Currently submitted to: JMIR Serious Games
Date Submitted: Nov 4, 2025
Open Peer Review Period: Nov 11, 2025 - Jan 6, 2026
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SpaceDefenderVR: A novel universally accessible virtual reality serious game for the functional assessment of neck movement control: an observational study
ABSTRACT
Background:
Virtual reality (VR) provides an accessible, standardized environment to objectively evaluate functional cervical movement control by leveraging built-in head-tracking and game-based tasks. Making such tools available through VR app stores can bridge the lab-to-clinic gap and enable remote administration, allowing clinicians to establish baselines and track therapy response over time with repeated, comparable measurements.
Objective:
This study aimed to (a) develop a novel VR serious game designed for the assessment of neck movement control and kinematics and (b) to evaluate its reliability, side effects, sense of presence, perceived mental workload and usability.
Methods:
A multidisciplinary team developed an immersive VR serious game using Unity engine and Meta Quest 3 headsets. The game places users in a space station scenario where they destroy meteorites/space debris by precise head movements over 4 minutes. A descriptive, observational repeated-measures reliability study was conducted with 49 asymptomatic participants (aged 18-65 years). Participants completed three sessions separated by one week to assess test-retest reliability. Variables analyzed included final score, meteorites destroyed/failed, and maximum level reached. Reliability was measured using intraclass correlation coefficients. Side effects (Simulator Sickness Questionnaire), presence (Igroup Presence Questionnaire), mental workload (NASA Task Load Index), and usability (System Usability Scale) were evaluated.
Results:
The present study allowed for the development of a novel serious game designed to assess neck movement control. It is freely available for use by clinicians or researchers through Meta Quest 3 VR headsets. Forty-five participants completed the protocol (25 men, 20 women; mean age 27.49±10.74 years). The final score showed good reliability (ICC=0.788). The game demonstrated high usability (86.09±13.67), negligible side effects (SSQ: 2.04±2.84), moderate presence levels (IPQ total: 3.43±1.03), and high but acceptable mental workload (NASA-TLX: 61.94±12.85). No major adverse events occurred during 135 game sessions.
Conclusions:
The novel VR serious game demonstrated good reliability, safety, and usability for neck movement control assessment in asymptomatic individuals. Future research should investigate its application in clinical populations with pain to establish discriminative validity and responsiveness before determining clinical utility.
Citation
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