MazeOut Adaptive Serious Game: Evaluation of Performance and Usability for Motor Rehabilitation in Individuals with Autism Spectrum Disorder.

Objective: To evaluate the effectiveness of MazeOut, an adaptive serious game for motor rehabilitation, in individuals with autism spectrum disorder (ASD), by comparing their performance and usability with that of individuals with typical development (TD) and assessing the impact of adaptive (AG) versus nonadaptive gameplay on task performance. Materials and Methods: A mixed-design study with 30 participants (15 ASD, 15 TD), aged 8 to 40 years, had each participant experience both adaptive and nonadaptive interventions in randomized order, allowing within- and between-subject comparisons. Performance was measured using overall scores (based on maze navigation speed and coin collection), and usability was assessed with the System Usability Scale (SUS). Data analysis was conducted using R software, with performance trends evaluated through segmented regression and the Kruskal-Wallis test. Results: The TD group outperformed the ASD group across all conditions (TD median score: 27.54; ASD median score: 23.79, P < 0.001). Notably, participants in both groups achieved significantly better performance when AG was introduced first (ASD: 24.04 vs. 19.1, P < 0.001; TD: 30.2 vs. 24.31, P = 0.005), suggesting that the adaptation facilitates initial task learning. ASD participants reported slightly higher usability (mean SUS = 77.2) than TD participants (74.6), with the highest scores among younger users (81.9). Conclusions: Adaptive serious games can enhance motor performance, particularly for individuals with ASD. The findings suggest that early exposure to AG may improve task performance. Future studies with larger samples and longer interventions are needed to assess long-term benefits.