Designing Multiuser VR Rehabilitation Games
Balancing Semi-Structured Play and Clinical Structure for Engagement and Care Support
DOI:
https://doi.org/10.54337/aau.icdvrat26.06Abstract
Virtual reality (VR) can increase motivation and access in stroke rehabilitation, but designers must balance engaging play with clinically meaningful activity. We present En-ACT, a multiuser VR system for Meta Quest headsets combining semi-structured social play, structured assessment-style tasks, and an AI-supported virtual physiotherapy assistant. We report an early Patient and Public Involvement (PPI) evaluation with six health professional lecturers and a consultation with two NHS occupational therapists. Feedback
was strongly positive: participants highlighted the motivational benefits of playful shared activities, the clinical relevance of structured tasks such as a virtual Box and Block Test, and the potential of multiuser VR to reduce isolation and support remote care. We argue that future platforms should treat social presence, adaptable game mechanics, and measurable therapeutic tasks as complementary rather than competing goals, with the multiuser layer acting as “social glue”.
References
Darryl Charles, Dominic Holmes, Therese Charles, and Suzanne McDonough. Virtual reality design for stroke rehabilitation. Advances in Experimental Medicine and Biology, 1235:53–87, 2020. doi: 10.1007/978-3-030-37639-0 4.
Peter Langhorne, Julie Bernhardt, and Gert Kwakkel. Stroke rehabilitation. The Lancet, 377(9778): 1693–1702, 2011.
Virgil Mathiowetz, Gloria Volland, Nancy Kashman, and Karen Weber. Adult norms for the box and block test of manual dexterity. American Journal of Occupational Therapy, 39(6):386–391, 1985.
Catherine S Oh, Jeremy N Bailenson, and Gregory F Welch. A systematic review of social presence: Definition, antecedents, and implications. Frontiers in Robotics and AI, 5:114, 2018.
S´ergio Oliveira, Bernardo Marques, Paula Amorim, and Beatriz Sousa Santos. Collaborative virtual reality serious games as a therapeutic medium for stroke survivors at a rehabilitation center. In 2025 IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW), pages 1051–1058. IEEE, 2025. doi: 10.1109/VRW66409.2025.00212.
Alexandra Retevoi, Giada Devittori, Tobias Kowatsch, and Olivier Lambercy. Building conversational agents for stroke rehabilitation: An evaluation of large language models and retrieval augmented generation. In Proceedings of the 24th ACM International Conference on Intelligent Virtual Agents (IVA ’24), pages 1–4. ACM, 2024. doi: 10.1145/3652988.3673924.
Juan J S´anchez-Gil, Aurora S´aez-Manzano, Rafael L´opez-Luque, Juan-Jos´e Ochoa-Sep´ulveda, and Eduardo Ca˜nete-Carmona. Gamified devices for stroke rehabilitation: A systematic review. Computer Methods and Programs in Biomedicine, 258:108476, 2025. doi: 10.1016/j.cmpb.2024.108476.
Mohsen Soleimani, Marjan Ghazisaeedi, and Soroush Heydari. The efficacy of virtual reality for upper limb rehabilitation in stroke patients: a systematic review and meta-analysis. BMC Medical Informatics and Decision Making, 24(1):135, 2024. doi: 10.1186/s12911-024-02534-y.
Kelly Thielbar, Nicole Spencer, Daria Tsoupikova, Mohammad Ghassemi, and Derek Kamper. Utilizing multi-user virtual reality to bring clinical therapy into stroke survivors’ homes. Journal of Hand Therapy, 33(2):246–253, 2020. doi: 10.1016/j.jht.2020.01.006.
