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As mentioned above, another gesture-recognition system is image processing through an external camera. In the study performed by Rautaray et al. \cite{Rautaray_2011}, various image processing techniques were applied for hand tracking and gesture recognition in a virtual gaming environment such as Camshift, Lucas Kanade, Haar etc. The different gestures used for the game interactions were grab, punch and go.  According to Jayarathne et al. \cite{Jayarathne_2015}, a surface EMG (sEMG) application that can indicate muscle efforts has been created. After developing, the muscle effort indicator application was then implemented in the Flappy Bird game. It has been demonstrated that with the use of fast Fourier transform (FFT) and several other computer algorithms that sEMG can be used to provide biofeedback in a gaming environment.  Several studies have been conducted about the implementation of EMG based gestures on therapeutic games for rehabilitation purposes. An alternate interface has been developed in the study conducted by Armiger et al. \cite{Armiger_2008} for Guitar Hero® using surface EMG to train and assess the performance of upper-extremity amputees. Instead of using the guitar, EMG electrodes were used to record the myoelectric activity. After recording, the acquired data is processed in real-time using pattern recognition algorithms to classify the gestures and then use them to control the game. The scores obtained by the amputees were relatively lower than those of the non-amputees.  Another study Studies  about therapeutic games was were also  performed by Brown et al. \cite{Donoso_Brown_2014} and  Viriyasaksathian et al. \cite{Viriyasaksathian_2011}. EMG gestures were applied to an augmented reality a  game for the upper-limb rehabilitation and motor control improvement  of stroke patients. The In the research conducted by the latter, the  combination of music synchronization, biofeedback technology and augmented reality was employed to attract the attention of stroke patients since existing therapy methods are often boring thus results to lack of motivation. Aside from using EMG signals as computer inputs for game control, a notable study performed by Schuuurink et al. \cite{Schuurink_2008} applied the said technology for measuring the user's engagement in the game. It has been learned that effects of sound and dynamics in serious gaming have shown a significant influence on the affective appraisal of the environment.