Transformative Virtual Reality Games for Adaptive Sports Training: Exploring the Perceptions of Individuals with Mobility Impairments

Abstract

The rise of virtual reality (VR) technology has opened up new opportunities for individuals with mobility impairments to participate in adaptive sports training. This paper reports on a survey study of individuals with mobility impairments to explore their expectations and needs when designing and developing VR games for adaptive sports training. Results indicate that participants are highly motivated to engage in VR adaptive sports training due to its promising potential and have specific requirements for game design and development, including ease of use, realistic gameplay, and accessible controls. This study highlights the transformative potential of VR technology in providing equal opportunities for individuals with mobility impairments to participate in adaptive sports training and promotes the development of inclusive VR games for disable users. Our findings have actionable implications for game designers, developers, and researchers, as they underscore the importance of accessibility and inclusiveness in the design and development of VR games for adaptive sports training.

Keywords:

• Accessible VR games
• individuals with mobility impairments
• virtual reality
• accessibility
• VR gaming
• disability

1. Introduction

Adaptive sports are an increasingly popular form of physical activity modeled after traditional sports, such as soccer and hockey, in a special way to meet the needs of individuals with disabilities (Lastuka & Cottingham, 2016). Adaptive sports training (AST) involves modifying traditional sports and recreational activities to make them accessible and inclusive for disabled people (Cooper and Luigi, 2014; Tow et al., 2020). Through the use of adaptive equipment, modified rules and playing spaces, and specialized coaching and instruction, AST enables individuals with mobility impairments to participate in a wide range of activities, including team sports, individual sports, and outdoor recreation (Diaz et al., 2019; Tow et al., 2020).

Academic interest in the use and applications of virtual reality (VR) games in sports training has increased in recent years (Farizi et al., 2021; Neumann et al., 2018), with a growing body of research demonstrating the potential of bespoke VR games for sports training to improve player performance and enhance the training experience (Argelaguet Sanz et al., 2015; Cmentowski & Krueger, 2021; Lee & Kim, 2018; Liu et al., 2020). Nevertheless, the application of VR games for AST remains understudied despite their transformative impact (Recio et al., 2013). Specifically, VR games have the potential to revolutionize AST for individuals who use wheelchairs for mobility and face unique challenges in sports training due to mobility impairments, accessibility issues, and limited access to adaptive sports facilities (Diaz et al., 2019). Traditional AST programs may not fully accommodate their needs and can be limiting in terms of skill development and training variety. In this context, VR games have the affordance of providing a safe, accessible, and personalized training environment that can enhance skill development and improve overall performance (Gerling et al., 2020; Recio et al., 2013).

As with any technological innovation, the success of VR games for AST (referred to as VR-AST henceforth) will depend on the extent to which they are accepted and adopted by individuals with mobility impairments. Therefore, it is of great importance to understand their perceptions of VR technology with respect to its potential benefits and barriers, which remains underexplored in the human-VR interaction literature. To address this need, we conducted an online survey among individuals with mobility impairments who use wheelchairs and actively participate in adaptive sports. The survey was designed as a video elicitation study to better understand disabled users’ perceptions of VR technology and to explore their expectations and needs from VR-ASTs for the specific adaptive sport they play. Using the Technology Acceptance Model (TAM) (Davis, 1989) as the theoretical framework for our study, we particularly focused on exploring the factors affecting the perceived usefulness and ease of use of VR games for AST among individuals with mobility impairments. Our research questions were as follows:

1. What are the perceptions of individuals who use wheelchairs for mobility regarding the usefulness of VR games for AST?

2. What are the perceptions of individuals who use wheelchairs for mobility regarding the ease of use of VR games for AST?

3. What are the expectations of individuals who use wheelchairs for mobility from bespoke VR games for AST?

Our findings revealed that individuals who use wheelchairs for mobility believed that the use of VR games for AST would be highly useful in terms of making AST more accessible and inclusive, offering greater flexibility in training, providing individualized and realistic training, facilitating the learning of game rules, and promoting the adaptive sport. As for the perceived ease of use of VR technology, participants highlighted two major categories of barriers to their use of VR technology with ease: physical barriers associated with their specific mobility impairment and equipment barriers associated donning the VR headset and using the handheld VR controllers. Regardless of the perceived barriers, participants were keenly interested in using VR-AST and had specific recommendations for and expectations from bespoke VR games for AST.

The main contributions of this paper are as follows:

1. the first in-depth investigation into the perceptions of individuals who use wheelchairs for mobility regarding the use of VR games for AST,

2. the exploration of factors affecting the perceived usefulness and ease of use of VR-AST,

3. guidelines for the design of bespoke VR games for AST for individuals who use wheelchairs for mobility.

The rest of this article is structured as follows: Section 2 provides a synthesis of the related work on VR-AST by providing background on AST and on accessible VR games for people with mobility impairments. Section 3 provides a detailed description of the method followed to conduct the study. Section 4 presents the results of the thematic analysis of the qualitative data, while Section 5 provides a discussion of the results and presents design guidelines for VR-AST. Lastly, Section 6 presents the conclusion of the paper.

2. Related work

2.1. Adaptive sports training

Previous research has shown that participation in adaptive sports offers numerous physical and psychological benefits for disabled people. To begin with, it promotes physical fitness, strength, and flexibility, which can improve overall health and quality of life (Diaz et al., 2019; Groff et al., 2009). Participation in adaptive sports has also been shown to build self-confidence, promote social interaction and teamwork, and provide opportunities for personal growth, achievement, and rehabilitation (Carless et al., 2013; Côté-Leclerc et al., 2017; Declerck et al., 2019). In addition, AST offers individuals with mobility impairments a sense of community and belonging, as they are able to connect with others who share similar experiences and challenges, which results in positive mental health outcomes (Diaz et al., 2019; Lee & Uihlein, 2019; Lundberg et al., 2011; Peacock et al., 2019).

While AST is a valuable and empowering form of physical activity that has the potential to positively impact the lives of individuals with mobility impairments in numerous ways, it is not always accessible to disabled people. In a recent review of the literature on adaptive sports training, Diaz et al. (Diaz et al., 2019) identified two major barriers to the participation of disable people in AST. The first barrier relates to the limited availability of AST programs (or lack thereof) in one’s community, with such programs not being widespread in all communities. Even when disabled people can find an AST program, practice and training time can be limited due to the limited availability of adaptive equipment, which tend to be expensive. Therefore, accessing AST programs and getting ample practice time are challenging for disabled people. The second barrier pertains to transportation to the training site (Diaz et al., 2019). Because most individuals with mobility impairments cannot drive, they rely on others or public transportation when they need to travel to AST practice sites. Taken together, it seen that AST has great potential for disable people but may not always be accessible to individuals with mobility impairments. This points to a need for devising transformative AST programs that can address and enhance the limitations associated with traditional AST programs. To this end, the present study sought to explore the potential of VR games as a transformative training paradigm for adaptive sports.

2.2. Accessible VR games for individuals with mobility impairments

While VR gaming has been extensively studied by researchers in the HCI and gaming circles (Frommel et al., 2017; Hart et al., 2018; Krekhov et al., 2018; Yildirim, 2019), the design and development of accessible VR games for disabled individuals has received limited attention (Gerling & Spiel, 2021). That said, previous research has shown that individuals with limited mobility are highly interested in using VR applications for entertainment, socialization, and productivity purposes (Mason et al., 2022; Mott et al., 2020; Wentzel et al., 2022).

Notwithstanding the scarcity of studies in this burgeoning field, it is increasingly crucial to develop and evaluate VR games for and with individuals with mobility impairments for several reasons. To begin with, accessible VR games ensure that disabled users can also enjoy and participate in the gaming experience, promoting a more inclusive environment. They have the potential to enable disabled users to participate in the same activities as their non-disabled peers, promoting equality. In addition, developing accessible VR games can increase engagement and participation from a wider audience, as it ensures that everyone can participate in the gaming experience. By the same token, accessible VR games can empower disabled users to explore new environments, engage with new experiences, and overcome limitations that may exist in the physical world. Lastly, the development of accessible VR games usually requires new approaches and technologies, which can lead to innovative solutions that benefit everyone, regardless of their abilities.

To address the lack of research into accessible VR games for individuals with mobility impairments, Gerling et al. (Gerling et al., 2020) developed three VR games based on the needs and expectations of wheelchair users, ensuring that players could control their wheelchairs during gameplay. While wheelchair users were not directly involved in the design of the games, they did participate in the evaluation process. The study found that wheelchair users enjoyed being able to play VR games while using their wheelchairs. The researchers also emphasized the importance of making controls adaptable and flexible so that wheelchair users can customize how they provide input based on their mobility limitations. Gerling et al.’s study demonstrated that involving disabled users in the design of VR games can mitigate accessibility issues and enable the development of VR games that cater to the abilities of disabled users, allowing them to take full advantage of the immersive capabilities of VR gaming.

Mott et al. (Mott et al., 2020) focused on exploring the hardware-related challenges faced by individuals with mobility limitations when setting up and using VR systems. They interviewed 16 individuals with mobility limitations using semi-structured interviews and identified seven categories of accessibility issues. These included challenges related to setting up the VR system, preparing VR peripherals, donning and removing the VR headset, managing cords, holding and using two motion controllers simultaneously, reaching and pressing the buttons on VR controllers, and keeping the VR controllers in view of the cameras on the VR headset. Relevant to our study, Mott et al.’s findings showed that the need to use two controllers at the same time would prevent individuals with mobility limitations from using these systems. This emphasizes the importance of moving away from the assumption of two-handed interactions in VR and developing more accessible options.

2.3. VR games for adaptive sports training: A gap in the literature

Our review of the literature showed that when it comes to the design and evaluation of bespoke VR games for AST, the extant literature provides more limited information than what was revealed in the previous section regarding accessible VR games for individuals with mobility impairments. In fact, our review has revealed only one study addressing the topic, in which Recio et al. (Recio et al., 2013) examined the effects of a VR-based sailing simulator on sailing performance among individuals with spinal cord injury. They found that the 12-week program led to significant improvements in sailing performance and psychological health outcomes. While this study provides useful insights, it should be noted that their VR system did not use a head-worn headset. The simulator was developed for desktop displays and included a sailboat cockpit. This, coupled with the foregoing review of the literature, points to a dire need for designing and evaluating bespoke VR games for AST and for studying their efficacy in improving athletic performance and in promoting psychological wellbeing. Such an investigation would need to begin by exploring the needs and expectations of individuals with mobility impairments, as the efficacy of these custom VR games will be determined by the extent to they are accepted and adopted by individuals with mobility impairments.

3. Method

The current study focuses on two particular adaptive sports: Power Soccer and Volt Hockey. The reason why we chose two adaptive sports over others is that as part of our community engagement efforts we partnered with a local non-profit organization that provides AST resources and practices for these two sports to wheelchair users in the local community. Our ultimate goal is to develop bespoke VR games for this non-profit organization to train players in these sports and to enable them to practice game rules and skills on their own. For this reason, the focus of our project was on developing VR games instead of augmented reality games, which would require players to find a large room over which virtual objects could be superimposed. By utilizing the immersive affordances of VR technology, VR games can fully engross players in a virtual replica of the basketball court used for practices and matches, thereby enabling them to virtually experience the actual game atmosphere in their homes and learning the game rules in the actual setting where they would need to apply them.

Before designing and developing the bespoke VR games, we sought to explore the expectations and needs of players through a survey study, as outlined in the rest of this section. Before diving into the methodological details of the study, we first introduce the two adaptive sports targeted in this study, given their importance for the interpretation of the findings and implications.

3.1. Adaptive Soccer and Hockey

Power Soccer is the adaptive variant of the conventional soccer game and involves two teams (two to four players with at least one goalkeeper) competing against one another to score a large ball into the other team’s goal area. Players use power chairs with custom footguards attached to the front of the chair as “feet” (see Figure 1(a)). Players control the chair using a fixed joystick attached to either armrest of the chair. Power soccer practices usually take place at an indoor basketball court (see Figure 1(b)), and the typical play area is 94 ft x 50 ft.

Figure 1. Power Soccer.

Volty Hockey is the adaptive variant of the conventional hockey game. The game is played by two teams of three players in special chairs called Volt chairs (see Figure 2(a)). Attached to the front of the chair is a plastic paddle as the “hockey stick.” The goal of the game is to maneuver a small ball with the stick and score the ball into the opposing team’s goal area. Players control the chair using a fixed joystick attached to either armrest of the chair. Volt Hockey practices usually take place at an indoor basketball court (see Figure 2(b)), and the typical play area is 66 ft x 46 ft.

Figure 2. Volt Hockey.

3.2. Theoretical framework

The guiding theoretical framework for our investigation into the perceptions of individuals with mobility regarding VR-ASTs is the Technology Acceptance Model (TAM), which explains how people perceive and adopt new technology (Davis, 1989). TAM has been widely used in human computer interaction circles to understand users’ acceptance of various technologies, including VR (Sagnier et al., 2020). TAM provides a useful way of understanding and predicting users’ intention to adopt and technological innovations. At the core of the model are two key components: Perceived Usefulness (PU) and Perceived Ease of Use (PEOU) (Davis, 1989)

Perceived Usefulness (PU) refers to users’ perception of the extent to which a technology is useful in achieving specific goals or tasks (Davis & Venkatesh, 1996). TAM postulates that users will be more likely to accept and use a technology if they perceive it as useful in achieving their goals. Perceived Ease of Use (PEOU) refers to users perception of the extent to which a technology is easy to use (Davis & Venkatesh, 1996). According to the model, users will be more likely to accept and use a technology if they perceive it as easy to use.

When applied to understanding disabled users’ acceptance of VR games for adaptive sports training, TAM can be tremendously helpful to understand the factors that affect users’ acceptance of the technology. In the case of VR-AST, for instance, disabled users may perceive the technology as useful if it helps them achieve their training goals, improve their performance in adaptive sports, or make training more engaging and enjoyable. They may perceive the technology as easy to use if it has a user-friendly interface, requires minimal physical effort to operate based on their mobility impairment, and does not cause discomfort or fatigue.

By identifying the factors that affect disabled users’ perceptions of PU and PEOU, it would be possible to improve the design and functionality of bespoke VR games, paving the way for more accessible and inclusive VR games and higher levels of acceptance and adoption. Moreover, applying the TAM framework can help researchers understand how the users’ perceptions of PU and PEOU affect their intention to use the technology and their actual usage behavior, allowing them to improve the technology’s effectiveness. We, thus, believe that TAM is a suitable framework that can be applied to the exploration of the perceptions of individuals with mobility impairments regarding VR games for AST. While the extended TAM includes additional factors related to VR, such as cybersickness and presence (Sagnier et al., 2020), introducing these factors may unnecessarily complicate our research without commensurate benefits, because the extended version of TAM, as applied to VR technology does assume experience with or exposure to VR, rendering it unsuitable for exploring perceptions in a video-elicitation study that our study was. Our study aimed to identify the core drivers of technology acceptance among disabled users for AST, and TAM’s focus on PU and PEOU offers the right level of granularity for this purpose.

3.3. Survey design

To gather participants’ perceptions of VR games for AST, we conducted an online survey. The rationale behind our survey study was to recruit as many participants as we could and give our participants the chance to take as much time as they needed to answer the questions, with increased anonymity and privacy to encourage more honest and open responses. Considering the sensitive aspect of discussing personal experiences with mobility impairments, we believed an online survey would provide a more comfortable environment for our participants to share their opinions freely. In addition, given our participants’ need for assistance for transportation to the practice site in their local community, it was infeasible to conduct one-on-one interviews before or after their practice in the time we had for data collection.

The survey was comprised of three main sections: adaptive sports background, VR perceptions, and demographics. The adaptive sports section contained questions about the adaptive sports participants took part in (Power Soccer and/or Volt Hockey), how often they attended the in-person practices, and potential barriers to their regular attendance in these in-person practices.

The VR perceptions sections of the survey was designed as a video elicitation study (Henry & Fetters, 2012; L. Franz et al., 2021; Yamagami et al., 2022), wherein participants were shown a short video introducing how to set up a standalone VR headset (Meta Quest 2) and how it can be used in a seated position. The link to the video is available in Appendix A. The video is one of Meta’s official tutorial videos for Meta Quest headsets and covers how to set up the VR headset, how the controllers work, and how the headset can be used in standing and seated positions. The video also demonstrates the mobility-related requirements imposed on by the VR system. We therefore deemed it appropriate for such a video elicitation study whose goal was to understand the perceptions of disabled users regarding the ease of use and usefulness of VR technology within the context of bespoke games for AST.

Following the video, participants were presented with the open-ended questions tapping into their perceptions of VR technology, of how it can be useful for AST, of how easy it would be for them to use, of what expectations and recommendations they had for the design of VR games simulating their adaptive sport. At the end of the VR perceptions section, participants were presented with six statements about their perceptions of the usefulness and ease of use of VR simulations for AST and were asked to rate them on a 5-point Likert scale. The questions are also available in Appendix A. The demographics section contained basic demographics questions and questions about the nature of respondents’ disability.

3.4. Participants

We used purposive sampling (Creswell & Poth, 2016) to recruit participants into our online study. Because our goal was to reach out to individuals with mobility impairments who take part in adaptive sports, purposive sampling enabled us to identify the participants who met our inclusion criteria (Creswell & Poth, 2016). The sample consisted of 15 individuals with mobility impairments (3 females and 12 males), with an average age of 32.6 (SD = 16.1). All participants were wheelchair users. Refer to Table 1 for a summary of participants’ demographic information, including the self-disclosed nature of their mobility impairment.

Table 1. Summary of participants’ demographics.

PID	Mobility Impairment	Experience with VR	Experience with Video Games
P01	Muscle disease affecting all muscles	Some experience	Core player
P02	Spinal muscular atrophy (SMA)	Never used before	Casual player
P03	Duchenne muscular dystrophy	Tried a couple times	Casual player
P04	Muscle disease affecting most muscles	Never used before	Core player
P05	C4/5 Quadriplegic (spinal cord injury)	Tried a couple times	Newbie/novice player
P06	Not disclosed	Tried a couple times	Core player
P07	Arthrogryposis multiplex congenita (AMC)	Tried a couple times	Core player
P08	Spinal muscular atrophy (SMA)	Never used before	Casual player
P09	Muscle strength reduction	Tried a couple times	Expert player
P10	Hard to walk	Extensive experience	Expert player
P11	Paraplegic	Never used before	Casual player
P12	Spinal cord lesion at C1	Tried a couple times	Core player
P13	Becker muscular dystrophy (BMD)	Never used before	Core player
P14	Quadriplegic (Guillain-Barre Syndrome)	Extensive experience	Casual player
P15	Muscle and mobility reduction	Tried a couple times	Core player

Most of the participants were regular attendees in weekly adaptive sports training sessions in their local community, with 80% (n = 12) reporting attending the practices for Power Soccer or Volt Hockey every week or every other week. The remaining three participants were not regular attendees. In terms of participants’ experience with VR, approximately 33% (n = 5) had never used VR before, whereas 54% (n = 8) reported having tried VR a couple of times or having some experience with VR. Only 13% of the participants (n = 2) had extensive experience with VR. In relation to their experience with video games, almost all participants (n = 14) reported playing video games, with two expert players (13.33%), seven core players (46.67%), and five casual players (33.33%). Of the 15 participants, approximately 7% (n = 2) reported spending an average of less than 1 hour per week playing video games, 27% (n = 4) 1–2 hours, 33% (n = 5) 3–5 hours, 20% (n = 3) 6-8 hours, and 7% (n = 1) more than 9 hours.

Regarding their attendance in in-person practices, participants noted several barriers, including difficulties associated with logistics and transportation, schedule conflicts, and weather and environmental factors. Most participants need a ride to travel to the practice site or use public transportation, which makes it challenging to attend the practices regularly. In addition, their other commitments conflict with the schedule of practice sessions, preventing them from attending practices every week. Lastly, living in the New England region of the US, inclement winter weather conditions present an obstacle to participants’ regular attendance in on-site practices.

3.5. Procedure

To recruit participants for our online survey, we partnered with a local non-profit organization run by disabled people to provide support and resources for others with physical disability in the New England region of the US. The survey link was sent out via email to disabled players who actively attend the practice sessions for Power Soccer and Volt Hockey, the two adaptive sports that this non-profit organization organizes for disabled people. Participation in the survey was voluntary, and those interested in taking part in the survey were asked to go to the link to learn more and complete it. Participants were entered into a raffle for one of three $10 Amazon gift cards. Participants started the online survey by first completing the informed consent form and then proceeded to the survey question. On average, participants completed the entire survey in 30 minutes. The study procedures were approved by the institutional review board of the university where the study was conducted.

3.6. Data analysis

Following constant comparative analysis procedures (Creswell & Poth, 2016), we analyzed the open-ended survey responses in three stages: open coding, axial coding, and selective coding (Adams et al., 2008). Open coding enabled us to identify emerging themes in the qualitative data about participants’ perceptions of the usefulness and ease of use of VR games for AST, which were then grouped into categories during axial coding. Because we approached the exploration of participants’ perspectives from the lenses of TAM, perceived usefulness and perceived ease of use were used as pre-determined broad categories during axial coding. That said, the emergence of subcategories under these broad categories was driven by the qualitative data. In the final stage of selective coding, we elaborated on and interpreted the emerging categories and developed a conceptual understanding of the participants’ perceptions of VR technology.

4. Results

The thematic analysis of participants’ responses showed that multiple factors affected the perceptions of individuals with mobility impairments on the usefulness and ease of use of VR games for AST. In what follows, we describe the recurrent themes for each of these components of the TAM, incorporating the feedback provided by participants.

4.1. Perceived usefulness

Regarding the perceived usefulness of VR training for adaptive sports, our analysis revealed several themes: accessibility and inclusivity, flexibility in training, individualized and realistic training, learning game rules, and promotion of the adaptive sport.

4.1.1. Accessibility and inclusivity

Many participants noted that VR technology could be beneficial for individuals with disabilities, as it allows for remote and safe training opportunities. The technology can also help to introduce and teach new players the rules of the game.

“The VR technology would be great to initially introduce disabled people to the game and teach them the rules. Since you wouldn’t necessarily need to travel to the gym to use the simulator, it could be used to attract more players and they could try it out in the comfort of their own home.” [P02]

“To use VR would be a safe and risk-free way to try and test the sport, if it’s a bit scary in real life.” [P09]

4.1.2. Flexibility in training

Many participants highlighted the advantage of being able to practice certain aspects of the sport outside of practice time and without the need for gym space, where in-person AST practices take place. This theme was emphasized by participants who mentioned the ability to practice from home or when remote, thereby increasing the flexibility and accessibility of training.

“It could add ability to practice some aspects of sport outside of practice time and without the need for gym space.” [P01]

“It would be useful because players would be able to practice without having to go to the gym and often times the gyms aren’t available to be used frequently.” [P03]

“[It’d] allow for some type of training/practice even when people are remote.” [P12]

Participants also emphasized the usefulness of VR-AST in enabling players to train and practice remotely on their own, which is beneficial for individuals who are unable to attend physical training.

“It would be useful in digital training from home/across countries or to show how certain things are done.” [P15]

“It would give the ability to practice outside of the gym.” [P11]

4.1.3. Individualized training

Several participants mentioned the ability to personalize their training to focus on areas of the game they need to improve. They emphasized the usefulness of VR simulations in choosing what to practice, enabling them to work on rounding out areas of the game they need to work on individually.

“It would be a great tool to be able to develop my own skills that I know need improvement. Oftentimes at practice, everyone will do the same drills and focus on a particular area of the game as a group. This means that sometimes I might be practicing something that I’m already proficient at, but could instead be using the time to focus on another skill that I’m lacking in. With a VR simulation, I’d be able to choose what I want to practice and spend that extra time to work on rounding out areas of the game that I need to work on individually.” [P02]

“For me, trying to time a spin kick would be very helpful. Despite having played for 10 years, I am truthfully not very good at this aspect.” [P05]

“I might be able to view recorded games from different angles. I could also try to simulate striking the ball and timing correctly to see if it goes in the correct direction. It might also help with formulating plays and simulating them prior to practice.” [P05]

4.1.4. Realistic training

Several participants expressed that VR technology could offer a more immersive and realistic training experience, better replicating the speed and intensity of a real game.

“One of the fundamental problems with practice and the drills we do… is that it doesn’t simulate how quickly things happen in a real game. Could a VR practice app better replicate this?” [P14]

“It would seem like I’m actually there, and I can move my body to control it instead of using my fingers on a screen.” [P08]

In addition, P02 and P06 emphasized the importance of making the VR simulation as similar as possible to real-life gameplay. This included having the same positioning of the controllers and similar joystick sensitivity.

“It would also be ideal to have the positioning of the controller in relation to me be the exact same as it is when I play in real life. Another issue might be how stiff the VR controls are compared to the volt hockey chair joysticks. You would also want them to be as similar as possible because if one joystick is more sensitive than the other, it could also throw off how you perform in real life vs. VR.” [P02]

4.1.5. Learning game rules

Participants emphasized the usefulness of VR simulations in helping them understand the game and its rules better. This theme was highlighted by participants who mentioned the usefulness of VR in explaining fundamental play, rules, tactics, and overall understanding.

“It would benefit explaining fundamental play and rules. Another thing would be to explain a play-scenario and show choices, options and ideas for that particular scenario.” [P09]

“It would be a great way to understand the game and learn the rules. If it can explain what is going on and why.” [P04]

Beyond learning game rules, a few participants mentioned that VR-AST would be helpful for developing specific technical skills, such as timing spin kicks.

“Defensive and offensive positioning could be easier shown and learned.” [P09]

4.1.6. Promotion of the adaptive sport

Several participants highlighted the promotional benefits of using VR to introduce the sport to non-chair users. They mentioned the usefulness of VR in showcasing what the adaptive game feels like.

“[It would be useful] as an introduction to the game. A promotional tool to show non-chair users how athletic power chairs feel.” [P07]

“VR could show people, especially children, what a fun and freeing sensation it is to play Volt Hockey.” [P09]

4.2. Perceived ease of use

In relation to the perceived ease of use of VR training for adaptive sports, the thematic analysis of the responses yielded several potential barriers to the use of VR systems for AST, as perceived by individuals with mobility impairments. We categorized these barriers into two themes: physical limitations and equipment limitations.

4.2.1. Physical limitations

Participants mentioned difficulties in independently putting on/off the VR headset and limited hand/arm mobility. These limitations may require the assistance of others, which can be a restriction to practicing alone.

“To put the VR headset on, I would need to ask another person to put it on my head since I can’t lift my arms above my chest, so I would always need the assistance of another person which isn’t a huge deal but could be restricting if I wanted to practice when I was alone.” [P02]

“Independently putting on/off a VR headset is challenging/impossible for some people depending on their disability.” [P12]

“In general, the wheelchairs equalize mobility for everyone, so it is hand function that then makes it more difficult for some (such as myself, even though I’m otherwise more mobile than my teammates). This will be the case with a VR app as well.” [P14]

Some participants expressed concerns about the use of handheld controllers because it may require fine motor skills, such as holding VR controllers and pressing buttons at the same time, that may be difficult for individuals with paralysis or limited fine motor skills. One participant suggested the use of a joystick instead of buttons to accommodate those with limited hand strength or curled hands. Specifically, when asked about the compatibility of VR controllers with their mobility impairment, P08 responded:

“It works for me, but it won’t for some people I know. Some people have their hands curled in or they don’t have the strength to push a button. Maybe you can use a joystick instead of buttons, like it is on the actual chair!!”

P01, P12, and P13 echoed the same concern about the need to hold and use handheld VR controllers, highlighting the importance of minimizing physical demands associated with holding a VR controller:

“I wouldn’t have any issues but some of my teammates have paralysis or poor fine motor skills, could see some issues there with holding items.” [P01]

“I could not use two controllers like the ones shown. I can operate a joystick/thumbstick with my right hand. I could not press buttons and operate a joystick with my hand at the same time.” [P12]

“I might have a hard time clicking buttons on the vr controllers” [P13]

Participants also expressed concerns about their ability to experience virtual space due to their lack of sensation throughout their body. They noted that they may not be able to feel the physical impact of the game and may have difficulty experiencing the full extent of the game:

“Because I don’t have very good sensation throughout my body, I am not sure how I’m going to react to virtual space. I cannot feel in my hand so some of what I need to experience in virtual space is visually seeing the chair move and the ball which very well might be possible. I have tried some virtual-reality before and feel a bit like I am in one of those water tanks with no light and floating. Truthfully though I am excited to try it out and would hope it would lead to other experiences such as exploring museums, countries that I’ve never been to, etc.” [P05]

4.2.2. Equipment limitations

The VR headset and controls may pose challenges to some participants, such as the need for help taking on and off the headset, the issue with a joystick into VR, and the precision needed for steering. Several participants expressed concerns about equipment and controls:

“The controls and tactic Will be major for adaptive hockey if it can be formed into VR.” [P10]

“The issue with a joystick into VR, and how precise the steering needs to be.” [P09]

Some participants expressed concerns about holding the controllers for a long period of time and how this might affect their performance and lead to fatigue. Some suggested the use of stationary mounts to minimize the need to hold the controllers, while others mentioned that the positioning of the controllers in relation to their bodies would be important for maintaining consistency between VR and real-life gameplay.

“If I had to hold the controllers in my hands for a long period of time instead of being able to have the controller/joystick mounted in place so I didn’t have to hold it, I might get tired easily.” [P02]

“The only potential issue is the controllers might be to heavy to hold but if it was on a stationary mount it wouldn’t be a problem.” [P03]

Related to equipment limitations, one participant mentioned that VR systems may not be affordable to all players, highlighting the need for targeting the most affordable VR headsets when developing VR-AST programs. In addition, some participants noted that the inability to communicate with others on their team during play may be a barrier to their use of VR training for adaptive sports:

“The inability to communicate with others on your team during play.” [P11]

This illustrates the desire of players to maintain social interaction with their teammates during VR training in a manner similar to how their in-person practice sessions work.

4.3. Expectations from VR games for AST

In their responses, participants provided their ideas for the design of the VR simulations for adaptive hockey and soccer. Based on their experience with the adaptive sports, they had specific expectations from the VR versions of the sports they played. One recurrent theme was that participants emphasized the importance of making the VR simulations as realistic as possible and resemble the in-person practice and gameplay sessions. For instance, P02 clearly outlined what he thought the VR simulations could look like:

I would imagine the VR simulation of volt hockey to almost imitate what sports video games do. There could be a series of drills where you just focus on certain skills like passing, shooting, and maneuvering and are scored based on how accurate/fast you are. Then there could be practice games which could be less difficult and the game might pause to give you tips on what drill you should run at a specific point or give feedback on what you did well/poorly. Then of course an actual game simulation where it would simulate exactly how a game would go in real life. [P02]

Some participants mentioned the need to use their dominant hand or switch between hands while using the handheld controllers, while others mentioned the potential use of a mouth input to supplement their dominant hand.

“If I have to control both at the same time I might need a mouth input to go along with my left hand which is dominant.” [P05]

Table 2 provides a summary of the game-specific recommendations/expectations participants had. Given their direct relation to design implications, participants’ expectations are further elaborated on in the next section.

Table 2. Summary of participants’ expectations/recommendations.

PID	Expectations/Recommendations
P01	Practice shooting the ball or passing.  Spin kicks seem like most useful. Perhaps speed and accuracy as well in these two areas.
P02	A series of drills Specific skill practice like passing, shooting, and maneuvering Scoring based on how accurate/fast you are Adjustable game difficulty Tips on drills to run and feedback on performance
P03	Simulate different teams playing style so players can prepare for games against specific teams
P04	Ideas on how this can work for someone who can not stand or has limited arm movement Explain the rules or why you can or can not do something
P05	Simulating different angles of ball speed coming in and allowing for practice spinning, hitting on the side of the guard, and directly from the front of the guard Simulating set plays such as corner kicks, sideline kicks, Goal Kicks, kicks generated from 2-1 penalties, and penalty kicks
P06	Make it as realistic as possible
P07	The ability to track how high level athletes handle their joystick Seeing their controller input in game situations could help lower level players
P08	Call out fouls Teach techniques Maybe it can be online so you can play with friends
P09	Being able to setup starting positions during start of play and during freekicks. Learn basic rules and basic principles of play, goaltending, defensive/offensive play. Practice shots, passes or other drills. Training packs which features all from shooting, dribbling and steering control (e.g., Rocket League)
P10	See a overview off the field to see what u can do in a attack and defensive look good to make a bird view off it
P11	The ability to simulate games Practice visualizing and setting up screens/plays
P12	Being able to do drills like the training packs in the game Rocket League. Maybe a implementing a few drills would be a good starting point for an app. Then progress to implementing full gameplay and ultimately multiplayer gameplay.
P13	No response
P14	No response
P15	Several setups for different courses and/or multiplayer

5. Discussion

Our study addressed a growing need in VR games research by exploring the perceptions of individuals with mobility impairments who use wheelchairs for mobility regarding the design of bespoke VR games for AST. Echoing past research (Gerling et al., 2020; Mott et al., 2019; Wentzel et al., 2022), our results revealed that participants saw great potential in the use of VR games for AST, while at the same time raising some concerns about physical and equipment limitations associated with VR systems. In what follows, we discuss our results in relation to our research questions.

5.1. Perceived usefulness of VR-ASTs

Our first research question was concerned with the perceptions of individuals with mobility regarding the usefulness of VR games for AST. Based on the feedback from participants, it is clear that the perceived usefulness of VR-ASTs among individuals with mobility impairments is high. Specifically, our results indicate that participants believe that VR-ASTs could be useful as they provide unique affordances in terms of the accessibility and flexibility of training, individualized training opportunities, learning game rules, and promotional benefits.

Regarding the accessibility and flexibility of training, several participants pointed out that VR technology could prove advantageous for individuals with mobility impairments, because it provides a secure and remote means of training, removing barriers associated with transportation to the practice site, which is a key deterrent when it comes to their participation in AST (Diaz et al., 2019). In addition, a significant number of participants emphasized the benefits of being able to practice specific aspects of the sport outside of regular practice hours and without requiring access to the gym where in-person training takes place. This idea was repeatedly mentioned by those who noted that being able to practice from home or remotely would increase training flexibility and accessibility. This finding echoes the findings from Mason et al. (Mason et al., 2022), wherein they reported that wheelchair users had a keen interest in independently playing games using multimodal input. While Mason et al.’s focus was not on VR games, our findings overlap in relation to the potential of games as a tool for facilitating independence for individuals with mobility impairments. By removing their dependence on others for traveling to the practice site, for instance, VR-ASTs could enable wheelchair users to practice independently, which should be a key design consideration when developing bespoke VR games for AST.

In relation to individualized training opportunities, a number of participants highlighted the affordance of customizing their training sessions and honing in on specific areas of the game that they need to improve upon. They emphasized the utility of VR-ASTs in terms of selecting what to practice, which enables them to concentrate on refining individual areas of their game. Moreover, several participants brought up the realism factor, pointing out that VR-ASTs could provide a more realistic and immersive training experience by more accurately emulating the speed and intensity of an actual game.

As for learning game rules and strategies, participants stressed the practicality of VR simulations in facilitating their comprehension of the game and its rules. This theme was echoed by those who indicated that VR could be useful in clarifying basic gameplay, rules, tactics, and overall comprehension of the sport. Furthermore, participants emphasized the potential promotional advantages of utilizing VR technology to introduce the sport to individuals who do not use wheelchairs. They pointed out that VR could be helpful in demonstrating what it is like to play the adaptive game to both disabled and non-disabled individuals. Collectively, these themes highlight the potential benefits of VR games in improving adaptive sports training and accessibility as perceived by individuals with mobility impairments.

5.2. Perceived ease of use of VR-ASTs

Our second research question pertained to the perceived ease of use of VR games for AST. In line with previous research (Mott et al., 2019; Wentzel et al., 2022), our results identified two major categories of barriers to the ease of use of VR-ASTs: physical and equipment limitations.

Regarding physical limitations, the feedback from individuals with mobility impairments highlighted the importance of considering individual differences in physical abilities and preferences when choosing input methods for VR-ASTs. A similar finding was reported by Gerling et al. (Gerling et al., 2020) when they explored the perceptions of wheelchair users regarding VR gaming. In particular, Gerling et al. also found that wheelchair users pointed to the importance of customizability to better accommodate their mobility impairments. Our findings and those of Gerling et al. converge in that a wider range of physical abilities need to be considered when designing VR games for individuals who use wheelchairs, whether they be for entertainment purposes or for AST.

In terms of equipment limitations, participants noted that for some individuals, the VR headset and controls may present challenges, including the need for assistance in putting on and taking off the headset, the difficulty of incorporating a joystick into the VR experience, and the precision required for steering. Several participants raised specific concerns regarding equipment and controls, with some expressing worries about the impact of holding the controllers for an extended period, which could lead to fatigue and affect their performance. This finding is in line with the findings from Gerling and Spiel (Gerling & Spiel, 2021) and Mott et al. (Mott et al., 2020), wherein the authors found that wheelchair users had similar concerns about the mobility-related assumptions baked into the design of existing VR hardware. Given the consistency across multiple studies conducted with different groups of disabled players, one implication of this finding for VR accessibility is that accommodations such as stationary mounts, joystick inputs, and minimal button presses can help ensure better accessibility and usability for individuals with mobility impairments, which should be available in VR games as customizable settings by default rather than being considered an add-on feature (Mason et al., 2022).

5.3. Design guidelines for VR-ASTs

Our last question tapped into the expectations of individuals from bespoke VR-ASTs. We sought to understand what they would like to see in these VR-ASTs to ensure that the design of bespoke VR games would incorporate these expectations. Our results indicated that participants had specific expectations from VR-ASTs and provided invaluable recommendations for the design of bespoke VR-ASTs. We categorize these expectations and recommendations based on the recurrent themes and present them as design recommendations below:

Design for accessibility and inclusivity: Participants emphasized the importance of making the VR training accessible and inclusive for players with different abilities. Some participants suggested providing explanations of the rules and the reasons why certain actions are or are not allowed, as well as tracking how high-level athletes handle their joystick to help lower-level players. By the same token, participants also highlighted the importance of making the VR training customizable and adaptable to meet different players’ needs. Some participants suggested providing options for different courses, game setups, and multiplayer options. Therefore, the design of VR-AST should enable disabled users to customize drill setups, to practice specific skills with varying levels of difficulty, and to play with other VR users, which is critical to building a sense of belonging among individuals with mobility impairments.

Provide game simulation and preparation: Several participants suggested that a VR training for adaptive sports should include actual game simulations to prepare players for real-life games. Participants mentioned the importance of simulating different teams’ playing styles and different game situations such as set plays, corner kicks, and penalties.

Provide practice drills and simulation of specific skills: Many participants mentioned the importance of practicing specific skills such as shooting, passing, and maneuvering. Some participants suggested the use of VR simulations that imitate what sports video games do and include a series of drills that focus on certain skills, where players are scored based on their accuracy and speed.

Emphasize realism and visualization: Participants mentioned the importance of making the VR training for adaptive sports as realistic as possible, including the ability to visualize and set up screens/plays. Some participants suggested providing an overview of the field to see what players can do in an attacking and defensive look and including the ability to track controller input in game situations to help players improve their skills. One way to make virtual games and practices more realistic would be to add bot opponents driven by game artificial intelligent techniques so that players can play against adequately strong opponents.

Provide feedback and guidance: Several participants suggested providing feedback and guidance during practice games, including pausing the game to give tips on specific drills, and providing feedback on what players did well and poorly to help them better develop their skills.

5.4. Limitations and future work

While our study provides valuable insights into the perceptions of individuals who use wheelchairs for mobility regarding VR-ASTs, a few limitations should be noted when interpreting its results. To begin with, our sample included a small number of participants recruited from a local non-profit organization providing AST for wheelchair users. Although this is common in studies working with disabled users, the small sample size limits the generalizability of our results. In addition, the sample included only three female participants. It would be important to recruit more female participants to better capture their perceptions in future studies. Moreover, we recruited participants from a local adaptive sports community, and all were wheelchair users. Our participants were active attendees in practice sessions and had certain means of transporting to the practice site (power chair, car/public transportation access, etc.). While our participants had various mobility impairments, it is important to note that not all mobility impairments were represented in our sample. Lastly, not all participants had extensive prior experience with VR. Their limited experience with VR may have impacted their perception of the usefulness and ease of use of VR technology as a conduit for AST. Future research could focus on addressing this limitation by conducting in-depth interviews with individuals with mobility impairments and having them try VR headsets and controllers during the interview.

In future work, we plan on capitalizing on the results and implications from this study to design and develop bespoke VR games for adaptive soccer and hockey training for individuals with mobility impairments. Our design implications were derived from the feedback regarding these two adaptive sports. Yet, we believe that some of them are generic enough to be applied to a wider range of adaptive sports within the context of VR-ASTs.

6. Conclusion

In this paper, we explored the perceptions of individuals with mobility impairments regarding the potential benefits and barriers of using VR games for adaptive sports training (VR-AST). Using the Technology Acceptance Model as our theoretical framework, we conducted an online survey designed as a video elicitation study to understand their expectations and needs from VR-AST. Our findings suggest that individuals with mobility impairments perceived VR-AST as highly useful for making adaptive sports more accessible and inclusive, offering greater flexibility in training, providing individualized and realistic training, facilitating learning of game rules, and promoting the adaptive sport. Participants highlighted physical and equipment barriers associated with the ease of use of VR technology, nevertheless. In spite of the barriers, participants expressed a strong interest in using VR-AST and provided specific recommendations and expectations for bespoke VR games for AST. This paper provides the first in-depth investigation into the perceptions of individuals with mobility impairments regarding the use of VR games for AST, explores the factors affecting their perceived usefulness and ease of use, and provides guidelines for the design of bespoke VR games for AST for individuals with mobility impairments. These findings have important implications for the design of accessible and inclusive VR-AST for individuals with mobility impairments.

Our work demonstrates the potential of VR games to transform adaptive sports training for individuals with mobility impairments, providing new opportunities for inclusive and accessible sports training. By leveraging the unique affordances of VR technology, we can provide a safe, personalized, and engaging sports training experience that is tailored to the specific needs of individuals with mobility impairments, ultimately enhancing their performance and quality of life. The design and development of accessible VR games is an important step towards ensuring a more inclusive and equitable world, where people with disabilities are not excluded from the benefits of modern technology and entertainment. We, therefore, hope that more researchers, designers, and developers will join the efforts to improve the accessibility of VR gaming for individuals with mobility impairments.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Caglar Yildirim

Caglar Yildirim is a faculty member in the Khoury College of Computer Sciences at Northeastern University and a research scientist in the Computer Science and Artificial Intelligence Lab at Massachusetts Institute of Technology. His current research aims to improve the usability and accessibility of VR for people with physical disabilities.

Appendix A

A.1 VR demo used in video elicitation

https://www.youtube.com/embed/GojevL05Avw

A.2 questions about adaptive sports

1. Which adaptive sports do you play? (Volt Hockey and/or Power Soccer)

2. How often do you attend the in-person practice sessions in your community? (multiple choice

3. What are some barriers to your regular attendance in practice sessions? (open-ended)

A.3 open-ended questions about VR perceptions

1. How could VR technology be used to support your needs and expectations when it comes to simulating Volt Hockey/Power Soccer?

2. In what ways would a VR simulation of Volt Hockey/Power Soccer be useful?

3. What are some things/features you would like to see implemented in a VR simulation of Volt Hockey/Power Soccer? This is where you can share your ideas with us.

4. What are some potential barriers to using VR technology for practicing Volt Hockey/Power Soccer on your own?

5. Based on your mobility impairment, what are some potential issues with the use of the two VR controllers you saw in the video? Do they seem compatible with your mobility constraints?

6. Based on your impression of the VR technology depicted in the video, what would facilitate the use of VR simulations for Volt Hockey/Power Soccer among individuals with mobility impairments?

7. Any other thoughts/comments/concerns/feedback?

A.4 demographics questions

1. What is your age? (open-ended)

2. Which of the following do you identify with? (multiple-choice)

3. Do you use a wheelchair? (yes/no)

4. Do you have simultaneous use of two hands? (yes/no)

5. How would you rate your experience with virtual reality? (Likert scale from” Never used before” to” Have extensive experience”)