RESEARCH QUESTION: Do the movement patterns of the center of pressure (COP) differ when a child is playing a virtual reality (VR) game alone or with another child?

BACKGROUND: VR provides graded and personalized activities and feedback in a fun and safe environment—all of these are key motivators. VR has the potential to help treat balance deficiencies of children, causing them to shift their COP from side to side to succeed in the game. It is possible that COP movement would be even greater if the child was paired with a second child. No previous research exists that quantifies how dual play with VR affects the movement of COP of children.

METHOD: We used a cross-sectional experimental design. Twenty healthy children (9 boys and 11 girls; median age = 6.1 yr, interquartile range = 5.5 to 6.8) were recruited and divided into age-matched pairs.

A VR game (made by Timocco, Tel Aviv, Israel) was chosen for this age group, in which the child wears a colored bean-bag ball in one hand and controls the hand of a virtual monkey that has to hit floating bubbles. After getting acquainted with the VR game, each subject played four times while the COP movement was monitored. First, the subject played alone using the dominant hand. Then, the subject played twice with a second child, who was controlling the second hand of the monkey. In these trials, each subject played once with the dominant hand and then with the nondominant hand. Then the child played alone again with the dominant hand to confirm that the order of the trials had no effect on the difference between paired and alone trials.

Two thin pressure pads provided data of COP path—lateral and anterior–posterior ranges. The Wilcoxon signed-rank test was used to compare between the alone and dual play COP movement patters of the related samples.

RESULTS: There were no significant differences in the movement of the COP when playing with the dominant hand and the nondominant hand. In addition, the order of the trials did not affect the results. The lateral range of the COP was significantly greater during the dual game compared to the single game (p = .037). There were no differences, however, in the anterior–posterior range and total path of the COP between the two trial conditions.

CONCLUSION: The increase in lateral movement of the COP while playing a dual game as opposed to playing alone may indicate the benefit of pairing the children during balance treatment sessions in the clinic, thus enhancing their ability to practice balance control. A study limitation is the small sample (n = 20) that was used.

The significance of incorporating dual play in the clinic during treatment of children with balance impairment is allowing for a more effective exercise while the child is entertained, thereby reducing the rehabilitation time and costs. This also provides an opportunity for the child with social difficulties to interact with another child, under the guidance of the clinician, thereby enhancing social confidence.

The presented new and simple clinical approach has yet to be thoroughly explored. Although VR is used worldwide in the clinical settings for treatment of children with various motor and cognitive deficiencies, the benefits of dual play—among which is the herein-reported significant increase in lateral shifting of the COP during dual play— have not been researched until this study.