An Intelligent Game Engine for the At-Home Rehabilitation of Stroke Patients N. Alberto Borghese 1 Renato Mainetti 1 Michele Pirovano 1 , 2 Pier Luca Lanzi 2 1 Applied Intelligent Systems Laboratory - Department of Computer Science - University of Milano, Milano - Italy 2 Politecnico di Milano - Dipartimento di Elettronica, Informazione e Bioingegneria, Milano, Italy {alberto.borghese, renato.mainetti, michele.pirovano}@unimi.it {pirovano,lanzi}@elet.polimi.it Abstrct-The recent availability of advanced video game interfaces (such as the Microsoft Kinect, the Nintendo WiiMote and Balance Board) is creating interesting opportunities to provide low-cost rehabilitation at-home for patients. In this context, video games are rising as promising tools to guide patients through their recovery experience and to increase their motivation throughout the rehabilitation path. However, to be applied to clinical scenarios, video games must be designed to adhere to the clinical requirements and to meet doctors/patients expectations. They also need to be integrated within multi-level platforms that can allow different levels of monitoring, e.g., at a personal level by the therapist, at the hospital level by the doctors, and at the regional level by the government agencies. In this paper, we overview an intelligent game engine for the at-home rehabilitation of stroke patients The engine provides several games that implement actual rehabilitation exercises and have been developed in strict collaboration with therapists. It is integrated in a patient station that provides several types of monitoring and feedback using virtual and/or human therapists. I. INTRODUCTION Stroke is a major cause of adult disability in developed countries and it totals about 16 million new frst stroke events per year [1]. Given such increasing fgures, the cost of stroke rehabilitation is expected to saturate National Health Service Providers which are expected to be forced to shorten the duration of the rehabilitation support. However, exercising should be continued also outside the hospital to avoid losing the benefts of hospital rehabilitation and to stabilize psycho physical conditions. Moreover, accumulating evidence sug gests that intensive rehabilitation allows recovering function also months after the stroke event [2]. This requires daily rehabilitation sessions that presently have to be carried out in specialized centers, with the support of therapists. Unfortu nately, only few patients can aford such an option as it is often not supported by public health systems. This has an enormous socio-economic impact also on the patients families who often feel left alone by the health service providers [3] and patients who should continue the therapy outside the hospital actually drop out mostly due to high costs. But even when the costs were covered, many patients lack the necessary motivation to continue training for their recovery. 978-1-4673-6165-1/13/$3l.00 © 2013 IEEE In fact, recent studies show that motivation is easier to be stimulated in a comfortable environment and often hospitals are not perceived as such so that patients may be better motivated at home. Virtual Reality (VR) has been explored as a viable tool to support rehabilitation either alone [4], [5] or in combination with robotics [6], as it was shown the potentiality of rich graphics environments in capturing patients attention and mo tivating them [7]. However, classical VR devices have turned out to be expensive, intrusive, and unsuitable for a deployment at home. Starting fom Nintendo Wii I, a shif of focus has been recently observed in the gaming industry, in which Natural User Interfaces (NUl) for home consoles, have been gaining much interest. This has also spurred the development of new low-cost interfaces: devices like Microsoft Kinect 2 make it possible integrating highly reliable patient tracking into a low cost platform that can be deployed at home. In this paper, we show how specifcally designing games and using NUl devices, a platform that can be used to guide rehabilitation robustly can be built. Such a platform can be used for rehabilitation at home only if it is integrated inside a multi-level platform that allows remote supervision by the hospital clinicians. These ideas have been developed inside the Fitrehab project 3 and are being currently further pursued inside the Rewire project 4 fnanced under the FP7 framework, both coordinated by University of Milano. II. RELATED WORK The use of leT technology to help elder people in their daily life has been explored in many research projects and application areas. The Oldes project S ofered new technolog ical solutions to improve the quality of life of elder people through low-cost and easy to use entertainment devices and health care platforms. The Neuroweb project 6 tried to improve healthcare delivery through vertical integration of existing clinical and genetic databases using an online web platform. The BrainAble projecr7 conceived, designed, implemented and 1 http://www.nintendo.com 2 http://www.microsof.com/en-us/kinectforwindowsl 3 http://www.innovation4welfare.eu/2S7/subprojects/ftrehab.htm! 4http://www.rewire-project.eu/ S http://www.oldes.eu/ 6 http://nuke.neurowebkc.eu! 7 http://www.brainable.org