“It Depends”: Re-Authoring Play Through Clinical Reasoning in Wearable AR Rehab Games

Paper Title

“It Depends”: Re-Authoring Play Through Clinical Reasoning in Wearable AR Rehab Games

Publication Info

• Topic area: Integration of augmented reality (AR) games into physical therapy practice.
• Keywords: Augmented reality, physical therapy, rehabilitation games, clinical reasoning, wearable AR, therapist-centered design, patient engagement, motor recovery, personalized therapy, situated play.

Background and Problem

• Problem / challenge: Despite the potential of AR games to enhance rehabilitation, their adoption in clinical practice remains limited due to a lack of therapist-centered design principles and challenges in integrating AR into routine workflows.
• Significance: Embedding AR games into physical therapy could transform repetitive exercises into engaging, personalized, and effective rehabilitation activities, improving patient adherence and outcomes.
• Motivation and related work: Prior work has demonstrated the benefits of XR technologies in rehabilitation but has focused largely on lab-based prototypes or short-term pilots. Persistent barriers include hardware complexity, limited therapist training, and the absence of frameworks that align AR games with therapists' clinical reasoning and workflows.

Solution

• Proposed approach: Development of a clinical reasoning–based framework for designing AR rehabilitation games that align with therapists' expertise, treatment goals, and daily practice constraints.
• Novelty:
  1. Introduction of three propositions for AR play: co-authored, situated, and dual.
  2. Adaptation of the WHO’s ICF framework to AR game design, emphasizing therapist-centered control and adaptability.
  3. Design principles and guidelines for creating AR games that integrate into physical therapy workflows.
• Procedure and key techniques:
  • Systematic review of 132 AR applications, narrowing to 21 movement-relevant games and selecting four for in-depth study.
  • Playtesting and interviews with 14 licensed physical therapists to analyze how they adapt AR games to clinical contexts.
  • Qualitative coding and thematic analysis to derive design principles and a conceptual framework.

Results

• Concrete findings:
  • AR games are co-authored by therapists, who adapt movement parameters, progression, and difficulty to patient needs.
  • Play is situated, with its meaning and application varying by patient condition, rehabilitation stage, and treatment setting.
  • Play is dual, addressing both physical recovery and psychological factors like motivation and self-efficacy.
• Advantage over baselines:
  • The proposed framework emphasizes therapist agency, enabling real-time adaptation and alignment with clinical reasoning, unlike prior systems that rely on fixed or auto-tuned parameters.
• Experiments / evaluation:
  • Playtesting of four AR games (e.g., "3 Dots–Pinch," "Squishy Run") with 10 licensed PTs.
  • Analysis of therapist feedback on movement relevance, cognitive engagement, and clinical suitability.
  • Development of eight design implications, such as progressive postural flexibility and therapist-editable play spaces.
• Limitations and future work:
  • The study did not include patient participants or long-term clinical deployment, limiting claims about therapeutic effectiveness.
  • Sampling skewed toward early- and late-career PTs, with limited representation of mid-career professionals.
  • Findings are specific to Snap Spectacles and may not generalize to other AR platforms.

Summary

This study proposes a clinical reasoning–based framework for integrating lightweight AR glasses into physical therapy, emphasizing therapist-centered design and adaptability. By analyzing how licensed PTs adapt AR games to diverse clinical contexts, the authors identify three key lenses—co-authorship, situated play, and duality—that inform design principles for AR rehabilitation systems. The findings highlight the potential of AR to enhance patient engagement, adherence, and recovery by aligning digital play with therapists' expertise and workflows. Future work should extend these insights to patient trials and broader deployment settings.