Development of an immersive Virtual Reality game for motor and cognitive rehabilitation in Multiple Sclerosis

Multiple Sclerosis (MS) is a progressive disease of the central nervous system. Among its symptoms, motor and cognitive impairments (from upper limb tremor to attention deficit) can severely affect the individual capability to perform activities of daily living. Consequently, motor and cognitive rehabilitation procedures constitute a priority for people with MS, and their beneficial effects have been proven. However, the effectiveness of the repetitive exercises adopted in rehabilitation typically depends on factors like the motivation of the patients, leading to difficulties in clinical compliance. Thus, engaging people with MS in performing the expected tasks is a challenge that must be faced for improving the individual adherence to the clinical procedures. A potential solution to this issue can derive from Virtual Reality (VR), considering how it has gained a lot of interest in the healthcare community. Studies have reported the positive and promising impact of serious games (especially exergames) and gamification in rehabilitation, paving the way for the potential of VR and the related technology, raising motivation and limiting fatigue in MS patients. Accordingly, this thesis presents the design and the development of an immersive video game that enables rehabilitation exercises in a playful and engaging context. Additionally, this interactive setting is enriched by biofeedback features to calibrate the difficulty of the game in real time to keep the user in a positive mental state. The game involves upper limb rehabilitation and cognitive rehabilitation, with a focus on dual-task. The developed game contains four phases that are played in sequence, each one proposes a particular exergame. After discussing the system design and development, the thesis focuses on the evaluation of the user experience - especially in terms of engagement - during the rehabilitation game session to obtain important data that can be used in the future to evaluate the effectiveness of the rehabilitation game over time.