Research Projects and Technologies

Modern healthcare systems strain under the weight of pediatric rehabilitation demands, particularly for children with fine motor challenges. The bottleneck is threefold: a shortage of specialized practitioners, limited rehabilitation facilities, and resource constraints. In response, clinicians and caregivers are exploring alternative modalities that leverage emerging consumer technologies to deliver pediatric rehabilitation interventions within the home environment.

While at-home interventions address accessibility, they introduce a critical challenge: engagement. Rehabilitation’s success hinges not only on repetition but on sustained motivation—particularly for children, whose participation thrives on structured, interactive, and intrinsically rewarding experiences. In clinical settings, therapists adapt exercises in real-time, shaping activities around a child’s interests. This personalized guidance is often lost in remote or independent therapy, raising the question: how can at-home rehabilitation maintain both therapeutic rigour and engagement?

Video games offer a compelling medium. Thoughtfully designed gamification has been shown to reduce anxiety, increase participation, and reinforce positive behaviours. Yet, many existing therapy "games" resemble guided exercises, lacking the narrative depth and interactivity that captivate young minds. Innovation in this sector relies on designing rehabilitation that doesn't feel like therapy, but play.

PEARL’s research embodies this principle. Our projects leverage movement-tracking technology to embed therapeutic exercises within dynamic, immersive gameplay. Read about our ongoing research projects and established technologies below!

Bootle Blast

Bootle Blast is a movement-tracking, mixed-reality video game to support the practice of motor movements for children with developmental disabilities. Using the Orbbec Persee (a 3D camera-computer), Bootle Blast provides real-time feedback on skeletal movements and interactions with real-life objects used in gameplay (e.g. steering wheels, batons, building blocks) that is tracked over time. This “mixed reality” play experience offers greater task specificity to enhance transfer of skills to everyday activities. It enables individualized treatment plans by supporting practice of a wide range of motor skills with activities that can be calibrated to each child’s abilities. Bootle Blast enables people of different abilities to play meaningfully together, enhancing social equalization. Game rewards are directly linked to therapeutic effort and incentivize frequent practice of goal-directed movements. These 5 attributes (feedback, task specificity, individualized treatment plans, social equalization, practice) are considered the system-level “active ingredients” of interactive computer play for motor learning that render it effective.

Bootle Blast is the first technology to deliver all five active ingredients, while also applying game design principles (e.g. use of narrative, relatable characters, short-, mid- and long-term rewards, variety in content to appeal to different personality types, inclusive multiplayer modes) that sustain engagement over time.

Learn More About Bootle Blast ▶

Current Research Studies Underway on Bootle Blast:

Testing a Mixed Reality Video Game for Home-Based Practice of Hand-Arm Skills for Children with Cerebral Palsy - A Pilot Randomized Controlled Trial (2019 - 2027)
Investigating the feasibility and acceptability of carrying out a randomized control trial to determine whether 12 weeks of home-based practice with Bootle Blast can improve function, activity, and participation outcomes associated with the upper limb in children with CP compared to “standard care”.

Trustworthiness of Person-Generated Health Data from Markerless Motion Capture for Personalized Motor Rehabilitation for Young People with Motor Disabilities (2025 - 2029)
Investigating the validity, usability, and real-world engagement of markerless motion capture (MoCap) technology for personalized motor rehabilitation in young people with motor disabilities. This study will (1) validate markerless MoCap against 2D and 3D camera-based motion analysis, (2) co-design person-generated health data (PGHD) interfaces tailored to user needs and priorities in pediatric motor rehabilitation, and (3) explore the feasibility and acceptability of integrating PGHD interfaces in both clinical and home-based rehabilitation settings.

Bootle Blast, A Movement Tracking Video Game for Home-Based Motor Therapy – Navigating Gaps to Market Readiness (2020 - 2025)
Investigating whether it is (1) feasible for families to independently set-up and sustain use of BootleBlast at home and (2) whether using Bootle Blast at home over 15 weeks impacts perceived performance on family-identified goals.

Bootle Boot Camp

Bootle Boot Camp is an interactive exercise application designed to support home exercise programs (HExPs) for children with neuromotor disorders. Developed by the PEARL Lab in collaboration with rehabilitation specialists, the app transforms traditional home-based therapy into an engaging, personalized, and effective experience. Using 3D motion tracking technology, Bootle Boot Camp provides real-time feedback, tracks movement accuracy, and integrates game-based incentives to enhance motivation and adherence.

For many children undergoing rehabilitation, home exercise programs account for a significant portion of their therapy, yet traditional paper-based methods often lead to low adherence due to limited engagement, lack of therapist oversight, and the heavy reliance on caregivers to enforce program completion. Bootle Boot Camp addresses these challenges by incorporating interactive computer play (ICP), a proven approach to rehabilitation that enhances motor learning through active participation, individualized feedback, and gamified experiences. With a customizable exercise system designed to meet each child's needs, Bootle Boot Camp ensures that rehabilitation remains both effective and enjoyable.

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The Virtual Music Teacher: Banding Together in Early Childhood Music Education

Children with disabilities are less likely to take part in music learning than their typically developing peers. Music-making training, especially in the preschool years, has many social, emotional, cognitive and physical benefits for children with and without disabilities. Young children with disabilities are unable to benefit from music lessons because of scheduling, resource, and accessibility barriers in traditional teacher-led programs. A “virtual music teacher” that can engage young children with disabilities in early music learning at home may overcome some of these barriers.

The Virtual Music Teacher project is a suite of games to promote music participation and social play for children of all abilities. To that end, we are developing music applications that intelligently responds to children’s play with real-life musical instruments (e.g. maracas, xylophone, etc.) and guides them in music learning. New ways to track a child’s music play, encourage learning and group play, and adapt musical tasks to diverse physical abilities will be created. This system will put music learning and its benefits within reach of thousands of young children with and without disabilities.

Current Research Studies Underway on the Virtual Music Teacher:

The Virtual Music Teacher: Children of All Abilities Banding Together in Early Childhood Music Education
Investigating the feasibility and acceptability of using an AI-driven virtual music teacher (AI-MiRMA) to support early music learning for young children with cerebral palsy in a home-based setting. This study will (1) develop AI-MiRMA, an adaptive music application that responds to children’s real-life instrument play and guides them in music learning, (2) co-design AI-MiRMA with families, therapists, engineers, game developers, and music educators to ensure accessibility and engagement, and (3) evaluate whether children achieve the minimum “dose” of music-making (6 hours over 10 weeks).

Bootle Band

Bootle Band is an immersive mixed-reality game that fosters collaborative musical engagement through the integration of real-life and virtual instruments. Originally conceived as an engaging therapeutic tool to support fine motor skill development in young children, Bootle Band has since expanded in scope, demonstrating broad applicability as an inclusive platform for early childhood music education.

It leverages real-time interactive music generation, encouraging children to explore foundational music theory concepts such as rhythm, pitch, and tempo. The game’s adaptive musical score—developed in collaboration with two-time Juno-nominated composer Chris Donnelly—dynamically responds to user input, creating an engaging, responsive auditory experience that enhances creative exploration and motor learning.

By offering both solo and group play experiences, Bootle Band promotes cooperative engagement and social interaction, supporting the development of collaborative play skills. Its design is grounded in principles of participatory and user-centered development, ensuring accessibility for children of diverse abilities.

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Bootle Pop

Music-making training, especially in the pre-school years, has many social, emotional, cognitive, and physical benefits. Unfortunately, there are notable disparities in access to high-quality early childhood music education for youth with disabilities. While a plethora of musical content is available on the internet, children require a simple, safe, and user-friendly interface through which they can easily access a selection of curated content that expands their exposure to and love for diverse music.

Bootle Pop is an inclusive iOS and Android app designed to educate and expose children to diverse aspects of music and music-making through interactive, episodic content of human musicians appearing alongside animated Bootle characters. It aims to serve as a "window" into various musical cultures and as a "mirror" reflecting a spectrum of experiences, including those of musicians with disabilities.

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ScreenPlay: Interactive Media in Healthcare Spaces

ScreenPlay is an interactive, motion-activated system designed to reimagine waiting spaces as dynamic, multisensory play environments. By leveraging touch-free motion-sensing technology, ScreenPlay enables children and families to collaboratively generate real-time digital animations on a large display through physical movement. The system is universally accessible, accommodating individuals with diverse motor and cognitive abilities, ensuring engagement regardless of whether participants are sitting, standing, walking, or using a mobility aid.

Developed to mitigate waiting-related anxiety and enhance engagement, ScreenPlay promotes social interaction, creativity, and active play. In contrast to traditional passive waiting room distractions, ScreenPlay offers an adaptive, interactive experience where animations and soundscapes respond dynamically to user movement, fostering an immersive and inclusive environment. The system is designed to support both individual and cooperative play, reinforcing collaborative engagement while reducing stress and perceived wait times in healthcare and other public settings.

Screenplay has been clinically validated through a randomized controlled trial involving over 300 children and their caregivers, which demonstrated a significant reduction in waiting-related anxiety and an increase in caregiver and clinic staff satisfaction.

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