Upper limb paralysis after stroke significantly reduces patients' quality of life (QOL). In recent years, various rehabilitation approaches have been developed to address this issue, among which gamification and virtual reality (VR) applications have gained increasing attention. Meanwhile, the advancement of STEM education has led to the development of accessible game production environments in schools, enabling students to realize their ideas through game development.
This study applies such game development environments to clinical rehabilitation settings, aiming to create a system that allows therapists to offer personalized training games for their patients. We explore the feasibility and effectiveness of developing training games that therapists can use and potentially create themselves, without adding operational burden in clinical practice.

Background
Previous studies have demonstrated the effectiveness of using computer programs and robotic systems for supporting upper limb rehabilitation in stroke patients. However, many of these systems require complex operation, placing a heavy burden on clinical staff.
In parallel, the rise of integrated development environments such as Unity has significantly lowered the barriers to PC game development, enabling non-specialists to create high-quality applications. Based on this trend, we developed a rehabilitation support game for upper limb training using a tablet PC and the Unity platform.

Methods
The system displays game pieces on a tablet PC screen that appear from the top and fall downward. Users are required to "pinch" the pieces using their thumb and index finger. When the pinch is successfully detected, the system plays a sound and removes the piece from the screen. The goal of the game is to eliminate as many pieces as possible within a given time limit.
In occupational therapy, pegboards are commonly used to assess and train basic upper limb movements. To replicate the pinching action more realistically in the game environment, we developed a custom stylus-like tool that simulates the pinching motion on the tablet screen. This device acts as a functional substitute for fingers, allowing users to interact with the game similarly to how they would with a physical pegboard.
To evaluate usability and engagement, we conducted a survey with 30 healthy older adults aged 70 and above, a demographic at high risk for stroke. Over 95% of participants provided favorable feedback, suggesting high user acceptance of the system.

Conclusion
For effective rehabilitation of upper limb paralysis, comprehensive and quantitative interventions that address both motor and cognitive functions are essential. While VR-based rehabilitation systems are increasingly introduced in clinical settings, achieving both sophistication and user-friendliness remains a challenge.
This study proposes a lightweight and accessible training system that can be used not only in hospital rooms but also in home environments. The Unity platform proved to be a suitable tool for developing gamified rehabilitation applications with a focus on ease of use. Positive responses from elderly participants support the potential efficacy and acceptability of the proposed system.

Keywords: Gamification, Occupational Therapy, Upper Limb Rehabilitation.