Video Games and Rehabilitation: Using Design Principles to Enhance Engagement in Physical Therapy

Lohse, Keith PhD; Shirzad, Navid MASc; Verster, Alida; Hodges, Nicola PhD; Van der Loos, H. F. Machiel PhD

Journal of Neurologic Physical Therapy: December 2013 - Volume 37 - Issue 4 - p 166–175
doi: 10.1097/NPT.0000000000000017
Special Interest Articles
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Patient nonadherence with therapy is a major barrier to rehabilitation. Recovery is often limited and requires prolonged, intensive rehabilitation that is time-consuming, expensive, and difficult. We review evidence for the potential use of video games in rehabilitation with respect to the behavioral, physiological, and motivational effects of gameplay. In this Special Interest article, we offer a method to evaluate effects of video game play on motor learning and their potential to increase patient engagement with therapy, particularly commercial games that can be interfaced with adapted control systems. We take the novel approach of integrating research across game design, motor learning, neurophysiology changes, and rehabilitation science to provide criteria by which therapists can assist patients in choosing games appropriate for rehabilitation. Research suggests that video games are beneficial for cognitive and motor skill learning in both rehabilitation science and experimental studies with healthy subjects. Physiological data suggest that gameplay can induce neuroplastic reorganization that leads to long-term retention and transfer of skill; however, more clinical research in this area is needed. There is interdisciplinary evidence suggesting that key factors in game design, including choice, reward, and goals, lead to increased motivation and engagement. We maintain that video game play could be an effective supplement to traditional therapy. Motion controllers can be used to practice rehabilitation-relevant movements, and well-designed game mechanics can augment patient engagement and motivation in rehabilitation. We recommend future research and development exploring rehabilitation-relevant motions to control games and increase time in therapy through gameplay.

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School of Kinesiology (K.R.L., N.J.H.) and Departments of Biomedical Engineering (N.S., H.F.M.V.d.L.) and Electrical and Computer Engineering (A.V.), University of British Columbia, Vancouver, British Columbia, Canada.

Correspondence: Keith Lohse, PhD, School of Kinesiology, University of British Columbia, 210-6081 University Blvd, Vancouver, BC V6T 1Z1, Canada (

This research was funded in part by #11-079 from the Peter Wall Solutions Initiative at the University of British Columbia awarded to H.F.M.V.d.L. N.J.H. was also funded by the Canadian Institutes of Health Research.

The authors have no conflict of interest to disclose.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2013 Neurology Section, APTA