JMIR Publications

ABSTRACT

Background:

Augmented reality (AR) has shown promise for enhancing engagement in pediatric rehabilitation. We partnered with an existing, commercially available AR mobile application, Augment Therapy™, to develop an adaptive game module for children with cerebral palsy (CP). A pilot clinic-based trial demonstrated initial feasibility and favorable reception of the platform among children with CP.

Objective:

This qualitative study aimed to identify and categorize the facilitators and barriers to participation in a 4-week home-based intervention using the Augment Therapy™ AR mobile app among children with CP and their parents.

Methods:

Children with CP (Gross Motor Function Classification System [GMFCS] levels I-II, ages 5-18 years, English- or Spanish-speaking) and their parents were recruited at a single pediatric tertiary care center between October 2024 and August 2025. Participants used the Augment Therapy™ app at home for 4 weeks, with a goal of at least 3 sessions per week consisting of five 2-minute assigned games followed by free play. Upon completion, parents completed a one-on-one semi-structured interview (20-60 minutes) to share their own and their child's experiences with the app. Interviews were audio-rOf 97 patients approached, 46 declined and 35 enrolled; 8 were lost to follow-up, 2 withdrew, and 25 completed the 4-week program. Nineteen parents completed a post-intervention interview. Four themes emerged: (1) the app supplemented physical therapy (PT) in an engaging way; (2) the app's user-friendly design motivated continued use; (3) technology issues, including login challenges and app crashing, were a barrier; and (4) concerns about additional total screen time were a barrier, particularly for younger children with CP.ecorded, transcribed via secure, HIPAA-compliant Microsoft Teams artificial intelligence transcription, and analyzed using rapid qualitative analysis to identify facilitators of and barriers to app engagement, motivation, usability, and integration into the home routine. App usage and demographic data were also collected.

Results:

Of 97 patients approached, 46 declined and 35 enrolled; 8 were lost to follow-up, 2 withdrew, and 25 completed the 4-week program. Nineteen parents completed a post-intervention interview. Four themes emerged: (1) the app supplemented physical therapy (PT) in an engaging way; (2) the app's user-friendly design motivated continued use; (3) technology issues, including login challenges and app crashing, were a barrier; and (4) concerns about additional total screen time were a barrier, particularly for younger children with CP.

Conclusions:

AR-based mobile applications such as Augment Therapy™ may be a feasible and acceptable adjunct to PT for increasing physical activity engagement in children with CP. Modifiable barriers—particularly technology reliability and parental screen-time concerns—should be addressed to maximize impact and sustain engagement in future implementations. Clinical Trial: Using Augmented Reality to Promote Physical Activity in Children With Cerebral Palsy, NCT06096272, https://clinicaltrials.gov/study/NCT06096272