88, 8% of the specialists, after two rounds of evaluation, considered that the exergame was appropriate for telerehabilitation sessions.


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Afyouni, I., Einea, A., and Murad, A. (2019). Rehabot: Gamified virtual assistants towards adaptive telerehabilitation. In Adjunct Publication of the 27th Conference on User Modeling, Adaptation and Personalization, UMAP’19 Adjunct, page 21–26, New York, NY, USA. Association for Computing Machinery.

Aldrich, C. (2005). Learning by doing: a comprehensive guide to simulations, computer games, and pedagogy in e-learning and other educational experiences. Pfeiffer.

Alexandre, N. M. C. and Coluci, M. Z. O. (2011). Content validity in the processes of construction and adaptation of measurement instruments (in Portuguese). Ciência e Saúde Coletiva, 16:3061 – 3068.

Andrade, L. G. and Evangelista, E. (2018). The meaning of colors in the perception of the game ”this war of mine” (in Portuguese). Available at: [link]. Accessed: 17 July 2021.

Battisti, D. (2020). Exergame with cycle ergometer for patient rehabilitation (in Portuguese). Master’s thesis, Universidade Federal de Goiás, Goiânia.

Battisti, D., de Carvalho, S. T., and Battisti, L. (2019). Game with cycle ergometer for the rehabilitation of patients (in Portuguese). In Proceedings of SBGames 2019, pages 1402–1403.

Bloor, M., Sampson, H., Baker, S., and Dahlgren, K. (2015). Useful but no oracle: reflections on the use of a delphi group in a multi-methods policy research study. Qualitative Research, 15(1):57–70.

Cerf, V. G. (2020). On the internet of medical things. Commun. ACM, 63(8):5.

Chen, J. (2007). Flow in games (and everything else). Commun. ACM, 50(4):31–34.

Chou, J. C., Hung, C., and Hung, Y. (2014). Design factors of mobile game for increasing gamer’s flow experience. In 2014 IEEE International Conference on Management of Innovation and Technology, pages 137–139.

Costa, A. C. S. and Marchiori, P. Z. (2015). Gamification, game elements and strategy: a reference matrix (in Portuguese). InCID: Revista de Ciência da Informação e Documentação, 6(2):44–65.

Coutinho, S. S. (2013). The use of the delphi technique inprimary health care research: an integrative review (in Portuguese). Revista Baiana de Saúde Pública, 37(3):582–596.

Csikszentmihalyi, M. (2020). Flow: The Psychology of High Performance and Happiness (in Portuguese). Objetiva.

da Silva Peixoto, C. (2019). Multiplayer real-time war strategy games and their development in the unreal engine 4 engine (in Portuguese). Master’s thesis, São Paulo.

de Azevedo Cardoso, L. R., Abiko, A. K., Haga, H. C. R., Inouye, K. P., and Gonçalves, O. M. (2005). Future prospecting and the delphi method: an application for the housing construction production chain (in Portuguese). Ambiente Construído, 5(3):63–78.

de Cássia Barros Dias, R. (2007). DELPHI Method: A description of its main concepts and characteristics (in Portuguese). Monografia (Especialização em Pesquisa de Mercado em Comunicação), USP (Universidade de São Paulo), São Paulo, Brasil.

de Oliveira, L. W. (2018). L framework for mhealth developers in the context of self-care and gamification (in Portuguese). Master’s thesis, Goiânia.

e Silva, R. L., Bulla, G., da Silva, L., and Lucena, J. (2018). Serious games and sensibility regimes: Paradoxes in using games for human formation. education policy analysis archives, 26(117).

Epic Games (2020). Client-server model - unreal engine documentation. Available at: [link]. Accessed: 16 August 2020.

Fleury, A., Nakano, D., and Cordeiro, J. H. D. O. (2014). Mapping of the Brazilian and Global Digital Games Industry (in Portuguese). Banco Nacional de Desenvolvimento Econômico e Social (BNDES).

Fullerton, T. (2008). Game design workshop: a playcentric approach to creating innovative games. CRC press.

Glazer, J. and Sanjay, M. (2015). Multiplayer game programming: Architecting networked games. Addison-Wesley Professional.

Gonçalves, D. R. (2019). The importance of the physical education professional in the outpatient care of pediatric patients with cystic fibrosis (in Portuguese). Trabalho de Conclusão do Programa de Residência Integrada Multi-profissional em Saúde (HCPA), Porto Alegre.

Gregory, J. (2014). Game Engine Architecture. AK Peters/CRC Press.

Huizinga, J. (2020). Homo Ludens (in Portuguese). Estudos. Editora Perspectiva S/A.

Jack, K., McLean, S. M., Moffett, J. K., and Gardiner, E. (2010). Barriers to treatment adherence in physiotherapy outpatient clinics: A systematic review. Manual Therapy, 15(3):220 – 228.

Kapp, K. (2012). The Gamification of Learning and Instruction: Game-based Methods and Strategies for Training and Education. Pfeiffer essential resources for training and HR professionals. Wiley.

Munaretto, L. F., Corrêa, H. L., and da Cunha, J. A. C. (2013). A study on the characteristics of the delphi method and focus group, as techniques for obtaining data in exploratory research (in Portuguese). Revista de Administração da UFSM, 6(1):09–24.

Needham, D. M., Truong, A. D., and Fan, E. (2009). Technology to enhance physical rehabilitation of critically ill patients. Crit Care Med, 37(10 Suppl):S436–441.

Ren, S., Shi, W., Hou, Z. G., Wang, J., and Wang, W. (2020). Engagement Enhancement Based on Human-in-the-Loop Optimization for Neural Rehabilitation. Front Neurorobot, 14:596019.

Rodrigues, J., Menezes, P., and Restivo, M. T. (2019). Travelling in a virtual city: a physical exercise promoting game. In 2019 5th Experiment International Conference (exp.at’19), pages 256–257.

Santos, D. and Pinheiro, I. (2016). Telerehabilitation in the treatment of neurological disorders: A narrative review (in Portuguese). Revista Scientia, 1:96–106.

Scarparo, A. F., Laus, A. M., and Azevedo, A. I. C. S. (2012). Reflections on the use of the delphi technique in nursing research (in Portuguese). Revista da Rede de Enfermagem do Nordeste, 13(1):242–251.

Silva, A. d. S. d., Valenciano, P. J., and Fujisawa, D. S. (2017). Playful Activity in Pediatric Physiotherapy: A Literature Review (in Portuguese). Revista Brasileira de Educação Especial, 23:623 – 636.

Souza, C., Oliveira, D., Berreta, L., and Carvalho, S. (2021a). A distributed exergame for telerehabilitation: An engaging alternative to improve patients’ quality of life. In Proceedings of the 1st Life Improvement in Quality by Ubiquitous Experiences Workshop, Porto Alegre, RS, Brasil. SBC.

Souza, C. H. R., Battisti, D., Berretta, L., and de Carvalho, S. T. (2020). Exergame with cycle ergometer for the rehabilitation of patients in the covid-19 period (in Portuguese). In Anais Principais do XX Simpósio Brasileiro de Computação Aplicada à Saúde, Porto Alegre, RS, Brasil. SBC.

Souza, C. H. R., de Oliveira, D. M., Berretta, L., and de Carvalho, S. T. (2021b). Digital games and engagement in patient rehabilitation: A systematic review of the literature (in Portuguese). In Anais Principais do XXI Simpósio Brasileiro de Computação Aplicada à Saúde, Porto Alegre, RS, Brasil. SBC.

Souza, C. H. R., de Oliveira, D. M., de Oliveira Berretta, L., and de Carvalho, S. T. (2021c). Serious games and game elements in promoting engagement in patient telerehabilitation contexts (in Portuguese). In Proceedings of SBGames 2021, Gramado, RS, Brasil. SBC.

Subtil, M. M. L., Goes, D. C., Gomes, T. C., and Souza, M. L. d. (2011). Interpersonal relationships and adherence in physiotherapy (in Portuguese). Fisioterapia em Movimento, 24:745 – 753.

Wang, J., Wang, W., and Hou, Z. G. (2020). Toward improving engagement in neural rehabilitation: Attention enhancement based on brain–computer interface and audio-visual feedback. IEEE Transactions on Cognitive and Developmental Systems, 12(4):787–796.

Wendisch, C. (2010). Quality assessment of hospital food and nutrition units (fnu): construction of an instrument (in Portuguese). Master’s thesis, Rio de Janeiro.

Werbach, K. and Hunter, D. (2012). For the win: How game thinking can revolutionize your business. Wharton Digital Press.

Wright, J. T. C. and Giovinazzo, R. A. (2000). DELPHI - a tool to support prospective planning (in Portuguese). Caderno de Pesquisas em Administração.

Zyda, M. (2005). From visual simulation to virtual reality to games. In Computer, volume 38, pages 25–32. IEEE Computer Society Press.




How to Cite

SOUZA, C. H. R.; DE OLIVEIRA, D. M.; DO NASCIMENTO, D. F.; BERRETTA, L. de O.; DE CARVALHO, S. T. A Serious Games and Game Elements Based Approach for Patient Telerehabilitation Contexts. Journal on Interactive Systems, Porto Alegre, RS, v. 13, n. 1, p. 179–191, 2022. DOI: 10.5753/jis.2022.2679. Disponível em: https://sol.sbc.org.br/journals/index.php/jis/article/view/2679. Acesso em: 20 mar. 2023.



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