User experience of a custom augmented reality-based exergame for children with cerebral palsy and acquired brain injuries

Background Conventional pediatric rehabilitation for cerebral palsy (CP) or acquired brain injury (ABI) prioritizes motor outcomes, often neglecting cognitive deficits and their interplay. Sessions are often perceived as repetitive and demotivating, reducing engagement. Immersive exergaming, especially through augmented reality (AR), enables simultaneous cognitive-motor training in safe, interactive settings. There is little evidence on immersive exergames for these children, and no immersive AR exergames target cognitive-motor rehabilitation or report on user experience (UX). Objective This study aims to assess the overall UX of a purpose-built immersive AR exergame for children with brain injuries. Methods Twenty-nine children (11.8 ± 1.6 years; 12 CP / 17 ABI) participated in two sessions using the Microsoft HoloLens2, each involving one cognitive-motor AR game (AR Corsi and AR Zoo). UX was assessed through standardized questionnaires: System Usability Scale (usability), Technology Acceptance Model (acceptance), AttrakDiff (perceived experience quality), MeCue (emotions), Intrinsic Motivation Inventory (motivation), and Rating scale of Perceived Exertion for Children (fatigue). Results The exergame was well accepted and perceived as easy to use. Scores for motivation, emotions, and perceived experience quality were high and positive. A small but significant increase in mental and physical fatigue was observed after the sessions (P < .01). No significant differences were found between the two game conditions. Conclusion This immersive AR exergame demonstrates a positive UX in children with brain injuries, supporting its potential use in rehabilitation. These results emphasize the importance of conducting comprehensive UX assessments when developing innovative rehabilitation tools and provide a basis for future investigations into therapeutic impact.