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 engagement, motivation, and functional recovery. This study reviews 68 gamified prototypes for post-stroke neurorehabilitation published between 2019 and 2023, integrating hardware, software, and gamification design criteria under a unified framework. Technological trends, therapeutic domains, and gamification components are analyzed, yielding eight overarching guidelines for developing patient-centered devices. Results confirm a predominance of solutions targeting the functional domain (79% motor), an expansion of immersive environments (VR/IVR, 66%), and the emergence of hybrid systems that combine robotics, sensors, and artificial intelligence algorithms to adapt assistance in real time. However, affective and social domains remain underrepresented, and clinical interoperability continues to pose challenges. Based on current design criteria, future directions propose advanced gamification frameworks that foster intrinsic motivation. By laying the groundwork for more motivating, personalized, and cost-effective gamified therapies, this work offers a practical guide for engineers, therapists, and developers.