A Virtual Reality Exergame: Clinician-Guided Breathing and Relaxation for Children with Muscular Dystrophy

Abstract

This study introduces a VR-based breathing and relaxation exergame tailored for individuals with Duchenne muscular dystrophy (DMD). DMD is a rare neuromuscular disease that leads to respiratory muscle dysfunction with anxiety being a common comorbidity. Clinical management requires frequent visits to rare disease specialists to manage symptom progression. Limited availability and/or proximity of rare disease experts present challenges to care and can lead to missed care opportunities and reduced quality of life. We propose a breathing and relaxation exergame with remote telehealth applicability that incorporates shared patient-clinician VR interaction, and physiological sensors that provide both real-time feedback to the patient and health analytics for the clinician. The game focuses on two key aspects of DMD clinical care that can be mediated through control of breathing: relaxation/mindfulness training and respiratory muscle exercise. The system was evaluated among 13 individuals, including 4 participants with DMD. Feedback surveys, interviews, and focus group discussions with participants, accompanying family members, and clinicians demonstrated the feasibility of this VR tool for telehealth or as part of a home exercise program.

Keywords: Human computer interaction (HCI); Human-centered computing; Interaction paradigms; Telehealth; VR Mindfulness; VR Rehabilitation; Virtual reality.

Figure 1:

Player view of the Planet Pulse where they are immersed in outer space with a halo around the planets representing their breathing patterns.

Figure 2:

A) Participant playing Planet Pulse game, and B) clinician dashboard showing the patient’s game view and a health analytics overlay.

Figure 3:

Likert scale images used in the SUES survey.

Figure 4:

Mean SUES ratings for Planet Pulse are based on Likert scores ranging from 1 (worst) to 5 (best). Error bars show 95% confidence intervals.