Computer-Aided Rehabilitation for the Carpal Tunnel Syndrome using Exergames

  • Ioannis Pachoulakis Department of Informatics Engineering, Technological Educational Institute of Crete Heraklion, Crete,
  • Diana Tsilidi Department of Informatics Engineering, Technological Educational Institute of Crete Heraklion, Crete,
  • Anastasia Analyti Institute of Computer Science, Foundation for Research and Technology – Hellas (FORTH) Vassilika Vouton, Heraklion, Crete, Greece;
Keywords: Carpal tunnel syndrome, Traditional Physiotherapy, Computer-aided rehabilitation, Game-based Rehabilitation


Carpal tunnel syndrome (CTS) has reached epidemic proportions as the surgical release of the transverse carpal ligament is included in the top ten most common operations, which significantly affects health care costs. Additional costs to consider include time off work, lost wages, and diminished workplace productivity. Non-surgical management of CTS such as splinting, non-steroidal anti-inflammatory medication, steroid injections and ergonomic modification of the work habits can help in early cases, but can be ineffective in more advanced cases, often leading to recommendation for surgical treatment. It is possible to attain meaningful physiotherapy results through interesting and engaging computer-based games which provide the motivation to continue therapy at home, even away from direct therapist supervision. Motivation and immersion in the game scenario also helps patients forget that they are performing exercises as a part of their therapy. Accordingly, we present a Unity3D Fly-A-Plane game, the scenario of which combines CTS-specific physiotherapy exercises in a natural game scenario to fly an airplane through a sequence of hoops in the sky. The game employs the Leap Motion sensor, whose detailed wrist and hand (including fingers) tracking abilities make it an excellent hardware platform for rehabilitation oriented exercises intended for patients suffering from CTS.


(1) M. Chammas, J. Boretto, L. M. Burmann, R. M. Ramos, F. C. dos Santos Neto, and J. B. Silva, “Carpal tunnel syndrome – Part I (anatomy, physiology, etiology and diagnosis),” Rev. Bras. Ortop. (English Ed., vol. 49, no. 5, pp. 429–436, 2014.

(2) A. Alexander, “Carpal tunnel syndrome - Information for Physiotherapists,” Oxford University Hospitals NHS Trust. 2014.

(3) T. Gregory, D. Chamblin, J. Firestone, A. Friadman, H. Chirstopher, P. Douglas, M. Kliot, R. Lawrence, E. Thomas, B. Nicholas, D. Michael, T. Kjerulf, K. O’Bara, S. Carlson, and J. G, “Work-Related Carpal Tunnel Syndrome Diagnosis and Treatment Guideline,” Washingtonworkingsolutions.Net. Washington State Department of Labor & Industries, pp. 1–18, 2017.

(4) M. Abdur Rahman, “Multisensor Serious Game-Based Therapy Environment for Hemiplegic Patients,” Int. J. Distrib. Sens. Networks, vol. 11, no. 6, p. 910482, Jun. 2015.

(5) G. Alankus, R. Proffitt, C. Kelleher, and J. Engsberg, “Stroke Therapy through Motion-Based Games,” ACM Trans. Access. Comput., vol. 4, no. 1, pp. 1–35, Nov. 2011.

(6) A. Neil, S. Ens, R. Pelletier, T. Jarus, and D. Rand, “Sony PlayStation EyeToy elicits higher levels of movement than the Nintendo Wii: Implications for stroke rehabilitation,” Eur. J. Phys. Rehabil. Med., vol. 49, no. 1, pp. 13–21, 2013.

(7) A. M. D. C. Souza, M. a Gadelha, E. a G. Coutinho, and S. R. Santos, “A video-tracking based serious game for motor rehabilitation of post-stroke hand impairment,” SBC J. 3D Interact. Syst., vol. 3, no. 2, pp. 37–46, 2012.

(8) A. De Graaf, “Gaming Motion tracking technologies for rehabilitation,” Study Tour Pixel 2010, pp. 1–6, 2010.

(9) A. Gupta, “AXLR8R Spotlight: Making Physical Therapy Fun with Ten Ton Raygun,” 2017. [Online]. Available:

(10) “What if Physical Rehabilitation Were as Easy as Playing a Video Game? - Not Impossible.” [Online]. Available: [Accessed: 05-Mar-2016].

(11) D. L. McLellan and M. Swash, “Longitudinal sliding of the median nerve during movements of the upper limb,” J. Neurol. Neurosurg. Psychiatry, vol. 39, no. 6, pp. 566–570, 1976.

(12) R. M. Szabo, B. K. Bay, N. A. Sharkey, and C. Gaut, “Median nerve displacement through the carpal canal,” J. Hand Surg. Am., vol. 19, no. 6, pp. 901–906, Nov. 1994.

(13) S. L. Michlovitz, “Conservative Interventions for Carpal Tunnel Syndrome,” J. Orthop. Sport. Phys. Ther., vol. 34, no. 10, pp. 589–600, Oct. 2004.

(14) L. M. Rozmaryn, S. Dovelle, E. R. Rothman, K. Gorman, K. M. Olvey, and J. J. Bartko, “Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome,” J. Hand Ther., vol. 11, no. 3, pp. 171–179, Jul. 1998.

(15) K. Lohse, N. Shirzad, A. Verster, N. Hodges, and H. F. M. Van der Loos, “Video Games and Rehabilitation,” J. Neurol. Phys. Ther., vol. 37, no. 4, pp. 166–175, Dec. 2013.

(16) F. Anderson, M. Annett, and W. F. Bischof, “Lean on Wii: Physical rehabilitation with virtual reality Wii peripherals,” Stud. Health Technol. Inform., vol. 154, pp. 229–234, 2010.

(17) A. Y. Wang, “Games for Physical Therapy,” SIGCHI Conf., pp. 4–8, 2012.

(18) M. E. Kho, A. Damluji, J. M. Zanni, and D. M. Needham, “Feasibility and observed safety of interactive video games for physical rehabilitation in the intensive care unit: a case series,” J. Crit. Care, vol. 27, no. 2, p. 219.e1-219.e6, Apr. 2012.

(19) A. de Mauro, “Virtual Reality Based Rehabilitation and Game Technology,” in 1st International Workshop on Engineering Interactive Computing Systems for Medicine and Health Care (EICSMed 2011), co-located with the ACM SIGCHI Symposium on Engineering Interactive Computing Systems (EICS 2011), 2011, pp. 48–52.

(20) M. Khademi, H. Mousavi Hondori, A. McKenzie, L. Dodakian, C. V. Lopes, and S. C. Cramer, “Free-hand interaction with leap motion controller for stroke rehabilitation,” in Proceedings of the extended abstracts of the 32nd annual ACM conference on Human factors in computing systems - CHI EA ’14, 2014, pp. 1663–1668.

(21) L. Geurts, V. Vanden Abeele, J. Husson, F. Windey, M. Van Overveldt, J.-H. Annema, and S. Desmet, “Digital games for physical therapy: fulfilling the need for calibration and adaptation,” in Proceedings of the fifth international conference on Tangible, embedded, and embodied interaction - TEI ’11, 2011, vol. 53, p. 117.

(22) “Virtualrehab.” [Online]. Available:

(23) F. Weichert, D. Bachmann, B. Rudak, and D. Fisseler, “Analysis of the Accuracy and Robustness of the Leap Motion Controller,” Sensors, vol. 13, no. 5, pp. 6380–6393, May 2013.

(24) “Leap Motion API Reference.” [Online]. Available: [Accessed: 05-Mar-2016].

(25) J. Bae and A. Kim, “Design and Development of Unity3D Game Engine-Based Smart SNG (Social Network Game),” Int. J. Multimed. Ubiquitous Eng., vol. 9, no. 8, pp. 261–266, Aug. 2014.

(26) S. Wang, Z. Mao, C. Zeng, H. Gong, S. Li, and B. Chen, “A new method of virtual reality based on Unity3D,” 2010 18th Int. Conf. Geoinformatics, pp. 1–5, 2010.

(27) I. Pachoulakis and D. Tsilidi, “Technology-assisted Carpal Tunnel Syndrome Rehabilitation using serious games: the Roller Ball example,” Adv. Image Video Process., vol. 4, no. 4, Aug. 2016.

How to Cite
Pachoulakis, I., Tsilidi, D., & Analyti, A. (2018). Computer-Aided Rehabilitation for the Carpal Tunnel Syndrome using Exergames. European Journal of Applied Sciences, 6(2), 44.