Feasibility of an adaptive serious game system for stroke rehabilitation in a Low to Middle Income country: analysis, design, and evaluation

Conventional stroke rehabilitation often suffers from low adherence due to its monotonous nature. Although serious games offer an engaging alternative, their feasibility in resource-limited settings in developing countries remains underexplored. This study evaluates the acceptance of an adaptive serious game system among stroke survivors in Iran. A cross-sectional feasibility study investigated the potential of using exercise games for stroke rehabilitation in an Iranian clinical setting. The intervention employed a custom-developed adaptive system featuring four adjustable-level exercise games designed to target upper-limb motor function. The system included a calibration feature to tailor the range of motion (ROM) to the capabilities of each stroke survivor. Participants evaluated the system using a structured questionnaire based on the Technology Acceptance Model (TAM), assessing perceived usefulness, attitude, perceived ease of use, and intention to use. Ten participants with chronic stroke (8 males, 2 females; mean age = 60 ± 14.34 years) with a mean baseline FMA-UE score of 42.50 ± 6.80 participated in supervised sessions. Participants reported high perceived usefulness (0.83) and a positive attitude (0.87), indicating that the system was considered beneficial for rehabilitation. However, perceived ease of use (0.67) and intention to use (0.64) were moderate, likely reflecting the learning curve associated with digital technology in this demographic. Importantly, the adaptive calibration minimized pain and enhanced engagement. The adaptive serious gaming system demonstrates feasibility and high levels of engagement and satisfaction for upper-limb rehabilitation in stroke survivors in a developing country context. Participants found the games comprehensible, easy to use, useful, and enjoyable, suggesting that tailored technological interventions can be successfully implemented in this healthcare setting.