Gamifying therapy

Another benefit of such an approach is that children can continue working on their therapy goals at home after the therapy session is completed. All the child has to do is to put on the device and play the game


Just imagine having stiff muscles, uncontrollable movements, poor balance or lack of coordination? It sounds scary, but this sums up what a child with Cerebral Palsy (CP) goes through daily.

CP is a group of disorders, which affect movement. Data shows that out of every 400 births, at least one child is born with this disability. As a result of the disorder, the developing brain is damaged, which affects the child’s ability to control the muscles of his body. Even though there are different CP symptoms, all those who suffer from it have problems with movement and posture. Those who experience mild CP may walk without requiring any help, but those on the other end may be unable to walk at all.

Even though there is no cure for CP, treatment can significantly improve the lives of these children. It might include medicine, surgery, braces, or even therapy, to name a few. Of course, it really depends on the condition of the child.

In 2020, the University of Malta (UM), together with Invent3D ltd and Humain ltd, launched the SMARTCLAP project, a smart user-centred product-service system for evaluating and developing functional hand skills in children with Cerebral Palsy. The project led by Prof. Ing. Philip Farrugia, from the Department of Industrial and Manufacturing Engineering, UM, is funded by the Malta Council for Science and Technology (project reference R&I-2019-003-T).

It makes use of User-Centred Design to understand the basic needs of these children. The overall goal is to create a revolutionary product that monitors the child’s progress and personalised interaction.

The product in question is taking the shape of a wearable device, whose primary function is to capture the child’s hand movement and relay them back to a computerised system. This information is then used during therapeutic activities used during a paediatric occupational therapy session.

The role of the OT is to enable children to participate in daily life at home, school, and within the community by developing the skills needed to experience independence and life satisfaction. These skills include everyday activities like playing, learning self-care, socialising and carrying out daily roles or routines.

Through activity analysis, the OT can adapt such activities to support social, physical, cognitive and sensory-motor skills, including fine motor function and posture. By assisting children in repeating different functional movements, the child learns and consolidates other motor plans and patterns applied to daily tasks.

Evidence-based research has shown that enjoyment is key to participation. It is no secret that very few children enjoy doing therapeutic exercises as most are not enjoyable! The SMARTCLAP project is unique because it offers a fun way of performing these crucial activities through a game. The game follows similar instructions provided by the OT. But since it is a game made up of animated characters living in a colourful virtual world, children will be more receptive to playing it. The game controls are all handled through the device being developed as part of the project.

Children use the movement of their hands or their fingers to control what’s going on throughout the game. This approach helps children to have fun by interacting with the game through hand movements during play. Without knowing it, they are also indirectly doing therapy.

The theory behind this approach is generally referred to as gamification. Gamification is the application of game-design elements and game principles in non-game contexts. In this case, it is used as part of therapy, but it can be used in any context in reality. Several studies have shown that gamification works, and in various cases, the performance of the individual increases drastically. Such approaches increase children’s engagement by providing incentives for them to pay attention and complete activities. Rewards given throughout the game can encourage better listening and observation. When the child is focused, the likelihood of absorbing the information presented and performing the required actions is increased.

Another benefit of such an approach is that children can continue working on their therapy goals at home after the therapy session is completed. All the child has to do is to put on the device and play the game.

Of course, this project is still in its infancy, and there is still a long way to go. However, following several focus groups held with children with cerebral palsy, their guardians, and other professionals, we are now in the process of shaping the final product. Through our work, we can make therapy fun. As a result, help children lead a more independent life, develop their ability to play, boost their confidence and improve their overall quality of life.

The project team is composed of a mix of academics and experts from various disciplines. Prof. Ing. Philip Farrugia, Mr Matthew Bonello and Mrs Nathalie Buhagiar pursue a user-centred design philosophy to develop the device. Prof. Ing. Simon Fabri, Dr Ing. Mario Farrugia and Dr Ing. Owen Casha are developing the hardware and software to capture motions. Whilst myself and Ing. David Sciberras handle the gamification and 3D printing aspects, respectively. More project details about the project are available at

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