Abstract
BACKGROUND: Virtual Reality (VR) Serious Games (SGs) can provide a functionally relevant framework to capture cognitive and motor dynamics. Their interactive and engaging nature improves compliance, measurement reliability and allows for more frequent evaluations. Additionally, VR SGs enable the parallel collection of multiple types of data within a single session. We present REAsmash-ET, an immersive VR adaptation of the REAsmash SG, grounded in Feature Integration Theory (FIT) and integrating eye-tracking (ET) and upper limb kinematic (UL) analyses. REAsmash-ET introduces a novel methodological framework for the simultaneous assessment of attentional and motor functions in VR. METHODS: REAsmash is an interactive search-and-reach task designed to elicit structured visual exploration and UL motor responses under varying target-distractor saliency conditions. Custom algorithms extract metrics on visual search strategies and UL motor efficiency. Three age groups of adult healthy participants (n = 15 each) were included to test the feasibility and methodological consistency of the task and its metrics. Relative Response Time (RRT) and ET metrics were analyzed using ANOVA with factors: age group (20-39, 40-59, 60-80 years), target-distractor saliency (high vs. low), and number of distractors (11, 17, 23). Kinematic metrics were analyzed by age group and response hand (dominant vs. non-dominant). RESULTS: REAsmash-ET differentiated visuomotor performance across task conditions. RRT and ET metrics showed significant effects of saliency, number of distractors, and their interaction, consistent with FIT. Age-related differences emerged in both RRT and visual search efficiency. Kinematic analyses revealed slower and less efficient movements in older participants, with effects of hand dominance.. The results support the robustness and feasibility of REAsmash-ET as a methodological framework. CONCLUSIONS: The results support the robustness and internal consistency of REAsmash-ET as a methodological framework for the integrated assessment of visual attention and UL motor control in immersive VR. The task's ability to capture visuomotor variability and its multidimensional approach highlight its potential for future research and clinical applications in both healthy and clinical populations. REGISTRY NUMBER: This study was registered at ClinicalTrials.gov (NCT04694833).