The field of serious games for health has grown significantly, demonstrating effectiveness in various clinical contexts such as stroke, spinal cord injury, and degenerative neurological diseases. Despite their potential benefits, therapists face barriers to adopting serious games in rehabilitation, including limited training and game literacy, concerns about cost and equipment availability, and a lack of evidence-based research on game effectiveness. Serious games for rehabilitation often involve repetitive exercises, which can be tedious and reduce motivation for continued rehabilitation, treating clients as passive recipients of clinical outcomes rather than players. This study identifies gaps and provides essential insights for advancing serious games in rehabilitation, aiming to enhance their engagement for clients and effectiveness as a therapeutic tool. Addressing these challenges requires a paradigm shift towards developing and co-creating serious games for rehabilitation with therapists, researchers, and stakeholders. Furthermore, future research is crucial to advance the development of serious games, ensuring they adhere to evidence-based principles and engage both clients and therapists. This endeavor will identify gaps in the field, inspire new directions, and support the creation of practical guidelines for serious games research.