title: Design and Evaluation of Virtual Reality-Based Therapy Games with Dual Focus on Therapeutic Relevance and User Experience for Children with Cerebral Palsy.
abstract: OBJECTIVE
  Virtual reality (VR)-based therapy for motor rehabilitation of children with cerebral palsy (CP) is growing in prevalence. Although mainstream active videogames typically offer children an appealing user experience, they are not designed for therapeutic relevance. Conversely, rehabilitation-specific games often struggle to provide an immersive experience that sustains interest. This study aims to design and evaluate two VR-based therapy games for upper and lower limb rehabilitation and to evaluate their efficacy with dual focus on therapeutic relevance and user experience.
  
  
  METHODS
  Three occupational therapists, three physiotherapists, and eight children (8-12 years old), with CP Level I-III on the Gross Motor Function Classification System, evaluated two games for the Microsoft(®) (Redmond, WA) Kinect™ for Windows and completed the System Usability Scale (SUS), Physical Activity Enjoyment Scale (PACES), and custom feedback questionnaires.
  
  
  RESULTS
  Children and therapists unanimously agreed on the enjoyment and therapeutic value of the games. Median scores on the PACES were high (6.24±0.95 on the 7-point scale). Therapists considered the system to be of average usability (50th percentile on the SUS). The most prevalent usability issue was detection errors distinguishing the child's movements from the supporting therapist's. The ability to adjust difficulty settings and to focus on targeted goals (e.g., elbow/shoulder extension, weight shifting) was highly valued by therapists.
  
  
  CONCLUSIONS
  Engaging both therapists and children in a user-centered design approach enabled the development of two VR-based therapy games for upper and lower limb rehabilitation that are dually (a) engaging to the child and (b) therapeutically relevant.
authors.affiliation: 1 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto , Toronto, Ontario, Canada .|2 Institute of Biomaterial & Biomedical Engineering, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Lian Ting
authors.initials: LT
authors.lastname: Ni
authors.affiliation: 2 Institute of Biomaterial & Biomedical Engineering, University of Toronto , Toronto, Ontario, Canada .|3 Department of Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Darcy
authors.initials: D
authors.lastname: Fehlings
authors.affiliation: 1 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto , Toronto, Ontario, Canada .|2 Institute of Biomaterial & Biomedical Engineering, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Elaine
authors.initials: E
authors.lastname: Biddiss