Beyond Score-Based Gamification: Designing Spatiotemporal and Musical Experiences for VR Neck Rehabilitation

Abstract

Pain-related anxiety and fear of movement are major barriers to adherence and therapeutic outcomes in rehabilitation exercises for chronic neck pain. Virtual reality enables the design of immersive experiences that can transform repetitive therapeutic movements into engaging and emotionally supportive interactions. In this exploratory work, we investigate how experience-oriented gamification can reduce anxiety and improve user experience during VR-based neck range-of-motion exercises. We introduce two novel interaction paradigms that embed therapeutic neck movements within multisensory VR experiences. The first paradigm, Spatiotemporal Progression, couples head-tracked trajectories with environmental progression in a tropical island setting, where movement segments dynamically transform time of day, weather, and spatial location as experiential rewards. The second paradigm, Musical Interaction, maps movement segments to meditative music notes layered with relaxing ambient soundscapes. We evaluate these designs against a conventional score-based gamification baseline in a controlled user study with 20 non-patient participants. We assess usability and user experience through subjective measures, exercise performance with motion tracking, and anxiety modulation using the Subjective Units of Distress Scale, heart rate, and skin conductance. Our findings suggest that, in comparison with traditional score-based gamification design, immersive environmental and musical feedback show better potential to reduce anxiety and improve user experience, with little to no impact on successful performance of the exercise. Our preliminary results highlight the potential value of experience-based interaction design for VR rehabilitation, suggesting an alternative to performance-centric gamification that prioritizes emotional engagement without compromising therapeutic efficacy.