Characterization of bilateral reaching development using augmented reality games.

Bilateral coordination is commonly impaired in neurodevelopmental conditions including cerebral palsy, developmental coordination disorder, and autism spectrum disorder. However, we lack objective clinical assessments that can quantify bilateral coordination in a clinically feasible manner and determine age-based norms to identify impairments. The objective of this study was to use augmented reality and computer vision to characterize bilateral reaching abilities in typically developing children. Typically developing children (n = 133) ages 6-17 years completed symmetric and asymmetric bilateral reaching tasks in an augmented reality game environment. We analyzed the number of target pairs they could reach in 50 s as well as the time lag between their hands reaching the targets. We found that performance on both tasks developed in parallel, with development slowing but not plateauing after age 12. Children performed better on the symmetric task than asymmetric, both in targets reached and with shorter hand lags. Variability between children in hand lag decreased with age. We also found gender differences with females outperforming males, which were most pronounced in the 10-11 year olds. Overall, this study demonstrates parallel development through childhood and adolescence of symmetric and asymmetric reaching abilities. Furthermore, it demonstrates the ability to quantify bilateral coordination using computer vision and augmented reality, which can be applied to assess clinical populations.