Adaptation in serious games for upper-limb rehabilitation: an approach to improve training outcomes

In this paper, we propose a game adaptation technique that seeks to improve the training outcomes of stroke patients during a therapeutic session. This technique involves the generation of customized game levels, which difficulty is dynamically adjusted to the patients’ abilities and performance. Our goal was to evaluate the effect of this adaptation strategy on the training outcomes of post-stroke patients during a therapeutic session. We hypothesized that a dynamic difficulty adaptation strategy would have a more positive effect on the training outcomes of patients than two control strategies, incremental difficulty adaptation and random difficulty adaptation. To test these strategies, we developed three versions of PRehab, a serious game for upper-limb rehabilitation. Seven stroke patients and three therapists participated in the experiment, and played all three versions of the game on a graphics tablet. The results of the experiment show that our dynamic adaptation technique increases movement amplitude during a therapeutic session. This finding may serve as a basis to improve patient recovery.