{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T18:35:17Z","timestamp":1773513317224,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2014NextGenerationEU and the Romanian Government","award":["760071\/23.05.2023"],"award-info":[{"award-number":["760071\/23.05.2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Applied Sciences"],"abstract":"<jats:p>Stroke, amyotrophic lateral sclerosis (ALS), and Parkinson\u2019s disease are some of the conditions that can lead to neuromotor disabilities requiring rehabilitation. To address the socio-economic burden that is amplified by the rapidly increasing elderly population, traditional rehabilitation techniques have recently been complemented by technological advancements, particularly Robot-Assisted Therapy (RAT). RAT enhances motor learning by improving both accuracy and consistency. This study proposes an innovative rehabilitation system that combines serious gaming and augmented reality (AR) with the LegUp parallel robot, developed for the spatial rehabilitation of the hip, knee, and ankle in bed-ridden patients. The system aims to improve patient outcomes and actively involve patients in their therapy. Electro-goniometers and a HoloLens 2 device are used to provide immediate feedback about the position of the patient\u2019s joints, forming the basis of an interactive game in which the patient moves their leg to reach various targets. Two game modes were developed, each targeting different aspects of neuromotor rehabilitation, such as coordination, strength, and flexibility. Preliminary findings suggest that combining RAT with augmented reality-based serious gaming can increase patient motivation and engagement. Furthermore, the personalized and interactive nature of the therapy holds the potential to improve rehabilitation outcomes by fostering sustained engagement and effort.<\/jats:p>","DOI":"10.3390\/app142412029","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T02:39:56Z","timestamp":1734921596000},"page":"12029","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Enhancing Robotic-Assisted Lower Limb Rehabilitation Using Augmented Reality and Serious Gaming"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2822-9790","authenticated-orcid":false,"given":"Calin","family":"Vaida","sequence":"first","affiliation":[{"name":"CESTER\u2014Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania"}]},{"given":"Gabriela","family":"Rus","sequence":"additional","affiliation":[{"name":"CESTER\u2014Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5660-8259","authenticated-orcid":false,"given":"Paul","family":"Tucan","sequence":"additional","affiliation":[{"name":"CESTER\u2014Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4917-2474","authenticated-orcid":false,"given":"Jos\u00e9","family":"Machado","sequence":"additional","affiliation":[{"name":"CESTER\u2014Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania"},{"name":"Campus of Azurem, Universidade do Minho, 4800-058 Guimar\u00e3es, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5531-6913","authenticated-orcid":false,"given":"Adrian","family":"Pisla","sequence":"additional","affiliation":[{"name":"CESTER\u2014Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0483-7691","authenticated-orcid":false,"given":"Ionut","family":"Zima","sequence":"additional","affiliation":[{"name":"CESTER\u2014Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4026-2318","authenticated-orcid":false,"given":"Iosif","family":"Birlescu","sequence":"additional","affiliation":[{"name":"CESTER\u2014Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7014-9431","authenticated-orcid":false,"given":"Doina","family":"Pisla","sequence":"additional","affiliation":[{"name":"CESTER\u2014Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania"},{"name":"Technical Sciences Academy of Romania, B-dul Dacia, 26, 030167 Bucharest, Romania"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization\u2014Disability and Health (2024, August 01). WPR-2017-DNH-005-Factsheet. [Online]. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/279966\/WPR-2017-DNH-005-factsheet-01-disability-eng.pdf."},{"key":"ref_2","unstructured":"World Health Organization (2024, November 20). \u2018Stroke, Cerebrovascular Accident\u2019 [Online]. Available online: https:\/\/www.emro.who.int\/health-topics\/stroke-cerebrovascular-accident\/index.html#:~:text=Annually%2C%2015%20million%20people%20worldwide%20suffer%20a%20stroke.,ocur%2C%20the%20main%20cause%20is%20high%20blood%20pressure."},{"key":"ref_3","unstructured":"World Health Organization (2024, April 20). Parkinson Disease. [Online]. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/parkinson-disease."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Smukowski, S.N., Maioli, H., Latimer, C.S., Bird, T.D., Jayadev, S., and Valdmanis, P.N. (2022). Progress in Amyotrophic Lateral Sclerosis Gene Discovery: Reflecting on Classic Approaches and Leveraging Emerging Technologies, Lippincott Williams and Wilkins.","DOI":"10.1212\/NXG.0000000000000669"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.neurol.2020.01.356","article-title":"Epidemiology of neurological diseases in older adults","volume":"176","author":"Dumurgier","year":"2020","journal-title":"Rev. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Pisla, D., Nadas, I., Tucan, P., Albert, S., Carbone, G., Antal, T., Banica, A., and Gherman, B. (2021). Development of a Control System and Functional Validation of a Parallel Robot for Lower Limb Rehabilitation. Actuators, 10.","DOI":"10.3390\/act10100277"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1080\/17483107.2021.1906960","article-title":"Robotic assistive and rehabilitation devices leading to motor recovery in upper limb: A systematic review","volume":"18","author":"Khalid","year":"2023","journal-title":"Disabil. Rehabil. Assist. Technol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e30852","DOI":"10.1097\/MD.0000000000030852","article-title":"Robot-assisted rehabilitation for total knee or hip replacement surgery patients: A systematic review and meta-analysis","volume":"101","author":"Yoo","year":"2022","journal-title":"Medicine"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Payedimarri, A.B., Ratti, M., Rescinito, R., Vanhaecht, K., and Panella, M. (2022). Effectiveness of Platform-Based Robot-Assisted Rehabilitation for Musculoskeletal or Neurologic Injuries: A Systematic Review. Bioengineering, 9.","DOI":"10.3390\/bioengineering9040129"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1046\/j.1525-1403.2003.03017.x","article-title":"Robotic Orthosis Lokomat: A Rehabilitation and Research Tool","volume":"6","author":"Jezernik","year":"2003","journal-title":"Neuromodulation Technol. Neural Interface"},{"key":"ref_11","unstructured":"(2024, July 29). Life Science Robotics, Robert\u00ae\u2014The Robotic Co-Therapist. [Online]. Available online: https:\/\/www.lifescience-robotics.com\/solutions\/lower-extremities\/."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.12669\/pjms.38.5.5259","article-title":"Clinical Effects of MOTOmed Intelligent Exercise Training Combined with Intensive Walking Training on the Rehabilitation of Walking, Nerve and Lower Limb Functions among Patients with Hemiplegia after Stroke","volume":"38","author":"Hu","year":"2022","journal-title":"Pak. J. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103210","DOI":"10.1016\/j.mechatronics.2024.103210","article-title":"Development of a novel cable-driven parallel robot for full-cycle ankle rehabilitation","volume":"101","author":"Huo","year":"2024","journal-title":"Mechatronics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1007\/s42235-022-00172-6","article-title":"Development and Evaluation of a Wearable Lower Limb Rehabilitation Robot","volume":"19","author":"Li","year":"2022","journal-title":"J. Bionic Eng."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Vaida, C., Birlescu, I., Pisla, A., Carbone, G., Plitea, N., Ulinici, I., Gherman, B., Puskas, F., Tucan, P., and Pisla, D. (2019). RAISE\u2014An Innovative Parallel Robotic System for Lower Limb Rehabilitation. New Trends in Medical and Service Robotics. Mechanisms and Machine Science, Springer.","DOI":"10.1007\/978-3-030-00329-6_33"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.ptsp.2022.04.011","article-title":"Extended reality in musculoskeletal rehabilitation and injury prevention\u2014A systematic review","volume":"55","author":"Schuermans","year":"2022","journal-title":"Phys. Ther. Sport"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gupta, M., Bhatia, D., and Kumar, P. (2023). Virtual reality, augmented reality technologies, and rehabilitation. Modern Intervention Tools for Rehabilitation, Elsevier.","DOI":"10.1016\/B978-0-323-99124-7.00001-8"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Innocente, C., Ulrich, L., Moos, S., and Vezzetti, E. (2021). Augmented Reality: Mapping Methods and Tools for Enhancing the Human Role in Healthcare HMI. Appl. Sci., 12.","DOI":"10.3390\/app12094295"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Phan, H.L., Le, T.H., Lim, J.M., Hwang, C.H., and Koo, K. (2021). Effectiveness of Augmented Reality in Stroke Rehabilitation: A Meta-Analysis. Appl. Sci., 12.","DOI":"10.3390\/app12041848"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1089\/cyber.2018.0261","article-title":"Three-Dimensional Augmented Reality System for Balance and Mobility Rehabilitation in the Elderly: A Randomized Controlled Trial","volume":"22","author":"Ku","year":"2019","journal-title":"Cyberpsychol. Behav. Soc. Netw."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Dama\u0161evi\u010dius, R., Maskeli\u016bnas, R., and Bla\u017eauskas, T. (2023). Serious Games and Gamification in Healthcare: A Meta-Review. Information, 14.","DOI":"10.3390\/info14020105"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"65","DOI":"10.5195\/ijt.2020.6326","article-title":"Serious Games for Stroke Telerehabilitation of Upper Limb\u2014A Review for Future Research","volume":"12","author":"Amorim","year":"2020","journal-title":"Int. J. Telerehabilit."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s12984-023-01225-5","article-title":"Robotic arm training in neurorehabilitation enhanced by augmented reality\u2014A usability and feasibility study","volume":"20","author":"Ruhnau","year":"2023","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Rodriguez-De-Pablo, C., Balasubramanian, S., Savic, A., Tomic, T.D., Konstantinovic, L., and Keller, T. (2015, January 25\u201329). Validating ArmAssist Assessment as outcome measure in upper-limb post-stroke telerehabilitation. Proceedings of the 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Milan, Italy.","DOI":"10.1109\/EMBC.2015.7319424"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Pisla, D., Birlescu, I., Vaida, C., Tucan, P., Gherman, B., and Machado, J. (2024). Parallel Robot for Lower Limb Joint Rehabilitation in Two Planes. (No. OSIM A 00116), Patent.","DOI":"10.1007\/978-3-031-59888-3_21"},{"key":"ref_26","first-page":"e41914","article-title":"Innovative Approaches and Therapies to Enhance Neuroplasticity and Promote Recovery in Patients with Neurological Disorders: A Narrative Review","volume":"15","author":"Kumar","year":"2023","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Wareham, L.K., Liddelow, S.A., Temple, S., Benowitz, L.I., Di Polo, A., Wellington, C., Goldberg, J.L., He, Z., Duan, X., and Bu, G. (2022). Solving Neurodegeneration: Common Mechanisms and Strategies for New Treatments, BioMed Central Ltd.","DOI":"10.1186\/s13024-022-00524-0"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"105674","DOI":"10.1016\/j.mechmachtheory.2024.105674","article-title":"Modeling and analysis of a parallel robotic system for lower limb rehabilitation with predefined operational workspace","volume":"198","author":"Birlescu","year":"2024","journal-title":"Mech. Mach. Theory"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Afyouni, I., Murad, A., and Einea, A. (2020). Adaptive Rehabilitation Bots in Serious Games. Sensors, 20.","DOI":"10.3390\/s20247037"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Alarc\u00f3n-Aldana, A.C., Callejas-Cuervo, M., and Bo, A.P.L. (2020). Upper Limb Physical Rehabilitation Using Serious Videogames and Motion Capture Systems: A Systematic Review. Sensors, 20.","DOI":"10.3390\/s20215989"},{"key":"ref_31","unstructured":"(2024, July 31). Biometrics Ltd.\u2019s Twin-axis Goniometers [Online]. Available online: https:\/\/www.biometricsltd.com\/blog\/electronic-goniometers.htm."},{"key":"ref_32","unstructured":"Microsoft (2024, July 31). HoloLens 2. Microsoft. [Online]. Available online: https:\/\/www.microsoft.com\/en-us\/hololens\/buy?msockid=1d8aaf670ae2690e3d42bcff0b3b6880."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Palumbo, A. (2022). Microsoft HoloLens 2 in Medical and Healthcare Context: State of the Art and Future Prospects. Sensors, 22.","DOI":"10.3390\/s22207709"},{"key":"ref_34","unstructured":"(2024, August 27). Biometrics Ltd. [Online]. Available online: https:\/\/www.biometricsltd.com\/system-integrations.htm."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3169262","DOI":"10.1155\/2023\/3169262","article-title":"DeapSea: Workflow-Supported Serious Game Design for Stroke Rehabilitation","volume":"2023","author":"Baranyi","year":"2023","journal-title":"Int. J. Comput. Games Technol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e200103","DOI":"10.1212\/NE9.0000000000200103","article-title":"Game-Based Learning in Neuroscience","volume":"2","author":"Edwards","year":"2023","journal-title":"Neurol. Educ."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Tucan, P., Vaida, C., Ulinici, I., Banica, A., Burz, A., Pop, N., Birlescu, I., Gherman, B., Plitea, N., and Antal, T. (2021). Optimization of the aspire spherical parallel rehabilitation robot based on its clinical evaluation. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18063281"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"5062","DOI":"10.1109\/TVCG.2022.3201120","article-title":"Systematic Review of Augmented Reality Training Systems","volume":"29","author":"Butaslac","year":"2023","journal-title":"IEEE Trans. Vis. Comput. Graph."},{"key":"ref_39","unstructured":"Schrepp, M. (2024, July 30). User Experience Questionnaire Handbook. Available online: https:\/\/www.researchgate.net\/publication\/281973617_User_Experience_Questionnaire_Handbook."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Gerbino, S., Lanzotti, A., Martorelli, M., Mir\u00e1lbes Buil, R., Rizzi, C., and Roucoules, L. (2022). Mixed Reality-Based Support for Total Hip Arthroplasty Assessment. Advances on Mechanics, Design Engineering and Manufacturing IV, Springer. JCM. Lecture Notes in Mechanical Engineering.","DOI":"10.1007\/978-3-031-15928-2"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e30985","DOI":"10.2196\/30985","article-title":"Augmented Reality in Physical Therapy: Systematic Review and Meta-analysis","volume":"9","year":"2021","journal-title":"JMIR Serious Games"}],"container-title":["Applied Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3417\/14\/24\/12029\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:58:10Z","timestamp":1760115490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3417\/14\/24\/12029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,23]]},"references-count":41,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["app142412029"],"URL":"https:\/\/doi.org\/10.3390\/app142412029","relation":{},"ISSN":["2076-3417"],"issn-type":[{"value":"2076-3417","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,23]]}}}