Effect of Longitudinal Practice in Real and Virtual Environments on Motor Performance, Physical Activity and Enjoyment in People with Autism Spectrum Disorder: A Prospective Randomized Crossover Controlled Trial

Abstract

(1) Background: People with ASD commonly present difficulty performing motor skills and a decline in physical activity (PA) level and low enjoyment of PA. We aimed to evaluate whether longitudinal practice of an activity in virtual and real environments improves motor performance and whether this improvement is transferred to a subsequent practice when changing the environment, promoting PA and providing enjoyment; (2) Methods: People with ASD, aged between 10 and 16 years, were included and distributed randomly into two opposite sequences. The participants performed a 10 session protocol, with five sessions practicing in each environment (virtual or real). Heart rate measurement was carried out and an enjoyment scale was applied; (3) Results: 22 participants concluded the protocol. Sequence A (virtual first) presented an improvement in accuracy and precision and transferred this when changing environment; they also had a greater change in heart rate reserve. The majority of participants reported "fun" and "great fun" levels for enjoyment; (4) Conclusions: The virtual reality activity presented a higher level of difficulty, with greater gains in terms of transference to the real environment. Considering PA, our task provided very light to light activity and the majority of participants enjoyed the task.

Keywords: Autism Spectrum Disorder; exercise; heart rate; motor skills; virtual reality.

Figure 1

Representative design of a participant playing the MoveHero software task (Research group and technological application in rehabilitation—PATER group, São Paulo, Brazil), with the use of the (A) Touch Screen interface—real and (B) WebCam interface—virtual.

Figure 2

Study design (D1–D5: Days of intervention).

Figure 3

Representation of mean and standard error of the Absolute Error (AE) of both Sequences (A: virtual → real and B: real → virtual) during the 10 days of intervention (D1–D5: Days of intervention). ● Important result: The participants that practiced first in the virtual interface (Sequence A) had better performance in the second practice with the real interface and this sequence presented better results than the inverse (Sequence B). This can be reinforced by the statistical difference in comparison between the first day after crossover in Sequence A with the first day of the first practice in Sequence B (marked with the blue sphere).

Figure 4

Representation of mean and standard error of the Variable Error (VE) of both Sequences (A: virtual → real and B: real → virtual) during the 10 days of intervention (D1–D5: Days of intervention). ● Important result: The participants that practiced first in the virtual interface (Sequence A) had better performance in the second practice with the real interface and this sequence presented better results than the inverse (Sequence B). This can be reinforced by the statistical difference in comparison between the first day after crossover in Sequence A with the first day of the first practice in Sequence B (marked with the blue sphere).

Figure 5

Representation of mean and standard error of the quantity of Hits of both Sequences (A: virtual → real and B: real → virtual) during the 10 days of intervention (D1–D5: Days of intervention).

Figure 6

Graphic representation of the %Heart Rate Reserve (%HRR) achieved during the VR activity of Sequences A (virtual–real) and B (real–virtual) during the 10 days of intervention (D1–D5: Days of intervention).

Figure 7

Graphic representation of the frequencies of each enjoyment score in Sequences A (virtual–real) and B (real–virtual).