# Usability of a virtual reality circle drawing task to assess upper-limb motor performance in children and young people with cerebral palsy: pilot study

## TL;DR

A virtual reality circle drawing task was tested as a usable and effective method to assess upper-limb motor performance in children with cerebral palsy.

## Contribution

This is the first pilot study to evaluate the usability of an iVR circle drawing task for assessing upper-limb motor function in children with CP.

## Key findings

- The iVR task had a high usability score (74 on the SUS) and no adverse effects were reported.
- Strong correlations were found between iVR metrics and established clinical assessments like the BBT and DHI.
- The task showed promise for capturing motor performance through metrics like velocity and roundness.

## Abstract

Cerebral palsy (CP) is a major cause of upper-limb impairments. Immersive virtual reality (iVR) is emerging as an adjunct to traditional CP rehabilitation methods. However, the potential utility of iVR for assessing upper -limb motor function in CP remains unexplored. The aim of this study was to evaluate the usability of an iVR circle drawing task in assessing the upper-limb motor function of children with CP.

Nine children with CP (age: 13 ± 2.9 y) completed an iVR circle drawing task delivered through a Meta-Quest-2 headset. Outcomes were children’s rating of the iVR task in the System Usability Scale (SUS), in addition to circle drawing metrics (movement time, mean velocity and circle roundness) derived from the position of the controllers during the task, which were correlated with scores from the Box and Block Test (BBT) and the Duruoz Hand Index (DHI).

The average score for the SUS was 74, indicating good usability and acceptability. No adverse effects were reported by participants. Strong positive correlations were found between the BBT scores and mean velocity (rho = 0.78, p = 0.01) and roundness (rho = 0.92, p < 0.001) scores in the circle drawing task. Strong negative correlations were also observed between the DHI scores and mean velocity (rho=-0.82, p = 0.007) and roundness (rho=-0.75, p = 0.02) scores.

This study shows that the iVR circle drawing task is a usable tool to capture upper-limb motor performance of children with CP, highlighting the value of clinical development of iVR in CP rehabilitation.

The online version contains supplementary material available at 10.1186/s12887-026-06626-8.