Rehabilitative exergaming in multiple sclerosis: Bimanual tasks in Mixed Reality

Exergames - i.e. games devised to promote exercising, to engage people in physical activities - demonstrated their potential in rehabilitation, especially for facing the challenges due to motor dysfunctions and cognitive impairments that sig-nificantly impact activities of daily living (ADLs). Accordingly, this paper presents an investigation of the potential of Mixed Reality (MR, when digital objects behave like physical ones in a real setting) in exercises for upper limbs, based on the needs of individuals with Multiple Sclerosis (MS), an inflammatory demyelinating disease of the central nervous system. The developed exergame requires the user to manipulate real objects while keeping in balance a virtual object in MR placed on top. The game focuses on repetitive movements towards specific target positions and provides two conditions, one involving the use of a single arm and the other requiring coordination of both arms. The final goal of proposing these two conditions is to assess the feasibility and potential of introducing bimanual tasks (often requested to perform ADLs in daily life) in rehabilitation. The system has been preliminarily tested by people without MS in order to gather data for evaluating user experience. MS specialists have contributed to the game design and the definition of the assessment protocol. Current results show that bimanual tasks are feasible in this MR setting, suggesting further improvements for extensive clinical tests.