In recent years games and game technology have been used quite widely to investigate if they can help make rehabilitation more engaging for users. The underlying hypothesis is that the motivating qualities of games may be harnessed and embedded into a game-based rehabilitation system to improve the quality of user participation. In this paper we present the PACT framework which has been created to guide the design of gamified rehabilitation systems; placing emphasis on people, aesthetics, context, and technology from the beginning of a design and development process. We discuss the evolution of PACT from our previous GAMER framework, which was used to develop a range of games for upper arm stroke rehabilitation with natural user interfaces. GAMER was established to guide the design of rehabilitation games from the viewpoint of a designer, whereas with PACT greater emphasis has been placed on an inclusive design process. We provide a detailed work flow illustration for the use of PACT in the development of rehabilitation systems and provide examples of practical design and analysis tools that improve the quality of workflow in PACT.
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