Facial paralysis is a consequence of damage or injury to the facial nerve, resulting in functional impairments. A challenge of rehabilitation through exercise repetition is maintaining patients' engagement and motivation in the intensive and repetitive execution of the exercises necessary for successful rehabilitation [1]. Repetitive and intensive movements are recommended for progress in treatment [2], and the variety of movements has significant effects on patient recovery [3].

In motor rehabilitation, exergames—serious games that require physical exercise to play—add fun to exercises and allow patients to forget about their condition and focus on the game [4]. Studies conducted with games for motor rehabilitation have achieved promising results [5] on patient motivation and engagement [4]. This study aimed to co-design RG4Face—an exergame for facial rehabilitation.

Per its initial conception, RG4Face uses computer vision (via a camera) for capturing, recognizing, and estimating human facial movements. The game prototype was implemented via the MediaPipe face mesh [7] to enable the recognition and use of 1 movement (eg, raising eyebrows; ie, frontal muscle) to control game elements. The game involves a spaceship moving horizontally across the bottom of the captured video window and firing a projectile when face movement is detected. The main objective is to hit triangles that randomly appear on the player's face.

Table 1 presents participants’ suggestions during co-design, game requirements, and rationales.

RG4Face is in the testing phase and, prior to evaluations, can recognize 6 movements used in mime therapy to improve facial muscle strength and mobility (Multimedia Appendix 2). To implement the recognition of these movements, MediaPipe was used [7]. The face mesh model allows for the real-time tracking of 468 3D landmarks on the human face that represent important facial features (eg, eyes, eyebrows, nose, and mouth). Distances between landmarks are calculated to recognize movements.

RG4Face provides a mirror therapy feature [8], which can mirror the healthy side of the face to create a visual illusion that can help reduce pain and improve function. RG4Face allows for parameter adjustment on the Rehabilite Game platform. Health care professionals can choose specific game mechanics for each rehabilitation case, thereby customizing the game according to patients’ needs and difficulties.

We co-designed a serious game for facial rehabilitation that represents a potential new approach to improving patients’ adherence to facial rehabilitation. The co-design procedure allowed stakeholders to participate in defining game requirements, thereby empowering the tool to meet the needs and expectations of patients and be more engaging and motivating.

Although there are studies that focus on games for rehabilitating specific parts of the face (eg, eyes [9] and mouth [10]), to our knowledge, no serious game for facial rehabilitation has been proposed that can recognize the face movements used in mime therapy. This study proposes the first such exergame.

Our results demonstrate that the co-design approach was effective for creating a serious game with the potential to meet patients' needs. We plan to evaluate the game with health care professionals, healthy participants, and patients with facial paralysis.