Blending Video Games and Cognitive Strategies to Improve Motor Performance in Autism Spectrum Disorders

SIGNIFICANCE: Motor impairments are highly prevalent in the population with autism spectrum disorder (ASD). It is likely that the impairments have far reaching consequences, including ones in participation and development. Clinicians frequently use sensory–motor interventions for children with ASD in a clinic and focus on improving sensory responses. There is a paucity of interventions addressing performance difficulties in context and the contributory motor deficits specific to ASD. This study advances a performance-based intervention protocol for children with ASD. The protocol aims to enable children to improve their performance in many occupations.

INNOVATION: New neuroscience studies report atypical motor processes in ASD, such as an overreliance on proprioceptive feedback. Evidence suggests individuals with ASD would benefit from a method to alter motor learning and the practice of motor sequences more than neurotypical peers. To better meet the needs, we blended virtual reality (VR) and the Cognitive Orientation to Occupational Performance Approach (CO–OP) to develop COSVR. No one to date has attempted to blend the two.

VR is commonly used in remedial approaches. COSVR utilizes motion-controlled VR gaming to increase the repeated practice of client-specific, goal-directed sequences (300 to 500 movement repetitions in a 40-min training period). COSVR also uses VR to present variations of an environment or motor demand to begin the development of cognitive strategies and metacognitive problem solving. As the child develops motor skills and cognitive strategies, the 11-wk protocol gradually builds from discrete skills in the clinic to performance of a goal in context.

PURPOSE: Blending CO–OP and VR may be synergistic and may better meet the specific intervention needs of children with ASD than existing approaches. The purpose of our study was to generate COSVR and to use the assembled views from a group of experienced pediatric occupational therapists to develop COSVR—Revised (COSVR–R) and to make it ready for pilot testing. To form COSVR, we blended the protocols and key features of CO–OP and our VR. We also used research specifying ASD motor abilities.

METHOD: Three occupational therapists who had at least 2 yr of ASD experience constituted the purposive sample. The lead researcher (LR) conducted a semistructured, 1-hr session in a conference room at the Washington University in St. Louis. The LR transcribed the audio and video recordings from the group, and another team member verified its accuracy. The LR and a coder used constant comparison to analyze the transcribed data. The LR cross-checked the initial codes, and these codes were used to develop themes. The themes were verified with the subjects. The LR modified the COSVR protocol on the basis of the themes.

RESULTS: Four themes emerged, including one about the perceived challenges of COSVR. We formulated seven modification areas and generated COSVR–R. The initial protocol was conceived to move from the clinic phase to the context phase over 16 sessions in 10 wk. The perceptions of experienced occupational therapists about the initial intervention were positive and guided refinements, particularly in its clinical implementation. COSVR–R was formed into six phases delivered over 18 sessions in 11 wk.

CONCLUSION: The protocol is not appropriate for all performance goals or all children with ASD. The study was limited by the size of the group. Further research is warranted to determine whether COSVR–R is feasible and enables children with ASD to achieve motor-based performance goals.