Design Recommendations for User-Centered Games for Multiple Sclerosis Balance Rehabilitation: An Evidence Review

Introduction: In recent years, exergames have emerged as a potential rehabilitation tool to address balance dysfunction in patients with multiple sclerosis (PwMS). Although preliminary findings have held promises, their overall effectiveness remains inconclusive, primarily because they rely on commercial games. This issue underscores the critical need for user-centered games tailored to patients' specific needs. Despite this necessity, the existing literature lacks established frameworks to develop such games, highlighting a gap. Therefore, the objective of this research was to propose the first evidence-based framework to create user-centered games for balance rehabilitation in PwMS. Materials and Methods: A two-step method was used to achieve this objective. The first step involved examining commercial games used in clinical studies, identifying their mechanics and limitations. The second step involved reviewing the literature to identify relevant findings that could help the development of user-centered games. Results: A set of targeted recommendations was proposed, emphasizing the need to develop adaptable games with focused therapeutic designs and to address the distinct balance impairments observed in PwMS effectively. A game prototype was also presented to illustrate the practical applications of these recommendations. Conclusion: This research establishes the first structured framework to design user-centered exergames for balance rehabilitation in PwMS. In addition to its theoretical insights, this framework provides actionable guidelines for developing clinically effective exergames that align with patient impairments and therapeutic needs. Ultimately, this work will contribute to improved therapeutic outcomes, enhanced patient care, and advancements in both rehabilitation and game design fields.