The World Health Organization (WHO) describes rehabilitation as a process meant to enable people with different abilities to reach their optimal intellectual, physical, psychological, sensory and social functional levels, by providing them with the necessary tools they need to attain self-determination and independence. Specialists in this field are paediatric occupational therapists, whose focus is to assist children in developing the necessary skills to grow into adults who can engage in meaningful occupations and have satisfying lives. Paediatric occupational therapists take a holistic, strengths based and person-centred perspective, in which the focus is adapting the environment and/or tasks to engage the person through universal, targeted or intensive intervention. In all of these play is used as a primary tool in therapy. This may include equipment such as assistive devices to encourage children in order to reach their full potential.

As part of their intervention, occupational therapists assess and determine what kind of programme and device is required to support the participation of their client depending on the goals the person wants to achieve in therapy. The use of technology in therapy has made a great impact on people's lives, increasing their independence in various daily tasks.

Recent popular devices used in occupation therapy intervention, are exoskeleton in nature, for both the upper and the lower limbs. Such devices include sensors which record the movement executed by the client during operation, of either the lower or upper limb. The measured data is inputted in a computer. This data could be used to encourage the use to interact with the computer in order to play special games that allow the user to conduct the rehabilitation exercises unconsciously through the serious game displayed on the screen.

When considering rehabilitation for the upper limb, namely the forearm and hand; wearable glove-like exoskeleton devices, with in-built sensors, can be worn by the clients in order to detect motion of the fingers, hand and wrist. Through such a device, users can play various games to improve their motor skills and stimulate their brain for reorganisation. Such a device supports occupational therapists to reach the gaols of the specific child by increasing the motivation to use their hand and providing the "just right challenge", via this technological medium which appeals especially to young people. This provides a sense of enjoyment and accomplishment, which also can be carried out from the comfort of one's home.

Gamified therapy is becoming more captivating by including an element of extended reality (XR). XR refers to the combination of human interaction, including virtual and real environments which are generated via either wearables or computer technology. XR is being used in various sectors like e-commerce, healthcare and rehabilitation, engineering and leisure purposes, among others. In rehabilitation, through the previously mentioned smart wearable devices, clients can immerse themselves in serious games with a more realistic environment. Currently, the market only offers off-the-shelf wearable devices and games which might not be suitable for persons having motor impairments to use for rehabilitation purposes. Rehabilitation for medical conditions such as Parkinson's and brain injuries, including cognitive impairments, would benefit more from using tailor-made interactive wearable devices and games which are suitable for their specific needs.

Cerebral Palsy (CP) is a group of disorders that affect a person's ability to move. It is the most common motor disability in children and may constitute a lack of motor coordination, variation in muscle tone and involuntary movements that often result in speech delay, difficulty walking and using one's hands as well as other functional limitations. Persons with CP can benefit from tailor-made interactive wearable devices for rehabilitation purposes, since no two children with CP are the same in terms of variations in type and extent of motor abilities. Occupational therapists focus on client centred care to try to ensure that therapy matches each child's goals and needs. It is therefore essential for smart devices used in therapy, to be personalised for each individual child.

This aspect was highlighted, among other requirements, during a number of focus groups conducted by a group of researchers at the University of Malta with parents of children with cerebral palsy, occupational therapists and technical experts. These studies were executed online due to the Covid-19 pandemic restrictions and the goal was to gather insights from the various relevant stakeholders about crucial requirements to develop a smart rehabilitation device for children with CP. These different stakeholders were essential to capture both the viewpoint of professional experts as well as the future service users namely the parents and their children. Meanwhile, sessions with different children with CP were conducted to gather their different characteristics, get to know what they like and dislike, their interests and challenges in daily life as well as the anthropometric measurements to build their "Persona", which are profiles that will be used to develop the user-centred device.

Other crucial requirements identified from the focus groups were the flexibility of the device to cater for different children and their different needs, characteristics to be included in the game specifically for children with cerebral palsy and the importance of feedback from the game to act as a source of motivation, among other technical outcomes. The use of such a device in different environments was also discussed, as it would be beneficial to use the rehabilitation device both at home and school. Meanwhile, participants acknowledged the social aspects of the game to interact with their peers through multi-player environments, in either cooperative or competitive games. Another important criterion, which was identified is the element of personalisation. This enables the design of the game and the device according to the preferences of the child, including their interests, to increase their motivation and ultimately support positive behaviour. 

These findings are part of the project titled A smart user-centred product service system for evaluating and developing functional hand skills in children with Cerebral Palsy (SmartClap), which is a project funded by the Malta Council for Science and Technology (project reference R&I-2019-003-T). The project is led by Prof. Inġ. Philip Farrugia from the Department of Industrial and Manufacturing Engineering at the University of Malta. Other members of the research team are Matthew Bonello, Prof. Inġ. Simon G. Fabri, Prof. Alexiei Dingli, Dr Inġ. Owen Casha, Dr Inġ. Mario Farrugia, Nathalie Buhagiar and David Sciberras. The SmartClap team is endeavouring to jointly develop a smart wearable rehabilitation device and serious games for children with CP, in order to provide a fun way to conduct therapy and ultimately achieve the children's individual functional goals. Further project details can be reviewed at: https://www.um.edu.mt/projects/smartclap/.