Development of a Virtual Reality Software for Upper Limb Physical Therapy in Pediatric Patients: Exploration of Pain, Motivation, Difficulty, and Acceptability Perceptions.

The physical rehabilitation of upper limb motor impairments in pediatric patients is often hindered by monotony, lack of motivation, and discomfort associated with traditional therapy methods. Although previous studies have shown that immersive virtual reality (VR) can help alleviate these issues by offering interactive environments and game-based tasks that make exercises more engaging, enjoyable, and distracting from pain, many have relied on commercial applications not initially designed for therapeutic use. As a result, children may quickly disengage or feel frustrated when tasks are not adapted to their abilities or interests. This study presents the design, development, and preliminary evaluation of custom Immersive Virtual Reality (IVR) software tailored for pediatric physical rehabilitation. The software integrates clinically based movements with fantasy-inspired game mechanics. Two rehabilitation scenarios were implemented to promote shoulder, elbow, and wrist movements through digital environments. The system was developed using Unity's XR Interaction Toolkit and deployed on the Meta Quest 2 headset. A pilot study was conducted with ten pediatric patients, their parents, and two rehabilitation professionals. Results demonstrated reduced pain perception, increased enjoyment, reduced difficulty perception, and positive feedback on software usability. This study highlights the potential of RVI as a complementary tool for pediatric rehabilitation, promoting adherence through a more enjoyable experience and improving outcomes through engaging approaches.