Games for physical therapy can motivate patients, and HCI research has provided various recommendations for their design. However, such recommendations often remain at a high level: They are rarely reviewed with patients or appraised through application to game design and analysis. We address this gap by refining and operationalizing existing lessons for therapeutic games for young people. First, we report on semi-structured interviews with young people (aged 7–16) and parents, reviewing the lessons. Second, we operationalize them using an established collection of game design patterns to provide concrete guidance for game design and analysis. We critically appraise our approach through application to two games for physical therapy, Liberi and Wii Fit. Results show that high-level design implications can be made actionable using existing game design patterns, and we contribute a practical approach for the analysis and design of games for physical therapy.

While it is widely assumed that games can engage patients in therapy through their inherent ‘motivational pull’, relatively little attention has been paid to what HCI games research can learn from strategies employed by therapists. We address this gap by leveraging Self-Determination Theory (SDT) and its mini-theories Basic Psychological Needs Theory and Organismic Integration Theory as a theoretical lens on physical therapy for children and adolescents. Results from in-depth interviews with twelve therapists show that they carefully adjust sessions to allow patients to experience competence, making more comprehensive adjustments than currently offered by games. Additionally, we highlight how therapists leverage their relationship with patients to support motivation, but struggle to reconcile meaningful experiences of autonomy with therapeutic goals. On this basis, we reflect on implications for researchers and designers who create games for physical therapy, and the potential of SDT to provide a foundation for game design and therapeutic practice.

Gamification is a popular technique to improve task engagement, and has broadly been deployed in health and education to a point where many users now expect gameful experiences in these settings. However, gamification has been criticised for being a potential obstacle to the experience of reflection. Motivated by this tension, our work examines how the addition of gamification to a Virtual Reality simulation of breastfeeding impacts player experience and reflection. Using a within-subjects design, we invited 34 participants to take part in a mixed-methods evaluation of a gamified and non-gamified variant of the simulation that included questionnaires and semi-structured interviews. Results show that gamification improved player experience and encouraged players to reflect on goal achievement and performance. However, it also diverted players’ attention from nuances within the act of nursing. Drawing on our findings, we contribute considerations for the application of gamification in personal and sensitive settings such as breastfeeding.