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

Abstract 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; t 26 =−4.99; P <.001; Cohen d =0.96) and the nondominant hand (ΔM 5.11, 95% CI 2.65‐7.57; t 26 =−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.