Hardware and software design trends and considerations in gamified stroke rehabilitation: Results from a systematic review

Gamification in stroke rehabilitation is a method that applies game-design elements to enhance patient en- gagement, motivation, and functional recovery. This study reviews 68 gamified prototypes for post-stroke neuroreha- bilitation published between 2019 and 2023, integrating hard- ware, software, and gamification design criteria under a uni- fied framework. Technological trends, therapeutic domains, and gamification components are analyzed, yielding eight overarching guidelines for developing patient-centered de- vices. Results confirm a predominance of solutions target- ing the functional domain (79% motor), an expansion of im- mersive environments (VR/IVR, 66%), and the emergence of hybrid systems that combine robotics, sensors, and artifi- cial intelligence algorithms to adapt assistance in real time. However, affective and social domains remain underrepre- sented, and clinical interoperability continues to pose chal- lenges. Based on current design criteria, future directions propose advanced gamification frameworks that foster in- trinsic motivation. By laying the groundwork for more mo- tivating, personalized, and cost-effective gamified therapies, this work offers a practical guide for engineers, therapists, and developers.