Structured Virtual Reality Exergame Intervention in Adolescents With Mild Intellectual Disabilities: Pre-Post Pilot Study on Motor Proficiency and Reaction Time.

Abstract

Background: Adolescents with mild intellectual disabilities often exhibit deficits in motor proficiency and neurocognitive processing, which can limit their functional independence. Although virtual reality (VR) exergames provide a motivating platform for physical activity, objective data quantifying their impact on standardized motor scales remain scarce, particularly when implemented through structured pedagogical frameworks. Earlier research established the WISH (warm-up, imitation, settings, half-hour) and WON (warm-up, objective evaluation, no problem!) protocols to facilitate gameplay independence in this population. However, the extent to which this systematic approach translates into measurable clinical motor and reaction time gains requires further investigation.

Objective: This study evaluated the effectiveness of a 16-session structured VR exergame intervention, using the WISH and WON protocols, in enhancing motor proficiency and shortening simple reaction time among adolescents with mild intellectual disability.

Methods: A multisession, single-group pretest and posttest pilot design was used. A convenience sample of 8 adolescents (3 males, 5 females; mean age 17.63, SD 1.77, range 15-20 years) was recruited from a special school complex in Poland. The intervention was conducted over an 8-month period (October 2023 to May 2024), consisting of 16 sessions conducted once every 2 weeks. The rhythmic fitness game "OhShape!" (Odders Lab) was played on the Meta Quest 2 system. Motor proficiency was assessed with the Bruininks-Oseretsky Test of Motor Proficiency short form, and simple reaction time to visual and auditory stimuli was measured using a standardized Alfa-Electronics meter. Statistical analysis was performed using the Wilcoxon signed-rank test (α=.05).

Results: Total Bruininks-Oseretsky Test of Motor Proficiency scores significantly improved from a baseline mean of 69.25 (SD 6.80; 95% CI 63.56-74.94) to 80.50 (SD 5.50; 95% CI 75.90-85.10) at the posttest (P=.01; r=0.74). Based on the standardized 5-point proficiency scale, the group mean rose from 1.88 (SD .64; 95% CI 1.34-2.42) at baseline to 2.88 (SD .35; 95% CI 2.59-3.17) postintervention (P=.008; r=0.89). Furthermore, the mean simple reaction time decreased from 426.50 (SD 52.3; 95% CI 382.78-470.22) ms to 392.10 (SD 38.4; 95% CI 359.98-424.22) ms at the final assessment (P=.02; r=0.72).

Conclusions: This pilot study suggests structured VR exergaming may address motor deficits in adolescents with mild intellectual disability. Promoting autonomy via protocols was associated with measurable motor gains within this cohort. Although the absence of a control group limits causal claims, immersive VR may offer a supportive tool for neuro-motor adaptations in special education, warranting validation in larger controlled trials.