Virtual reality as a telerehabilitation strategy for people with autism spectrum disorder during the COVID-19 quarantine scenario: physical activity, motor performance and enjoyment

Figures & data

Figure 1. CONSORT 2010 Flow diagram.

CONSORT 2010 Flow Diagram. It starts with enrolment, demonstrating that 57 participants were evaluated for eligibility, 13 were excluded, 11 for not meeting eligibility criteria, and 2 for other reasons. 44 participants were allocated, 22 ASD and 22 non-ASD. All participants received allocated intervention and entered into analysis.

Figure 2. Participant Positioning and game design. The task was to intercept different falling spheres using upper limb wave movements at the exact moment the spheres reached their specific target. Bottom right image, miss feedback - above this one, hit feedback. The game is available for free use in Portuguese https://movehero.com.br/ and English https://movehero.com.br/en/.

A participant positioned in the centre in front of the computer, with arms raised, playing the game that captures its movement. Next to him, there is his guardian who holds a cell phone with the left hand and shows the therapist through video call how the participant is performing the requested task. In the bottom right image, there is a representative drawing of miss feedback, and above this one, a representative drawing of hit feedback.

Figure 3. Study design.

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Flowchart demonstrating the study design. Starting with the recruitment of 35 ASD participants, followed by evaluation through the eligibility criteria, 22 participants with ASD were selected. These were paired with 22 non-ASD participants. Moving on to the intervention in all 44 participants. On day 1, participants underwent an assessment, containing the CARS scale (Childhood Autism Rating Scale) and the collection of sociodemographic information. After this evaluation, the participants performed Match 0 for familiarisation with the task, during 2 to 3 minutes in virtual reality (VR). On day 2, participants answered BRUMS questionnaire (Brunel Mood Scale), then the RPE (Rating of Perceived Exertion) called moment 0, and Match 1 with 3 minutes of activity in VR were evaluated, following RPE moment 1, and VR Match 2, followed by RPE moment 2 and VR Match 3, ending with RPE moment 3. At the end, the participants performed the BRUMS questionnaire again, and finally responded to the enjoyment scale.

Table 1. Participant’s characteristics.

Variables		Group		p-value
		ASD	NON-ASD
		Mean ± Standard Deviation	Mean ± Standard Deviation
		n (%)	n (%)
Sex	Female	3 (13.6)	5 (22,7)	0.698
	Male	19 (86.4)	17 (77.3)
I feel a lot of loneliness  during quarantine. How  much you agree with this sentence.	I disagree	2 (66.7)	1 (33.3)
	I Partially Agree	12 (60.0)	8 (40.0)	0.00
	I completely agree	8 (38.1)	13 (61.9)
Regarding sleep, do you have  difficulty sleeping?	Neither	9 (39.1)	14 (60.9)
	Light	8 (50.0)	8 (50.0)	0.00
	Moderate	5 (100)	0 (0.0)
Do you practice physical  activity?	Once a week	13 (61.9)	8 (38.1)
	between 2 and 4 times a week	9 (45.0)	11 (55.0)	0.00
	5 times a week or more	0 (0.0)	3 (100)
If YES, did you have to stop  physical activities during the quarantine?	No, I adapted the activities at home	5 (50.0)	5 (50.0)	1.00
	Yes	17 (50.0)	17 (50.0)
Would you use this game in a  physical therapy session?	No	4 (100)	0 (0,0)	0.108
	Yes	18 (45.0)	22 (55.0)
Do you play any games on   your cell phone?	No	2 (50.0)	2 (50.0)	1.000
	Yes	20 (50.0)	20 (50.0)

Figure 4. Absolute error and variable error mean and standard error for both ASD and non-ASD groups.

Graphical demonstration of absolute error and variable error. In both, the demonstration of each of the task targets is performed using four coloured spheres, similarly to the activity in VR. All spheres contain graphs of ASD and non-ASD participants’ performance during Task Matches. The results are described in the text of the manuscript.

Figure 5. Mean and standard error of percentage of hits, misses and the continuous score, for both ASD and non-ASD groups.

Graphical demonstration of hits percentage and misses percentage. In both, the demonstration contains graphs of ASD and non-ASD participants’ performance during Task Matches. The results are described in the text of the manuscript.

Figure 6. Mean and standard error of RPE score (a) and representation of the answers of the individuals regarding their enjoyment with the game (b) for both ASD and non-ASD groups.

Graphical demonstration of RPE (Rating of Perceived Exertion), containing a graph of ASD and non-ASD participants’ scores during Task Matches. And a demonstration graph of the Enjoyment Scale of ASD and non-ASD participants’ scores. The results are described in the text of the manuscript.

Table 2. Brunel Mood Scale (BRUMS) for both groups, before and after the intervention.

	ASD			NON-ASD
	before	After	p-value	Before	after	p-value
Tension	0.69	0.50	0.014	0.48	0.20	<0.001
Depression	0.28	0.28	1.000	0.06	0.04	0.329
Anger	0.26	0.76	0.020	0.00	0.09	0.329
Vigor	3.36	3.98	0.049	3.40	3.33	0.565
Fatigue	0.03	0.29	0.001	0.01	0.05	0.266
Mental Confusion	0.45	0.41	0.683	0.08	0.07	0.576
Total	0.88	0.91	0.536	0.71	0.64	<0.001

Legend: Table 2 represents the comparison between groups and moment of assessment (pre and post intervention) of mood using the Brunel Mood Scale. A value of p < 0.05 is considered significant.