Clinical Bottom Line
“How should I apply this information?”
This study demonstrates the feasibility of using commercially available virtual reality (VR) games while providing additional challenges using unstable surfaces (rocker boards and balance cushions) for young children with developmental coordination disorder (DCD). The authors detailed the rationale for VR game choices to promote specific motor control skills. They also described VR gaming parameters (game duration and the speed of games) and environmental adaptations (stable or unstable surfaces) to promote children's balance, coordination, and motor planning, which is useful when replicating the intervention. Also, the VR games were fun and motivating for the children, an important consideration for children with DCD who may be reluctant to participate in motor activities.
“What should I be mindful about in applying this information?”
VR games may provide task-oriented experiences that, in general, have been found to be more effective than process-oriented intervention approaches for children with DCD.1 The intervention in this study may improve balance more than gross motor skills (catching and throwing a ball). Children actively made postural adjustments during VR games, but during bowling, volleyball, and football they did not use a ball and, therefore, did not experience haptic feedback to promote skills.
The children received 15 minutes of goal-oriented, task-specific intervention in conjunction with VR intervention. Therefore, outcomes cannot be attributed to VR intervention alone but a combination of VR and conventional therapy. The authors discussed the specificity of training, which is important to consider when replicating the study. The intervention had a specific target population (children with DCD) and used specific VR game strategies to address child/parent goals. It is critical to consider these points when replicating this intervention with patients in clinic or in future research.
The authors mention that the children appeared to exert themselves, but they did not document exercise intensity levels. In the clinical setting, therapists could monitor heart rate during VR interventions to measure children's exercise intensity.
Maria Fragala-Pinkham, PT, DPT, MS
Franciscan Hospital for Children, Brighton, Massachusetts
Margaret E. O'Neil, PT, PhD, MPH
Drexel University, Philadelphia, Pennsylvania
1. Smits-Engelsman BC, Blank R, van der Kaay AC, et al. Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis. Dev Med Child Neurol. 2013;55:229–237.