In this thesis, we contribute to the field of rehabilitation robotics by designing haptic-enabled
tangible robot-based activities and exploring their added value for therapy and assistance.
The research specifically focuses on the design and development of gamified robot-enhanced
therapy and training activities for patients suffering from neurological disorders, children
with neurodevelopmental difficulties and elderly. We adopted an iterative design approach to
develop adaptive components tailored to the specific needs of the multiple target groups, and
introduced gamification as a way to increase users' engagement with the training.

The key accomplishments of our research are: (1) We designed and developed robot-mediated
gamified handwriting activities by iteratively adapting, testing and integrating the system
into occupational therapy environments for children with neurodevelopmental difficulties.
We showed that haptic-enabled tangible robots can be a useful tool for handwriting training
in multi-child therapy settings. (2) We designed and developed a novel robot-enhanced
upper limb rehabilitation game, the Tangible Pacman Game, with various adaptive and
configurable components and game elements. We showed that these adaptation elements
allow for personalized interventions tailored to individuals with varying level of impairments,
ranging from stroke patients, to older adults and to children with hemiplegia, overall aged 3 to
77 years old. (3) We investigated the effectiveness of our tangible robot-mediated activities
with chronic stroke patients, and showed the effect of gamification on performance outcomes
as well as patients' preferences via a controlled study. We showed that gamification leads to a
more controlled motor performance and discovered that there are patients who do not like
gamification, or for whom gamification is not well suited. (4) We extended the application
of our approach into the context of healthy aging, investigating the effect of the Tangible
Pacman Game and its game elements on the motor performance of the elderly. We explored
age-related differences within a controlled study with a young control group, and showed
positive motor learning and skill transfer. (5) We developed further variants of our proposed
system with additional adaptations and features to increase its effectiveness and acceptance
by: (5a) Designing dynamic game spaces with rearrangeable tiles, (5b) Incorporating IMUs
to our games to detect and prevent compensatory motions, (5c) Developing co-located and
remote multiplayer game modalities to promote social interaction, and elevating the tangible
robots to the online space to bridge the patient's interaction with therapists or family members
in the context of recent social distancing rules.

Throughout this thesis, we aimed to strike a balance between exploration and exploitation.
In the exploration side, we interleaved design, development and testing in multiple steps
involving 7 therapy centers in 5 cities in 2 countries. This allowed us to successfully introduce
and adapt our system to different therapy settings and persons affected by a large range
of neurological difficulties and impairment levels. In the exploitation side, we conducted
controlled studies, showing the effectiveness of our interventions on real target users. In total,
the designs in this thesis touched 122 healthy participants, 96 target users and 18 domain
professionals.