Home-Based Immersive Virtual Reality to Improve Motor Performance in Children and Adolescents With Developmental Coordination Disorder: Crossover Study.

Background: Children with developmental coordination disorder (DCD) experience motor difficulties that limit daily activities and reduce physical activity enjoyment. Immersive virtual reality (VR) offers the potential for feedback-rich movement practice, but evidence for these effects in DCD remains limited. Objective: This study aims to investigate the effects of an immersive VR rhythm game compared to tablet-based gameplay within a home-based setting on motor performance, enjoyment, and motivation in children and adolescents with DCD. Methods: This crossover study included 27 participants (21 boys and 6 girls) aged 10 to 16 years with DCD who completed 2 home-based interventions, each delivered over 5 consecutive days: VR gameplay using Beat Saber (Beat Games) and tablet-based gameplay using Cut the Rope (ZeptoLab). Participants were recruited in England using convenience sampling via social media; eligible participants were aged 10 to 16 years, met research criteria for DCD based on a Developmental Coordination Disorder Questionnaire screening, and had no alternative neurological or musculoskeletal diagnosis. Each condition required at least 30 minutes of daily gameplay and was separated by a 2-week or more washout period. Motor performance was assessed pre- and postintervention using the Movement Assessment Battery for Children, Third Edition (MABC-3) and the Box and Block Test. Enjoyment was measured pre- and postintervention using the Physical Activity Enjoyment Scale. Participants also rated their motivation and feelings during each gameplay session. Repeated-measures ANOVAs and paired-samples 2-tailed t tests (α=.05) were used to examine the data. Results: For MABC-3 domains, condition × time interactions were nonsignificant, although exploratory within-condition analyses showed pre-post improvements in the VR condition. For the Box and Block Test, condition × time interactions were significant for both hands, with a greater degree of pre-post improvement in VR than tablet-based gameplay. In the VR condition, mean block transfer increased for the dominant hand (ΔM 5.93, 95% CI 3.49-8.36; t26=-4.99; P<.001; Cohen d=0.96) and the nondominant hand (ΔM 5.11, 95% CI 2.65-7.57; t26=-4.27; P<.001; Cohen d=0.82), whereas no significant changes were observed in the tablet condition (all P≥.36). VR gameplay also yielded higher enjoyment, and children reported higher motivation and feeling ratings across VR sessions than tablet sessions. Conclusions: This study, in contrast to most of the existing literature on nonimmersive technologies, examined the effect of a home-based immersive VR rhythm game intervention for children and adolescents with DCD. This study provides early evidence that this VR rhythm game was engaging and may support greater short-term improvements in motor performance than tablet gameplay. These findings suggest home-based immersive VR rhythm games could be a practical adjunct to pediatric rehabilitation to increase movement practice and motivation, although larger and longer trials are needed to confirm clinical impact and identify which game features drive this benefit.