Using game performance measure to assess upper limb motor function in children with neuromotor disorders: a systematic review.

Abstract

Background: Upper limb impairments affect children with neuromotor disorders, limiting daily activities and participation. Videogames (ex: virtual reality, computer-based games) have emerged as promising tools for upper limb rehabilitation, offering better engagement and effects on upper limb movements. The capacity of video games to be used for assessing upper limb function with game-based metrics has not yet been explored, and their validation remains unclear. This systematic review aims to determine if game-based metrics can serve as relevant measures to evaluate upper limb impairments in children with neuromotor disorders.

Methods: A systematic review (PROSPERO: CRD42024550469) was conducted in PUBMED, MEDLINE, Web of Science, and Cochrane according to PRISMA guidelines. Articles published from inception to the 26th of May 2025 were screened according to inclusion/exclusion criteria and data were extracted focusing on game characteristics, outcomes measured, and their measurement properties.

Results: After screening, 26 studies on 1092 articles were included. In total, 443 children, mostly with cerebral palsy (n = 394), mean age 10.1 ± 2.4 years, underwent videogames with quantitative measurements. A total of 112 upper limb game-based outcomes were identified, measured either from the game itself or external instruments. These outcomes included kinematics (60%), game scores (24%), actimetry data (10%), electromyography (5%), and kinetics (>1%). Only 3 studies reported reliability data, with test-retest reliability ranging from poor to excellent across 7 outcomes. For discriminant validity, 8 studies included control participants, assessing 20 outcomes, of which 13 demonstrated the ability to differentiate between groups. Regarding responsiveness, pre-/post-therapy component was investigated through 12 studies across 52 outcomes. Only 29 showed significant improvements after intervention. Convergent validity, explored in 6 studies, reported moderate to high correlations with clinical assessments.

Conclusion: The present systematic review identified a wide range of game categories and upper limb game performance outcomes, involving different instrumented tools, and covering an interesting range of gestures. Despite the relevance of the game context and the use of instrumented outcomes, there is a lack of validation. To be used as research outcomes and to guide therapies in clinical practice, important work on the measurement properties has to be done.