Personalized Game Design for Balance Rehabilitation in Multiple Sclerosis: Insights from Neuroimaging and Neurophysiological Test

The application of exergames as tools for balance rehabilitation in patients with multiple sclerosis (PwMS) has demonstrated promising results. However, despite these findings, the efficacy of these games remains inconclusive, largely due to the reliance on commercially available games. This highlights the necessity for the design of personalized games that better address patients' needs. The development of such games requires an understanding of the mechanisms underlying balance dysfunction in PwMS. Previous research has identified impairments in sensory integration and reweighting process among the key contributors to this issue. These observations were based on correlations between balance measures and both neuroimaging and neurophysiological test findings from various regions of the central nervous system (CNS). Consequently, this study aimed to develop a personalized game that specifically targets impairments in sensory integration and reweighting process, thereby addressing these limitations and observations noted in the existing knowledge. Our objective was accomplished utilizing Unity, a three-dimensional game engine widely employed in video game development. As a result, we developed a game prototype that incorporates specific in-game features designed to facilitate balance training under varying sensory conditions, such as eyes-open and eyes-closed conditions. The incorporation of these features into the game design has the potential to improve rehabilitation outcomes, thereby contributing to advancements in both the fields of game design and neurorehabilitation. Future research will evaluate the effectiveness of the game prototype in improving balance control under variable sensory conditions.