Comparing VR and 2D game environments on mental workload, emotion and situation awareness: implications for rehabilitation game design

Purpose Virtual reality (VR) games are increasingly being explored as tools for physical and mental rehabilitation, yet their cognitive and psychological demands relative to conventional 2D games remain insufficiently understood. In rehabilitation-oriented tasks, factors such as mental workload (MWL), situational awareness (SA) and affect play a critical role in adherence and safety. As an initial, pre-clinical step, this study examines how these demands differ between immersive VR and traditional 2D gameplay. Design/methodology/approach A within-subjects study was conducted with 21 healthy adults who performed game-based tasks of varying difficulty in both VR and 2D environments. MWL, affect and SA were assessed after each condition using self-assessment questionnaires. Findings Compared with the 2D environment, VR resulted in significantly higher overall MWL, effort and physical demand, particularly at the easier task difficulty. VR was also associated with higher negative affect at the easy level; however, negative affect did not further increase at the high level, while positive affect remained stable across difficulty levels. Originality/value The findings offer foundational insight into the cognitive and affective demands associated with immersive VR gameplay prior to clinical application. The results underscore the need to balance workload, task difficulty and emotional intensity in the design of rehabilitation-oriented VR games, especially in scenarios where exercises are inherently challenging and sustained engagement is essential.