Purpose Active computer gaming (ACG) is a way for older people to participate in strength and balance exercise. Involving older adults in the development of a bespoke ACG system may optimise its usability and acceptability. The purpose of this paper is to employ user-centred design to develop an ACG system to deliver strength and balance exercises, and to explore its safety, usability and acceptability in older adults. Design/methodology/approach This paper describes user involvement from an early stage, and its influence on the development of the system to deliver strength and balance exercise suitable for display on a flat screen or using an Oculus Rift virtual reality (VR) headset. It describes user testing of this ACG system in older adults. Findings Service users were involved at two points in the development process. Their feedback was used to modify the ACG system prior to user testing of a prototype of the ACG system by n=9 older adults. Results indicated the safety, usability and acceptability of the system, with a strong preference for the screen display. Research limitations/implications The sample size for user testing was small; however, it is considered to have provided sufficient information to inform the further development of the system. Practical implications Findings from user testing were used to modify the ACG system. This paper identified that future research could explore the influence of repeated use on the usability and acceptability of ACG in older adults. Originality/value There is limited information on the usability and acceptability VR headsets in this population.

Stroke is a leading cause of disability, and with the stroke survivor population rising in most countries it is increasingly difficult to provide optimal treatment to patients once they return home. Assistive technology solutions can potentially contribute to meeting demand, and also be cost effective. In this chapter, we consider the design and development of engaging serious virtual reality (VR) games for upper arm stroke rehabilitation. Fundamental design principles are summarised and related to our experience of creating game-based VR rehabilitation. The application of ideas from psychology, particularly behavioural change and flow theory are discussed, as well as related learning and gamification principles. We address how to manage differences between people through design, user profiling, and intelligent dynamic system behaviour, and we also explore how to account for variation in stroke survivor capability and personality. The idea of a hero's journey as a metaphor for stroke recovery is introduced and we discuss how this metaphor may guide system design, its relationship to game design principles, and how patient narratives and embedded stories might support engagement with treatment. An overview of our previous work is summarised and we discuss how our experience and increased knowledge and capability has informed improved approaches to development processes. Finally, our approach is illustrated with reference to a recent EU project.

Existing literature has shown that games and virtual reality can help motivate people thus keeping them engaged for longer. Nonetheless, in most approaches the design of games or virtual reality for rehabilitation purposes tend to apply a basic motivational approach that focuses on the general population of game players. Recent research shows that individuals can be motivated quite differently and so it may be important to consider each individual's motivational characteristics within the context of rehabilitation to ensure continued engagement. In this paper we present the Rehabilitation Game Model (RGM), which can be used as a basis for evaluating existing systems and for designing new interactive rehabilitation systems that are more personalised and engaging. Initial evaluation of existing rehabilitation games and comparison with commercial games using the RGM indicate a potential over emphasis on achievement based reward systems in rehabilitation game design compared to other reward systems.

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