Haptic-enabled virtual reality for fine motor rehabilitation in children with autism spectrum disorder: a multi-session comparative study

BACKGROUND AND OBJECTIVE: Children with Autism Spectrum Disorder (ASD) frequently experience difficulties in fine motor development that may affect daily functioning and participation in structured activities. Virtual reality (VR) has emerged as a promising tool in pediatric rehabilitation; however, comparative evidence from multi-session studies remains limited in children with ASD. This study aimed to compare the effects of a multi-session haptic-enabled VR intervention and a traditional rehabilitation approach on task completion time, figure replication accuracy, attention, and frustration tolerance in children with ASD level 1. METHODS: Eight children diagnosed with ASD level 1 participated in the study and were divided into two groups of four participants each. Group A performed fine motor rehabilitation tasks in a haptic-enabled VR environment using the Phantom Omni device, whereas Group B performed equivalent tasks using physical geometric figures. Repeated-session data were summarized at the session level and analyzed using linear mixed-effects models including group, session, and the group × session interaction as fixed effects, with participant as a random effect. The intervention consisted of 12 sessions delivered over 6 weeks, at a frequency of 2 sessions per week. Each session lasted approximately 15 minutes. No post-intervention follow-up assessment was conducted. RESULTS: The mixed-effects analysis revealed significant effects of group, session, and the group × session interaction for task completion time, indicating different patterns across sessions between interventions. Post hoc comparisons showed that Group A significantly reduced task completion time from session 1 to session 12, whereas Group B did not show a significant change. For figure replication accuracy, a significant effect of session was found, and Group A showed a significant improvement between the first and last session, while Group B did not. For frustration tolerance, the group × session interaction was significant, and only Group A showed a significant increase from session 1 to session 12. No statistically significant effects were found for attention. CONCLUSIONS: These findings provide preliminary evidence that a haptic-enabled VR condition was associated with more favorable within-task performance than a traditional condition in children with ASD level 1, particularly in task completion time, figure replication accuracy, and frustration tolerance. Because outcomes were measured on the same task used during training, the observed effects should be interpreted as task-specific performance improvements rather than as evidence of generalized fine motor rehabilitation. The results support the potential of interactive multisensory environments as a supportive component of pediatric neurorehabilitation programs, while highlighting the need for future studies incorporating independent standardized motor assessments.