SIGNIFICANCE: The clinical feasibility and effectiveness of computer gaming has been demonstrated in several studies of child therapy. However, these gaming systems are usually not sufficiently adaptable to clinical goals. Timocco is a virtual reality (VR) environment that was developed to address these limitations. Accordingly, it may be used as a base performance assessment tool for occupational therapy evaluation in the clinical set.

INNOVATION: An essential component of VR is the ability to monitor the user’s performance. Accurate monitoring could also be harnessed for assessment. However, most gaming systems do not provide sufficient data to meet this need. The Timocco VR environment provides the clinician with information regarding specific abilities. To be an assessment tool of goal-directed hand movements, the psychometric properties should be first established.

RESEARCH OBJECTIVES: The aim of the current study was to establish the test–retest reliability and the construct and discriminant validity of a virtual program in children aged 4 to 8 yr with a typical motor development.

BACKGROUND: In the last decade, there has been a rapid increase in the use of VR. VR platform is an enjoyable and customized environment that increases the child’s cooperation and motivation during their evaluation and treatment.

METHOD: This is a test–retest reliability study. Validity was determined by distinction between the difficulty levels of the game and between age groups. The sample was composed of typically developing children.

Forty-seven typically developing children participated in this study. Twenty children (11 girls and 9 boys) aged 4 to 6 yr (4.80 ± 0.48 yr) were classified as the younger subgroup, and 27 children (14 girls and 13 boys) aged 6 to 8 yr (7.11 ± 0.48 yr) were classified as the older subgroup.

Two games out of the Timocco platform were chosen to be tested (“Bubble Bath” and “Falling Fruit”) in three difficulty levels. The assessment lasted 10 min. The child played the game again 3 to 7 days following the first session. The Short Feedback Questionnaire for Children (SFQ–Child) was also completed by the child.

The outcome measures were total duration of each level (in seconds), efficiency, average response time, and average action time. The data were collected using the VR platform. The statistical analysis was completed using t tests measuring correlation coefficients and Pearson correlations.

RESULTS: The performance of the older children was significantly better than that of the younger children, indicating the discriminative validity of both games. Construct validity was noted in both games: In the Bubble Bath game, in the two levels, significantly different results were noted in each age group (p ≤ .0001). A clear difference in the difficulty levels in the Falling Fruit game was noted in some of the measured outcomes (p < .0001). The enjoyment of the game in the SFQ–Child was high for all participants.

CONCLUSION: The VR game Timocco was found to be a reliable and enjoyable diagnostic tool with differentiated difficulty levels for typically developing children. Further research is planned to check the games on children with special needs.