Extended reality-based fine motor skills training in pediatric rehabilitation: a scoping review

Fine motor skill (FMS) impairment is common in children and has a significant impact on daily life activities. Extended reality (XR) offers potential advantages for FMS interventions, but device characteristics, interventional parameters, and the application of motor learning principles remain poorly synthesized. The objective of this scoping review was to map the extent, range and nature of XR-based FMS training in pediatric rehabilitation. The scoping review followed the Joanna Briggs Institute guidelines and the PRISMA-scR reporting recommendations. A search was conducted in four databases (PubMed, Web of Science, PsycInfo, Scopus) for studies developing or evaluating immersive or non-immersive XR applications for FMS training in pediatric rehabilitation. Data extraction was piloted by three authors and finalized by a single author, with a second author consulted in cases of uncertainty. Descriptive and content analyses were performed. Fifty-two studies were included, involving 630 children. Dexterity was the main FMS aspect targeted (94%). Thirty-eight different devices were used. Most devices were customized (82%) and non-immersive (86%). The most frequently used device was the Leap Motion Controller (36%). The median XR training time was 120 min per week (IQR 90–167). Regarding motor learning principles, 33 studies reported repeated practice, 17 reported functional tasks and 15 referred to goal-oriented training. Forty-four studies described the provision of augmented feedback by the XR device. Content analysis identified twenty-five core components considered important by the authors of the included studies, and classed into three main categories: “Motor learning principles”, in which motivation was considered key, “Unique opportunities offered by XR” such as adjustable parameters, home-based FMS rehabilitation, and social inclusion, and “Challenges in XR-based FMS training” which included the need for interdisciplinary collaboration to design XR-based FMS training devices aligned with motor learning principles. The use of XR technologies for pediatric FMS training demonstrates considerable technological diversity, though dominated by non-immersive, customized systems. Given this diversity, research is needed to develop evidence-based implementation guidelines. Future research should prioritize integrating motor learning principles into XR intervention designs that align with pediatric rehabilitation objectives.