Upper-limb impairments due to stroke can severely affect the quality of life in patients. Scientific evidence supports that repetitive rehabilitation exercises can improve motor ability in stroke patients. Rehabilitation games gained tremendous interest among researchers and clinicians because of their potential to make the seemingly mundane, enduring rehabilitation therapies more engaging. However, routine and longitudinal use of rehabilitation games in real-world clinical settings has not been investigated in depth. Particularly, we know little about current practices, challenges, and their potential impacts on therapeutic outcomes. To address this gap, we established a partnership with a rehabilitation hospital where game-assisted rehabilitation was routinely employed over a 2-year period. We then conducted an observational study, in which we observed 11 game-assisted therapy sessions and interviewed 15 therapists who moderated the therapy. Significant findings include (1) different engagement patterns of stroke patients in game-assisted therapy, (2) imperative roles of therapists in moderating games and challenges that therapists face during game-assisted therapy, and (3) lack of support for therapists in delivering patient-centered, personalized therapy to individual stroke patients. Furthermore, we discuss design implications for more effective rehabilitation game therapies that take into consideration both patients and therapists and their specific needs.

Individuals with cognitive impairments are evaluated using clinically validated cognitive assessment tools, which need to be administered by trained therapists. This serves as a major barrier for frequent and longitudinal monitoring of patients' cognitive impairment level. We introduce Neuro-World, a set of six mobile games designed to challenge visuospatial short-term memory and selective attention, which allows one to self-administer the assessment of his/her cognitive impairment level. Game performance is analyzed to estimate a widely accepted clinical measure, the mini mental state examination (MMSE), which highlights the translational impact of the system in real-world settings. We collected game-specific performance data from 12 post-stroke patients at baseline and a three-month follow-up, which were used to train supervised machine learning models to estimate the corresponding MMSE scores. The results presented herein show that the proposed approach can estimate the MMSE scores with a normalized root mean square error of 5.75%. We also validate the system's responsiveness to longitudinal changes in cognitive impairment level and demonstrate the system's positive usability in cognitively impaired individuals and their willingness to adhere to the longitudinal use. This study demonstrates that Neuro-world has great potential to be used to evaluate the cognitive impairment level and monitor its long-term change. This study enables new clinical and research opportunities for accurate, longitudinal assessment of cognitive function via mobile games.