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Blogpost by Eva Swinnen

  • November 20, 2020

Muscle strengthening in patients with motor or neuromuscular disorders, let's play the Ghostly game! 


Patients with motor or neuromuscular disorders are often treated by a physiotherapist. But that is not always enough for successful rehabilitation. Getting patients to actively practice at home outside the therapy-time remains a major challenge (1). To increase the motivation of the patients, computer, tablet or smartphone games can be implemented (2,3). Besides this, motivation, active participation and interaction (all elements stimulated by gaming) are related to better treatment outcomes and so important elements for successful rehabilitation. 


How the game is developed

A team of computer engineers from the Vrije Universiteit Brussel has developed a smartphone game named “Ghostly”.( With Ghostly, patients can move an avatar by using specific muscles in their body. This rehabilitation game has recently won awards in America. The game, which is currently available for Android, is based on the principle of electromyography. This is a technique in which the electrical activity of muscles and nerves is measured via sensors on the patient's skin. Such activity occurs when the brain stimulates a muscle to act.

With “Ghostly”, such sensors are applied on the patient on the muscle to be trained. These sensors register the muscle activity and then send that information to the game software, which in turn translates it into movements in the game itself. This allows the patient to make the main character in the game world run, jump, dive, for example, to collect coins or outwit enemies. “Ghostly” consists of different levels and the intention is that patients successfully reach the end of a level with the highest possible score and then unlock the next, but more difficult level. 

The goal of Ghostly is twofold. First, it allows us to train very specific and different muscles in various but very effective ways. Patients can only play if they use that particular muscle. This of course benefits the patient. In addition, such a game is a fun and challenging way to rehabilitate. The researchers’ game consciously opted for an adventurous gaming format based on the example of Super Mario that everyone knows and can play.


Next steps in research and implementation in practice

The app has been tested by several therapists in neurological rehabilitation. In the coming weeks it will also be used at the Covid-19 department of the University Hospital in Brussels. Together with the rehabilitation research (RERE) group, further research will now be conducted about the effectiveness and user-experiences of this game in elderly and in neurological patients. All with the aim of developing an effective and user-friendly app specifically for rehabilitation objectives. The long-term goal is to implement this app in clinical centers, hospitals and private practices for the rehabilitation of different types of neurological and musculoskeletal patients as well as in the elderly population.


Eva Swinnen

Professor neurological rehabilitation and rehabilitation technology of the Rehabilitation Research Group. 


References and further reading: 

1. Chen Y, Abel KT, Janecek JT, Chen Y, Zheng K, Cramer SC. Home-based technologies for stroke rehabilitation: A systematic review. Int J Med Inform. 2019 Mar;123:11-22. doi: 10.1016/j.ijmedinf.2018.12.001. Epub 2018 Dec 11. PMID: 30654899; PMCID: PMC6814146.


2. Perrochon A, Borel B, Istrate D, Compagnat M, Daviet JC. Exercise-based games interventions at home in individuals with a neurological disease: A systematic review and meta-analysis. Ann Phys Rehabil Med. 2019 Sep;62(5):366-378. doi: 10.1016/ Epub 2019 May 9. PMID: 31078706.


3. Bonnechère B, Jansen B, Omelina L, Van Sint Jan S. The use of commercial video games in rehabilitation: a systematic review. Int J Rehabil Res. 2016 Dec;39(4):277-290. doi: 10.1097/MRR.0000000000000190. PMID: 27508968.