Influence of virtual environment complexity on motor learning in typically developing children and children with cerebral palsy

Motion-controlled video games in virtual environments (VEs) are physical therapy interventions for motor skill learning in children with neuromotor conditions, such as cerebral palsy. Many VEs feature complex audiovisuals designed to motivate and engage children in repetitive use; however, the value of these enhancements remains unclear. The purpose of this study was to examine the effect of a simple versus a complex VE on motor learning of a novel balance task in typically developing (TD) children and children with cerebral palsy (CP). In addition, we explored the relationship between children’s motivation, engagement and their motor learning outcomes in each VE. Twenty-seven TD children and 6 children with hemiplegic or diplegic CP participated. Participants were randomized to practice the same novel postural control task in either a simple or a complex flat-screen display VE. Motor learning was measured by an error metric per trial. Following 40 acquisition trials, children completed motivation (Intrinsic Motivation Inventory) and engagement (User Engagement Scale) measures. They returned 2–7 days later for retention and transfer tests. Children with CP had significantly greater performance errors as compared to TD children at all sessions; however, there was no difference in performance between simple and complex VE conditions at any session, nor were there any differences in engagement or motivation between conditions or groups. Lower self-reported motivation was associated with greater performance error at retention and transfer in all participants. Study results provide no evidence for an effect of VE audiovisual complexity on children’s motor learning or affective state.