A modular non-immersive VR serious game framework for telerehabilitation: design and proof-of-concept feasibility study

There is a growing need for accessible and engaging rehabilitation tools for individuals with neurodevelopmental disorders such as Cerebral palsy (CP), Down syndrome (DS), and Autism spectrum disorder (ASD). Serious games offer a promising approach, yet few are tailor-made to meet the therapeutic demands of these populations. A tailor-made, non-immersive virtual reality (VR) serious games framework featuring a basketball task was developed, with therapist-controlled modules for customization and monitoring. Twenty-eight participants (CP: 14; DS: 7; ASD: 7) completed the game across eight sessions, grouped into three practice phases: an initial session, an early adaptation phase, and a consolidated practice phase. Performance metrics included accuracy, reaction time, and number of victories. All groups improved performance across phases, with accuracy increasing significantly in central (p = 0.005) and total positions (p = 0.007). The number of victories also increased from the initial to the early adaptation phase (p = 0.019) and from the initial to the consolidated practice phase (p = 0.008). Participants with ASD showed significantly higher accuracy than the DS group, while CP and DS participants showed a temporary increase in reaction time during the early adaptation phase, followed by a reduction in the consolidated phase, suggesting task adaptation. These findings support the feasibility and short-term effectiveness of a modular, tailor-made serious games platform for telerehabilitation.