Adaptive exergame-based balance training for adolescents with developmental coordination disorder and autism spectrum disorder: protocol for an assessor-blinded randomized controlled trial

Objective: To evaluate whether a 12-week adaptive exergame-based balance training program reduces total sway velocity during quiet standing more than dose-matched conventional exercise training in adolescents with developmental coordination disorder (DCD) or autism spectrum disorder (ASD).Design: Assessor-blinded, two-arm, parallel-group randomized controlled trial protocol.Methods: Sixty-eight adolescents aged 12-18 years with clinically diagnosed DCD or ASD and confirmed balance impairments will be recruited.Participants will be randomized 1:1 to an experimental group receiving adaptive exergame-based balance training (AIRPASS XR system) or a control group receiving conventional exercise training.Both groups will complete 40-minute sessions three times weekly for 12 weeks, with matched intervention duration.The experimental group will use a real-time algorithm that adjusts task difficulty according to success rates and center-of-pressure parameters.The primary outcome is the change in total sway velocity, a sensitive measure of postural control efficiency associated with fall risk, assessed using a force plate during a 30-second quiet standing task from baseline (T0) to post-intervention (T1).Secondary outcomes include spatiotemporal gait parameters, motor coordination, balance under sensory-challenge conditions, and treatment adherence.Results: The study will evaluate whether the adaptive exergame group achieves greater improvements than the conventional exercise group.Conclusions: This protocol addresses key methodological limitations by incorporating performance-based difficulty adjustment and objective movement analysis.If effective, the findings will support individualized digital rehabilitation strategies for adolescents with neurodevelopmental disabilities.