{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:23:34Z","timestamp":1782278614548,"version":"3.54.5"},"reference-count":50,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2017,2,12]],"date-time":"2017-02-12T00:00:00Z","timestamp":1486857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Spanish National Plan for Scientific Technical Research and Innovation","award":["TEC2013-48453-C2-2-R"],"award-info":[{"award-number":["TEC2013-48453-C2-2-R"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>The work presented here suggests new ways to tackle exergames for physical rehabilitation and to improve the players\u2019 immersion and involvement. The primary (but not exclusive) purpose is to increase the motivation of children and adolescents with severe physical impairments, for doing their required exercises while playing. The proposed gaming environment is based on the Kinect sensor and the Blender Game Engine. A middleware has been implemented that efficiently transmits the data from the sensor to the game. Inside the game, different newly proposed mechanisms have been developed to distinguish pure exercise-gestures from other movements used to control the game (e.g., opening a menu). The main contribution is the amplification of weak movements, which allows the physically impaired to have similar gaming experiences as the average population. To test the feasibility of the proposed methods, four mini-games were implemented and tested by a group of 11 volunteers with different disabilities, most of them bound to a wheelchair. Their performance has also been compared to that of a healthy control group. Results are generally positive and motivating, although there is much to do to improve the functionalities. There is a major demand for applications that help to include disabled people in society and to improve their life conditions. This work will contribute towards providing them with more fun during exercise.<\/jats:p>","DOI":"10.3390\/s17020354","type":"journal-article","created":{"date-parts":[[2017,2,15]],"date-time":"2017-02-15T10:09:07Z","timestamp":1487153347000},"page":"354","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["New Approaches to Exciting Exergame-Experiences for People with Motor Function Impairments"],"prefix":"10.3390","volume":"17","author":[{"given":"Martina","family":"Eckert","sequence":"first","affiliation":[{"name":"Centro de Investigaci\u00f3n en Tecnolog\u00edas Software y Sistemas Multimedia para la Sostenibilidad (CITSEM), Campus Sur Universidad Polit\u00e9cnica de Madrid (UPM), Madrid 28031, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"G\u00f3mez-Martinho","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n en Tecnolog\u00edas Software y Sistemas Multimedia para la Sostenibilidad (CITSEM), Campus Sur Universidad Polit\u00e9cnica de Madrid (UPM), Madrid 28031, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Meneses","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n en Tecnolog\u00edas Software y Sistemas Multimedia para la Sostenibilidad (CITSEM), Campus Sur Universidad Polit\u00e9cnica de Madrid (UPM), Madrid 28031, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9-Fern\u00e1n","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n en Tecnolog\u00edas Software y Sistemas Multimedia para la Sostenibilidad (CITSEM), Campus Sur Universidad Polit\u00e9cnica de Madrid (UPM), Madrid 28031, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,2,12]]},"reference":[{"key":"ref_1","first-page":"41","article-title":"KINECT applications for the physical rehabilitation","volume":"112","author":"Kitsunezaki","year":"2012","journal-title":"Ieice Technical Rep. Image Eng."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/1743-0003-11-108","article-title":"Systematic review of Kinect applications in elderly care and stroke rehabilitation","volume":"11","author":"Webster","year":"2014","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.physio.2013.10.003","article-title":"Feasibility, safety and outcomes of playing Kinect Adventures!TM for people with Parkinson\u2019s disease: A pilot study","volume":"100","author":"Pompeu","year":"2014","journal-title":"Physiotherapy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5697","DOI":"10.3390\/ijerph10115697","article-title":"A telerehabilitation program improves postural control in multiple sclerosis patients: A spanish preliminary study","volume":"10","year":"2013","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_5","first-page":"846514:1","article-title":"A Review on Technical and Clinical Impact of Microsoft Kinect on Physical Therapy and Rehabilitation","volume":"2014","author":"Hondori","year":"2014","journal-title":"J. Med. Eng."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/j.apmr.2014.09.008","article-title":"Virtual reality video games to promote movement recovery in stroke rehabilitation: A guide for clinicians","volume":"96","author":"Anderson","year":"2015","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12984-015-0057-x","article-title":"Clinical feasibility of interactive motion-controlled games for stroke rehabilitation","volume":"12","author":"Bower","year":"2015","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Madeira, R.N., Costa, L., and Postolache, O. (2014, January 16\u201318). PhysioMate-Pervasive physical rehabilitation based on NUI and gamification. Proceedings of the EPE 2014\u2014International Conference Exposition Electrical Power Engineering, Iasi, Romania.","DOI":"10.1109\/ICEPE.2014.6969982"},{"key":"ref_9","first-page":"391","article-title":"JeWheels: Kinect based serious game aimed at wheelchair users","volume":"7657 LNCS","year":"2012","journal-title":"Lect. Notes Comput. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1145\/2793107.2810304","article-title":"Exploring Casual Exergames With Kids Using Wheelchairs","volume":"2015","author":"Hicks","year":"2015","journal-title":"Chi Play"},{"key":"ref_11","first-page":"3602","article-title":"Usability Testing of Gaming and Social Media Applications for Stroke and Cerebral Palsy Upper Limb Rehabilitation","volume":"2014","author":"Hilderman","year":"2014","journal-title":"Eng. Med. Biol. Soc."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Martins, T., Carvalho, V.V., and Soares, F. (2015, January 26\u201328). A serious game for rehabilitation of neurological disabilities: Preliminary study. Proceedings of the 2015 IEEE 4th Portuguese BioEngineering Meeting, Porto, Portugal.","DOI":"10.1109\/ENBENG.2015.7088843"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijmedinf.2015.10.008","article-title":"Exercise and rehabilitation delivered through exergames in older adults\u202f: An integrative review of technologies, safety and efficacy","volume":"85","author":"Nawaz","year":"2016","journal-title":"Int. J. Med. Inform."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Abdur Rahman, M., Qamar, A.M., Ahmed, M.A., Ataur Rahman, M., and Basalamah, S. (2013, January 16\u201319). Multimedia interactive therapy environment for children having physical disabilities. Proceedings of the 3rd ACM Conference International Conference Multimedia Retrieval (ICMR \u201913), Dallas, TX, USA.","DOI":"10.1145\/2461466.2461522"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Roy, A.K., Soni, Y., and Dubey, S. (2013, January 23\u201324). Enhancing Effectiveness of Motor Rehabilitation Using Kinect Motion Sensing Technology. Proceedings of the IEEE Global Humanitarian Technology Conference: South Asia Satellite (GHTC-SAS), Trivandrum, India.","DOI":"10.1109\/GHTC-SAS.2013.6629934"},{"key":"ref_16","first-page":"454","article-title":"Developing a Digital Game for Domestic Stroke Patients\u2019 Upper Extremity Rehabilitation\u2014Design and Usability Assessment","volume":"Volume 9177","author":"Antona","year":"2015","journal-title":"Universal Access in Human-Computer Interaction. Access to Learning, Health and Well-Being - Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics)"},{"key":"ref_17","unstructured":"Papangelis, A., Mouchakis, G., Texas, A.B., Kosmopoulos, D., Karkaletsis, V., and Makedon, F. A game system for remote rehabilitation of cerebral palsy patients. Proceedings of the 5th International Conference on Pervasive Technologies Related to Assistive Environments."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"545","DOI":"10.3233\/NRE-130995","article-title":"A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients","volume":"33","author":"Page","year":"2013","journal-title":"NeuroRehabilitation"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Burke, J.W., McNeill, M.D.J., Charles, D.K., Morrow, P.J., Crosbie, J.H., and McDonough, S.M. (2009). Optimising engagement for stroke rehabilitation using serious games. Vis. Comput., 1\u201315.","DOI":"10.1007\/s00371-009-0387-4"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/978-3-642-45432-5_2","article-title":"Design issues for vision-based motor-rehabilitation serious games","volume":"536","author":"Varona","year":"2014","journal-title":"Stud. Comput. Intell."},{"key":"ref_21","unstructured":"Borghese, P.N.A. REWIRE. Available online: https:\/\/sites.google.com\/site\/projectrewire\/."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Pirovano, M., Mainetti, R., Baud-Bovy, G., Lanzi, P.L., and Borghese, N.A. (2012, January 11\u201314). Self-adaptive games for rehabilitation at home. Proceedings of the 2012 IEEE Conference Computational Intelligence Games, Granada, Spain.","DOI":"10.1109\/CIG.2012.6374154"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Borghese, N.A., Mainetti, R., Pirovano, M., and Lanzi, P.L. (2013, January 2\u20133). An intelligent game engine for the at-home rehabilitation of stroke patients. Proceedings of the 2013 IEEE 2nd International Conference Serious Games Applications Health, Vilamoura, Portugal.","DOI":"10.1109\/SeGAH.2013.6665318"},{"key":"ref_24","unstructured":"Moy, S. (2015). Do Try This At Home: Microsoft Kinect Turns Physical Therapy Into a Game. Fisc. Times."},{"key":"ref_25","first-page":"140","article-title":"Thoroughly Approach to Upper Limb Rehabilitation Using Serious Games for Intensive Group Physical Therapy or Individual Biofeedback Training","volume":"2014","author":"Cargnin","year":"2014","journal-title":"Brazilian Symp. Comput. Games Digit. Entertain."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/1743-0003-11-60","article-title":"Retraining function in people with Parkinson\u2019s disease using the Microsoft kinect: game design and pilot testing","volume":"11","author":"Galna","year":"2014","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.procs.2015.12.233","article-title":"Rehabilitation Using Kinect-based Games and Virtual Reality","volume":"75","year":"2015","journal-title":"Procedia Comput. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"12060","DOI":"10.1088\/1742-6596\/705\/1\/012060","article-title":"Development of a Kinect-based exergaming system for motor rehabilitation in neurological disorders","volume":"705","author":"Estepa","year":"2016","journal-title":"J. Phys. Conf. Series"},{"key":"ref_29","unstructured":"Microsoft Accessibility and Kinect for Xbox 360. Available online: http:\/\/support.xbox.com\/en-GB\/xbox-360\/accessories\/accessibility-kinect."},{"key":"ref_30","unstructured":"Apparelyzed Spinal Cord Injury and Cauda Equina Syndrome Support Forum. Available online: http:\/\/www.apparelyzed.com\/forums\/topic\/25204-xbox-360-best-kinect-game-for-wheelchair-users-fable-the-journey\/."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Eckert, M., G\u00f3mez-Martinho, I., Meneses, J., and Martinez Ortega, J.F. (2015). A Multi Functional Plug-in for Exergames. IEEE Int. Symp. Consum. Electron., 4\u20136.","DOI":"10.1109\/ISCE.2015.7177798"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Eckert, M., G\u00f3mez-Martinho, I., Meneses, J., and Martinez Ortega, J.F.M. (2016, January 5\u20137). A modular middleware approach for exergaming. Proceedings of the International Conference on Consumer Electronics, Berlin, Germany.","DOI":"10.1109\/ICCE-Berlin.2016.7684747"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.ijhcs.2015.08.009","article-title":"Creating wheelchair-controlled video games: Challenges and opportunities when involving young people with mobility impairments and game design experts","volume":"94","author":"Gerling","year":"2015","journal-title":"Int. J. Hum. Comput. Stud."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Chiang, I.T., Tsai, J.C., and Chen, S.T. (2012, January 27\u201330). Using Xbox 360 kinect games on enhancing visual performance skills on institutionalized older adults with wheelchairs. Proceedings of the 2012 4th IEEE International Conference Digital Game and Intelligent Toy Enhanced Learning (DIGITEL), Takamatsu, Japan.","DOI":"10.1109\/DIGITEL.2012.69"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1682\/JRRD.2015.03.0045","article-title":"Usability evaluation of low-cost virtual reality hand and arm rehabilitation games","volume":"53","author":"Seo","year":"2016","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.protcy.2014.02.010","article-title":"Natural User Interfaces in the Motor Development of Disabled Children","volume":"13","author":"Meleiro","year":"2014","journal-title":"Procedia Technol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Bossavit, B., and Pina, A. (2014, January 16\u201317). Designing educational tools, based on body interaction, for children with special needs who present different motor skills. Proceedings of the 2014 International Conference Interactive Technologies Games, iTAG 2014, Nottingham, UK.","DOI":"10.1109\/iTAG.2014.16"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"513","DOI":"10.3233\/NRE-131001","article-title":"Kinect Xbox 360 as a therapeutic modality for children with cerebral palsy in a school environment: A preliminary study","volume":"33","year":"2013","journal-title":"NeuroRehabilitation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.injury.2014.08.047","article-title":"Commercially available gaming systems as clinical assessment tools to improve value in the orthopaedic setting: A systematic review","volume":"46","author":"Ruff","year":"2015","journal-title":"Injury"},{"key":"ref_40","unstructured":"Chou, Y. (2015). Actionable Gamification. Beyond Points, Badges, and Leaderboards, Octalysis Media."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/MRR.0000000000000190","article-title":"The use of commercial video games in rehabilitation: A systematic review","volume":"39","author":"Bonnechere","year":"2016","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_42","unstructured":"Blender Foundation Blender.org. Available online: http:\/\/www.blender.org\/."},{"key":"ref_43","unstructured":"Oculus Oculus Rift V.R.. Available online: https:\/\/www.oculus.com\/."},{"key":"ref_44","unstructured":"Microsoft Kinect for Windows SDK v1.8. Available online: https:\/\/www.microsoft.com\/en-us\/download\/details.aspx?id=40278."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1016\/j.apmr.2004.01.043","article-title":"Joint range of motion limitations in children and young adults with spinal muscular atrophy","volume":"85","author":"Wang","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/1477-7525-5-31","article-title":"Living with muscular dystrophy: Health related quality of life consequences for children and adults","volume":"5","author":"Grootenhuis","year":"2007","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_47","unstructured":"ASEM\u2014Asociaci\u00f3n de Enfermedades Neuromusculares Madrid. Available online: http:\/\/www.asem-madrid.org."},{"key":"ref_48","unstructured":"Fundaci\u00f3n TAMBIEN. Available online: http:\/\/www.tambien.org."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Eckert, M., Lopez, M., Lazaro, C., Meneses, J., and Mart\u00ednez Ortega, J.F. (2015, January 24\u201326). Mokey\u2014A motion based keyboard interpreter. Proceedings of the IEEE International Symposium on Consumer Electronics (ISCE-15), Madrid, Spain.","DOI":"10.1109\/ISCE.2015.7177799"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Eckert, M., Lopez, M., Lazaro, C., Meneses, J., and Ortega, J.F.M. (2017). MoKey\u2014A versatile exergame creator for everyday usage. Assistive Technol., Under 2nd review.","DOI":"10.1080\/10400435.2017.1406016"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/17\/2\/354\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:28:05Z","timestamp":1760207285000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/17\/2\/354"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2,12]]},"references-count":50,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2017,2]]}},"alternative-id":["s17020354"],"URL":"https:\/\/doi.org\/10.3390\/s17020354","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,2,12]]}}}