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Serious gaming for stroke rehabilitation



Stroke rehabilitation is an intensive process. It requires one to perform repetitive exercises in order to relearn the functionality of affected limbs. Games assist the patients to stay involved in the exercises and promote healing.

Statistics state that fingers are often the last to recover. However, most existing games need the user to hold a controller or wear equipment in order to play. Thus, this project aims to provide a natural user interface by developing a Kinect-based game.



Dr Kavita Vemuri


Team of two


Unity, kinect  360

My contribution

I collaborated on complete research and design of the game features, prototype development, and user testing. I further worked on analyzing the test results to suggest design modifications and documentation of the process.

8 weeks (June - July 2019)



We visited a rehabilitation center and conducted a generative interview with doctors and stroke victims to empathize and understand their needs, mindset, and constraints. Focus points were established based on the insights to comply with the end-user goals.


A game motive appealing to majority of people from different age groups and backgrounds


Low cognitive load from the game keeping in account  the patient's state of mind

Movement Focused

Game play movements must align with the appropriate excercise and postures for rehabilitation

Frequent motivation

There is a need for constant motivation to assist in performing the difficult limb movements

Focus questions


How to make the game appealing to the user?


How to enable appropriate exercises?


How to perpetuate motivation?



Design decisions

How to make the game appealing to the users?

Provide a piligrimage experience to famous temples in India

  • A generic interest of a multitude of people from varied backgrounds and age group

  • A form of hope and support

  • Majority of the target users trust in God and hopes to visit places of worship

How to enable appropriate exercises?

A grid-based item collection

  • The vertical and horizontal movement of elbow or shoulder

  • Navigate in horizontal or vertical directions over the grid to collect items

  • For instance, a horizontal motion is achieved by collecting items from a single row with other rows frozen. Similarly, for vertical motion items are collected from a single column

  • To advance the level, the user can choose to collect from any grid

How to perpetuate motivation?

Set hierarchical goals

  • The user gets easily demotivated as the exercise is physically straining

    • Low - Collect appropriate items to fill the health bar -> unlocks a temple

    • Middle - Visit a temple -> see a replica of the real diety

    • High - Repeat to visit all the temples

Game flow

Immediate visual feedback upon item collection. Colour based on right or wrong object

Hold the hand for 2 seconds at a single grid to collect an item - improve hand stability

Wide spacing between the grids to allow enough hand movement

Alternate colored grids for easy differentiation -  reduces visual strain

A white handball to indicate the current hand position

Testing Iterations
Testing Iterations
User testing - Iteration I

We demonstrated the game to the head physician at a rehabilitation center and conducted user studies with two stroke victims. Participants were asked to visit a single temple by completing the following tasks.

  • Collect items to fill the health bar

  • Unlock a temple and walk inside to worship the Idol

key changes

Need for furhter simplification of gameplay.

Initially, the grid consisted of three different types of items. Health items to increase health points, prayer items for bonus points and restricted items to decrease health points. However, it was observed that the user needs high concentration to perform the physical movement and more item categories induced difficulty rather than encouragment.

Solution: Removed Prayer items. Items are only of two types, appropriate for worship or not. Simplicity is priority.

Repositioning the grid to accomodate movement for both the hands.

Users have motor impairment on left or right sides. Since the perpendicular hand position (start point) is calibrated to last column of the grid, it faltered the left hand movement and required the user to move from side to side.

Solution: The start position has been aligned with centre of the grid, with two columns of matrix to right and two to the left allowing similar movement for both the hands from a static position. This also ensures that the user has elbow movement in both the directions.

Facilitate gradual improvement by allowing increase of range.

To encourage users to increase their range of hand movement during the game, an option was added to increase or decrease the maximum width and height recorded during calibration through the keyborad.

Logging the user performance to monitor.

The data of patient’s performance such as maximum range of hand movement in horizontal and vertical directions, time taken to fill health bar and the mode played are automatically stored into an excel sheet for the doctor's analysis.

User testing - Iteration II

After implementing all the improvements from first iteration we re-conducted the usability testing for the first part of the game. The participant details along with their performance data were recorded.

Task: Collect relevant items to fill the health bar

Key insights

The participants were comfortable with the gameplay. They stated that the game was involving and were willing to replay.

It was observed that the users needed more time to interpret and move from one grid to another. Thus the duration of an item in a grid was increased from 6 seconds to 15 seconds.

The users mentioned that they preferred some form of hand support(for instance a table) for a longer duration of play to avoid the possibility of pain in the shoulder.


The physical movement required for controls in the game has a vital role in determining user's interest.

A gameplay with a realistic scenario, made it relatable and appealing to the users.

Obtaining a credit(collect an item -> health points) with small movement of hand(from one grid to another) kept the user engaged throughout.

Some rehabilitation centers would need additional arrangements to facilitate the game setup due to hardware or space constraints. In the physician's words, "If more similar games were developed, it would encourage rehabilitation centers to buy them as a package"


Scope to improve design for hand movement

As I understand the importance of the design process in ideating good designs, reflecting back on the project, I would try to add improvements to the grid-based item collection for hand movement. Address the issue of pain for longer play and make it more involving using ideas such as drag and drop action etc

Importance of user testing

The user testing phase helped me learn and analyze the design from different perspectives of the user. In-depth user research, in the beginning, could have helped in pointing out the majority of the issues observed in iteration I. These learnings from the project encouraged me to develop a foundation in UX.

Unity for prototyping

I was able to learn Unity from scratch and develop the game within the project duration. I learned the need to decide on how detailed the features in the prototype should be for better user testing

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