Abstract:

Mixed reality is increasingly used in pediatric neurorehabilitation to support task-oriented practice in children with motor impairments, including cerebral palsy. Its clinical adoption, however, is limited not only by technology readiness, but also by methodological issues that determine whether a mixed reality task is therapeutically meaningful, measurable, and feasible in routine care.

This paper describes challenges identified during the development and pilot deployment of 16 mixed reality rehabilitation applications designed for four functional domains, gross motor skills, fine motor skills, gait, and postural stability. The applications were built to allow therapist-controlled individualization through adjustable difficulty, time dosing, laterality, and the choice between sitting and standing execution. A structured educational layer is integrated via in-app audio guidance that supports attention, sequencing, and motor learning principles during training.

The analysis is based on an iterative development process combining rehabilitation expertise with practical testing in clinical settings. Pilot sessions with children with cerebral palsy, n=35, were conducted in two rehabilitation facilities, with feasibility and acceptability assessed through direct observation, field notes, and systematic review of session video recordings. Performance outcomes were operationalized through automated in-app logging of task completion time, repetitions and scoring, error events, and intra-individual variability across sessions. To ensure clinical interpretability and comparability, the planned evaluation approach also aligns mixed reality outputs with standardized clinical assessments for gait, balance, fine motor function, and usability, and includes therapist training and workflow-focused onboarding.

The paper offers methodological guidance for designing mixed reality interventions that are clinically credible, measurable, and implementable in pediatric rehabilitation practice.

Keywords:

Mixed reality, pediatric rehabilitation, motor disorders, methodology, gait analysis, usability, clinical integration, neurorehabilitation, user-centered design.