Stroke is a leading cause of disability, and with the stroke survivor population rising in most countries it is increasingly difficult to provide optimal treatment to patients once they return home. Assistive technology solutions can potentially contribute to meeting demand, and also be cost effective. In this chapter, we consider the design and development of engaging serious virtual reality (VR) games for upper arm stroke rehabilitation. Fundamental design principles are summarised and related to our experience of creating game-based VR rehabilitation. The application of ideas from psychology, particularly behavioural change and flow theory are discussed, as well as related learning and gamification principles. We address how to manage differences between people through design, user profiling, and intelligent dynamic system behaviour, and we also explore how to account for variation in stroke survivor capability and personality. The idea of a hero's journey as a metaphor for stroke recovery is introduced and we discuss how this metaphor may guide system design, its relationship to game design principles, and how patient narratives and embedded stories might support engagement with treatment. An overview of our previous work is summarised and we discuss how our experience and increased knowledge and capability has informed improved approaches to development processes. Finally, our approach is illustrated with reference to a recent EU project.
Keywords: Design; Gamification; Stroke rehabilitation; Upper limb; Virtual reality.