Integration of persuasive elements into exergames: Application in the development of a novel gait rehabilitation system for children with musculoskeletal conditions

[Display omitted] •Application of the Persuasive System Design model for the development of therapeutic VG/VR exergames.•Gait rehabilitation system using biofeedback and gamified/virtual reality (VG/VR).•A method that supports the progression of therapy for VG/VR exergames.•Technique for measuring gait parameters related to subjects’ psycho-motor status. The main contribution of this paper is the application of the Persuasive System Design (PSD) model for the analysis and development of exergame systems to stimulate pediatric patients to adhere to short-term gait rehabilitation. It resulted in a novel therapy consisting of a video gaming and virtual reality (VG/VR) biofeedback system for treadmill gait rehabilitation, including a method for progressing the rehabilitation settings. During gait rehabilitation (GR) sessions, therapy settings need to be adjusted by physiotherapists, based on their clinical experience, to address the deficiencies of individuals while maximizing their motor functioning and maintaining their motivation. The system integrates persuasive elements, adjusted when physiotherapists progress the therapeutic settings, such as the treadmill speed, auditory feedback, and game challenges. We followed a scenario-based design method to develop the system, which comprised an observational study of conventional GR sessions and evaluations with 6 and 9 rehabilitation specialists who provided feedback about the system design. They perceived that the proposed method was valuable for physiotherapists to adapt the rehabilitation based on the children’s performance. Also, they remarked that the system’s visual and auditory stimulus would help engage the children in the therapy.