Virtual Reality Training Boosts Gross Motor Skills in Children with Down Syndrome

For children with Down syndrome, the journey toward confident movement—running, jumping, hopping, and catching—is often slower and harder than for their peers. Gross motor delays are among the most consistent features of the condition, and they can ripple outward into every corner of a child’s life, from playground friendships to long-term cardiovascular health. A new pilot randomized study published in Pediatric Research now offers an intriguing glimpse of how immersive reality technology might help close that gap, reporting that a six-week virtual reality-based training program was not only feasible and safe for ten-year-old children with Down syndrome, but was associated with some of the largest gains in standardized motor scores the researchers measured.

The study, conducted by a team of clinicians and researchers at Hasanuddin University and Dr. Wahidin Sudirohusodo General Hospital in Makassar, Indonesia, set out to address a stubborn evidence gap. While immersive virtual reality rehabilitation has accumulated a growing body of support in populations ranging from stroke survivors to children with cerebral palsy, rigorous trial data in children with Down syndrome have remained scarce. Children with the condition face a distinctive constellation of motor challenges—hypotonia, ligamentous laxity, balance impairments, and delays in fundamental movement skills such as running, galloping, throwing, and catching—that make task-oriented, engaging practice especially valuable yet especially hard to sustain in conventional therapy settings.

The researchers enrolled ten children with Down syndrome, all aged ten, though with varying cognitive developmental ages, and randomly allocated them to one of two groups. Five children received immersive reality-based training while the other five received conventional motor training. Both groups completed supervised sessions twice weekly for six weeks, an intensity deliberately chosen to mirror what could realistically be delivered in a rehabilitation clinic. Outcomes were tracked with the Test of Gross Motor Development, Second Edition, a widely used and well-validated standardized instrument that yields a composite Gross Motor Quotient along with subtotals for locomotor and object-control skills. Assessments were performed at four time points: baseline, during the intervention, immediately after the intervention ended, and again at follow-up.

The numbers tell a striking story. In the immersive reality group, the Gross Motor Quotient climbed from 52.60, with a standard deviation of 4.93, at baseline to 75.40, again with a standard deviation of 4.93, by the end of the study. The conventional training group also improved substantially, rising from 61.60, with a standard deviation of 5.77, to 75.40, with a standard deviation of 2.51. Both trajectories represent clinically meaningful movement toward the standardized normative range, but the immersive reality group’s absolute change was greater, largely because those children started from a lower baseline. The researchers were careful to flag that this baseline imbalance between groups complicates any claim that immersive reality training is inherently superior; the difference in starting scores means the comparison must be interpreted with considerable caution.

Equally important as the score improvements is what the study did not find: no adverse events of any kind. Every one of the ten children completed the full intervention and the follow-up assessment, and session attendance was a remarkable 100 percent across both groups. For a population in which attention, motivation, and sensory processing differences can make repetitive therapy difficult to tolerate, that level of engagement is itself a meaningful result. The authors note that the immersive format appears to have been well tolerated by all participants, lending support to the idea that interactive, game-like environments can hold the attention of children with intellectual disabilities in ways that conventional drill-based exercises sometimes cannot.

The theoretical rationale behind the intervention draws on established principles of motor learning. Immersive reality systems allow therapists to embed repetitive, task-oriented practice inside multisensory environments that deliver immediate, continuous feedback about performance. Rather than asking a child to practice stepping, reaching, or balancing in a bare clinical room, the virtual environment transforms each repetition into a goal-directed activity with visible consequences and rewards. Research in other pediatric populations, including systematic reviews of virtual reality interventions for cerebral palsy, has suggested that when motor learning principles such as high repetition, augmented feedback, and progressively calibrated challenge are integrated into virtual environments, functional gains can follow. The Makassar team translated this framework, largely untested in Down syndrome, into a structured pediatric rehabilitation protocol.

The broader context underscores why even a small pilot study in this population matters. Global burden-of-disease analyses estimate that Down syndrome affects millions of people worldwide, and studies consistently document that children and adolescents with the condition show reduced postural balance, weaker trunk and lower-limb muscle performance, and delayed acquisition of fundamental movement skills compared with peers. These deficits are not merely cosmetic; fundamental movement skills in childhood predict physical activity levels, fitness, and health-related outcomes later in life. Exercise interventions targeting balance and motor skills in Down syndrome have shown promise in systematic reviews, but adherence and engagement remain persistent obstacles—precisely the obstacles that immersive, game-based formats are designed to overcome.

The authors are candid about the limitations of their work. A sample of ten children split between two arms is far too small to support definitive conclusions about efficacy, and the baseline imbalance in Gross Motor Quotient between groups means the apparent advantage for immersive reality training could partly reflect regression toward the mean rather than a true treatment effect. All participants were the same chronological age, which strengthens internal consistency but limits generalizability across the wide developmental range of childhood. The pilot was designed, as the name implies, primarily to test feasibility, safety, and signal detection—questions that this study answers affirmatively—rather than to serve as definitive evidence of superiority over conventional care. The researchers explicitly call for larger trials to evaluate immersive reality-based training as a complementary modality in pediatric motor rehabilitation.

Still, the convergence of findings is hard to ignore. Both training approaches moved children toward normative motor scores over the same six-week window, suggesting that structured, supervised practice of any kind delivers real benefits. The immersive reality group’s larger absolute gain, its perfect attendance record, and the complete absence of adverse events together paint a picture of a technology that is ready to be tested at scale. The study also adds Indonesia’s voice to a research landscape dominated by high-income countries, demonstrating that sophisticated rehabilitation technology trials can be conducted in public hospital settings in Southeast Asia, where the majority of the world’s children with Down syndrome actually live.

For families, therapists, and policymakers watching the rapid maturation of virtual reality rehabilitation, the message from Makassar is one of guarded optimism. Immersive reality-based training appears feasible, safe, and engaging for children with Down syndrome, and it was associated with improved standardized gross motor outcomes over a short intervention period. The next generation of studies will need larger and more diverse samples, longer follow-up to test whether skills transfer to real-world playgrounds and classrooms, and designs that balance groups at baseline. If those trials confirm what this pilot hints at, the headsets now appearing in rehabilitation clinics may become a routine part of helping children with Down syndrome run, jump, and play with confidence.

Subject of Research: Immersive reality-based training to improve gross motor outcomes in children with Down syndrome

Article Title: Immersive reality training for gross motor outcomes in children with Down syndrome

Article References: Mayasari, N., Yusuf, I., Ridha, N. R., Zainuddin, A. A., Waluyo, Y., Wulan, S. M. M., & Hamid, F. (2026). Immersive reality training for gross motor outcomes in children with Down syndrome. Pediatric Research. https://doi.org/10.1038/s41390-026-05501-7

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05501-7

Keywords: Down syndrome, immersive reality, virtual reality, gross motor skills, TGMD-2, pediatric rehabilitation, motor learning, pilot randomized study, balance, task-oriented training, physical therapy, child development