Exergames have been proposed as a potential tool to improve the current practice of musculoskeletal rehabilitation. Inertial or optical motion capture sensors are commonly used to track the subject’s movements. However, the use of these motion capture tools suffers from the lack of accuracy in estimating joint angles, which could lead to wrong data interpretation. In this study, we proposed a real time quaternion-based fusion scheme, based on the extended Kalman filter, between inertial and visual motion capture sensors, to improve the estimation accuracy of joint angles. The fusion outcome was compared to angles measured using a goniometer. The fusion output shows a better estimation, when compared to inertial measurement units and Kinect outputs. We noted a smaller error (3.96°) compared to the one obtained using inertial sensors (5.04°). The proposed multi-sensor fusion system is therefore accurate enough to be applied, in future works, to our serious game for musculoskeletal rehabilitation.

BackgroundThe progress in information and communication technology (ICT) led to the development of a new rehabilitation technique called “serious game for functional rehabilitation.” Previous works have shown that serious games can be used for general health and specific disease management. However, there is still lack of consensus on development and evaluation guidelines. It is important to note that the game performance depends on the designed scenario.ObjectiveThe objective of this work was to develop specific game scenarios and evaluate them with a panel of musculoskeletal patients to propose game development and evaluation guidelines.MethodsA two-stage workflow was proposed using determinant framework. The development guideline includes the selection of three-dimensional (3D) computer graphics technologies and tools, the modeling of physical aspects, the design of rehabilitation scenarios, and the implementation of the proposed scenarios. The evaluation guideline consists of the definition of evaluation metrics, the execution of the evaluation campaign, the analysis of user results and feedbacks, and the improvement of the designed game.ResultsThe case study for musculoskeletal disorders on the healthy control and patient groups showed the usefulness of these guidelines and associated games. All participants enjoyed the 2 developed games (football and object manipulation), and found them challenging and amusing. In particular, some healthy subjects increased their score when enhancing the level of difficulty. Furthermore, there were no risks and accidents associated with the execution of these games.ConclusionsIt is expected that with the proven effectiveness of the proposed guidelines and associated games, this new rehabilitation game may be translated into clinical routine practice for the benefit of patients with musculoskeletal disorders.

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