Virtual Reality Interventions' Effects for Children with Developmental Coordination Disorder (DCD)

DCD is a motor impairment condition affecting around 5% of school-age children (Blank et al. 2019). The current diagnosis is based on four interrelated criteria according to the Diagnostic and Statistical Manual of Mental Disorders—fifth edition (DSM-5): A—the children have insufficient motor performance for age and practice opportunities; В—the lack in motor performance interferes in daily, school, and leisure activities; C—children present these characteristics from their early development; D—the insufficient motor performance is not explained by disabilities or other known neurological conditions (American Psychiatric Association 2013). Since DCD interferes in several life components, negative consequences in children’s quality of life are expected (Zwicker et al. 2013). In that context, several researchers have tried to test intervention types in order to find the best option for helping these children improve motor outcomes, reaching a consensus that any type of intervention would be better than none (Hillier 2007). However, taking into account the motivation necessary to maintain children’s involvement in the intervention, approaches based on VR have been endorsed in recent investigations with DCD (Bonney, Ferguson et al. 2017, Bonney, Jelsma et al. 2017, Cavalcante Neto, Steenbergen et al. 2019). Despite this, further evidence is still needed regarding the effectiveness of VR for children with DCD.

Only two systematic reviews regarding VR interventions’ effects for children with DCD were retrieved. Given that DCD is still a new term used in this field and has a multifactorial and complex diagnosis, this small number of systematic reviews is expected. Also, the evidence about the effectiveness of VR for children with DCD has been explored in combination with other intervention types (Smits-Engelsman et al. 2018) or along with other neuromotor conditions (Hickman et al. 2017, Page et al. 2017), which would not be relevant to the purpose of this chapter. Therefore, the two systematic reviews included here exclusively considered studies that evaluated the effectiveness of VR interventions for children with DCD.

According to the information from the two systematic reviews, Nintendo Wii was the most frequently used VR device (Cavalcante Neto, de Oliveira et al. 2019, Mentiplay et al. 2019), and motor performance as assessed by the Movement Assessment Battery for Children (MABC) was the most frequent outcome across studies. Particularly, the systematic review' conducted by Mentiplay et al. (2019) classified outcomes from studies included according to the ICF framework, which attested to more benefits for body structure and function and activity. Although the other systematic review (Cavalcante Neto, de Oliveira et al. 2019) did not focus on the ICF, it is possible to notice these outcomes were in fact prioritized in interventions with VR for children with DCD.

Both systematic review's (Cavalcante Neto, de Oliveira et al. 2019, Mentiplay et al. 2019) decided not to conduct a meta-analysis due to the heterogeneity among studies. Regarding the dosage of VR interventions for this condition, the total length of therapy ranged from one day to 16 weeks, with intensities ranging from 4 to 60 minutes per session, occurring from one single session to five times per week. In summary, the most common weekly frequency is estimated at around tw'o to three times per week.

Both systematic reviews (Cavalcante Neto, de Oliveira et al. 2019, Mentiplay et al. 2019) also attested that VR interventions are effective in improving motor performance in children with DCD, but the effectiveness of this intervention type compared to conventional approaches, such as task-oriented training, is still uncertain. Task-oriented training is a therapeutic modality based on a specific movement task, aiming to improve corresponding skills (Hubbard et al. 2009, Miyahara et al. 2017). Despite finding no significant differences in motor performance between VR and no-VR

(task-specific) intervention groups, a recent study (Cavalcante Neto, Steenbergen et al. 2019) found greater effect size in favor of no-VR intervention, based on task-oriented training principles, for children with DCD. Similarly, in those studies in which task-oriented training principles were used as the control intervention group, greater improvements were observed and synthesized by one systematic review included here (Mentiplay et al. 2019).

In addition, a recent systematic review comparing various intervention types for children with DCD found the greatest benefits for motor performance with task-oriented training compared to other approaches, including VR (Smits-Engelsman et al. 2018). This finding does not mean that VR should be dropped, but clinicians and researchers must be cautious in recommending this approach as an exclusive therapeutic modality for the motor rehabilitation of children with DCD. Therefore, both systematic reviews (Cavalcante Neto, de Oliveira et al. 2019, Mentiplay et al. 2019) also agreed that VR should be used as a complementary therapeutic modality combined with other conventional modalities, particularly those with stronger evidence. So far, those including task-oriented training principles appear to be the best approaches.

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