Personalisation of a virtual gaming system for children with motor impairments: performance and usability

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Purpose: To demonstrate the potential role of virtual game personalisation for use as a therapeutic modality to improve upper extremity function in children with cerebral palsy (CP). Methods: The study tested a convenience sample of 60 typically developing children (TD) aged 6–10 years and 20 children with CP aged 7–11 years. Children participated in a single 30-min session when they played the game in accuracy mode (virtual targets are hit as they become progressively larger or smaller) or dwell mode (virtual targets are hit when the users remains on them for progressively shorter or longer durations). These two modes can be played in conventional (non-personalised), personalised and with and without arm weights conditions; weights were used for the TD group in order to ensure that game play would be sufficiently challenging as to require personalisation. We measured performance variables (frequency of changes in game level difficulty and accuracy as measured by percent success of hitting the virtual targets) in each condition and usability variables (self-reported perceived effort and enjoyment). Results: Comparisons between the usability of the conventional and personalised conditions among typically developing children showed that although children self-reported significantly more effort while playing the personalised game, the level of enjoyment remained high (no significant differences between conventional and personalised game play conditions). In addition, comparisons between playing the personalised game with and without weights by typically developing children, indicated that percent success was significantly higher for the game played without weights, suggesting that the system is sensitive to dynamic changes in performance. Comparisons between the TD and CP groups showed that when the game was played in personalised dwell mode (hovering over the target for several seconds) children with CP progressed significantly less quickly through different difficulty levels compared to typically developing children. In contrast, no significant differences were found in accuracy mode (immediate response on target hit), between the TD and CP groups in any of the experimental conditions. Discussion: The personalised game approach was shown to be enjoyable for both groups of users and able to change the level of difficulty in real time. The results suggest that this approach to gaming can provide motor challenges while preserving a high level of enjoyment. Conclusion: Personalised virtual therapy shows promise as a tool for upper extremity therapy for children with motor impairment.Implications for Rehabiliation In recent years, there has been an increase in the use of assistive technologies including virtual gaming in the general area of health care and clinical practice. Virtual gaming provides an interactive, real-time experiences that are flexible and ecologically valid ways to improve specific cognitive and motor abilities. Personalisation of virtual games entails dynamic adaptation of the parameters in real time according to the user’s functional level). The results have demonstrated that personalised virtual gaming is enjoyable and feasible for typically developing children and children with cerebral palsy. The results suggest that this approach to gaming can provide motor challenges while preserving a high level of enjoyment.

Original languageEnglish
Pages (from-to)876-882
Number of pages7
JournalDisability and Rehabilitation: Assistive Technology
Issue number6
StatePublished - Aug 2023

Bibliographical note

Funding Information:
The authors thank Rana Abbas who participated in the data collection and Sandra Zuckerman who provided support for the statistical analysis. ST was funded by a doctoral scholarship from the University of Haifa.

Publisher Copyright:
© 2021 Informa UK Limited, trading as Taylor & Francis Group.


  • Personalised rehabilitation
  • cerebral palsy
  • rehabilitation
  • user model
  • virtual games

ASJC Scopus subject areas

  • Speech and Hearing
  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Biomedical Engineering
  • Orthopedics and Sports Medicine


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