{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:08:06Z","timestamp":1785434886725,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF-RS-2025-2468362440982119420001"],"award-info":[{"award-number":["NRF-RS-2025-2468362440982119420001"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"award":["NRF-RS-2025-2468362440982119420001"],"award-info":[{"award-number":["NRF-RS-2025-2468362440982119420001"]}],"id":[{"id":"https:\/\/ror.org\/013aysd81","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Chonnam National University Hospital Biomedical Research Institute","award":["BCRI-23021"],"award-info":[{"award-number":["BCRI-23021"]}]},{"award":["BCRI-23021"],"award-info":[{"award-number":["BCRI-23021"]}],"id":[{"id":"https:\/\/ror.org\/00f200z37","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Muscular dystrophies (MDs) are progressive neuromuscular disorders in which rehabilitation is central to management, yet conventional physical therapy in children is constrained by motivation, accessibility, and the need to adapt across disease stages. Virtual reality (VR) offers an interactive, adaptable, and home-deliverable alternative, but prior reviews focused narrowly on upper-limb outcomes in Duchenne muscular dystrophy or on motor-learning paradigms. We aimed to evaluate VR-based rehabilitation in children and adolescents with MD across feasibility\/adherence, engagement and psychological outcomes, and clinical motor outcomes, and to propose a stage-based conceptual framework. Methods: PubMed, Embase, and Cochrane CENTRAL were searched on 21 April 2026, following PRISMA 2020 (PROSPERO CRD420261380539). Eligible studies enrolled children or adolescents (mean age \u2264 18 years or separable pediatric data) with any MD who received VR\/AR\/MR\/exergame\/serious-game rehabilitation. Risk of bias was assessed with RoB 2.0 and ROBINS-I, and certainty with GRADE. Given substantial heterogeneity, findings were synthesized narratively by disease stage. Results: Eight studies (2017\u20132024; 221 participants) met the inclusion criteria. No serious VR-related adverse events occurred, and feasibility and tolerability were consistently favorable. Engagement and psychological outcomes showed favorable trends, including sustained motivation and reduced perceived fatigue. Clinical motor outcomes were heterogeneous and stage-dependent. Conclusions: The evidence base is limited and clinically heterogeneous, precluding meta-analysis, with Low GRADE certainty for feasibility, safety, and adherence and Very low for the remaining four domains. Key limitations include small sample sizes, substantial clinical and methodological heterogeneity, and only a single advanced-stage study. The findings provisionally support a stage-dependent role for VR-based rehabilitation in pediatric MD: motor training in the ambulatory stage, upper-limb maintenance and interface-adapted training in the transitional stage, and feasibility-, engagement-, and psychological-support applications in advanced disease. Stage-stratified trials with standardized, domain-specific outcomes and explicit virtual-to-real transfer assessment are warranted.<\/jats:p>","DOI":"10.3390\/children13070895","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T15:15:04Z","timestamp":1783091704000},"page":"895","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Virtual Reality-Based Rehabilitation in Children and Adolescents with Muscular Dystrophy: A Systematic Review of Feasibility, Engagement, and Clinical Outcomes"],"prefix":"10.3390","volume":"13","author":[{"given":"Insu","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Chonnam National University Children\u2019s Hospital, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwa Jin","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chonnam National University Children\u2019s Hospital, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song-Ai","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Physical & Rehabilitation Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6652-9591","authenticated-orcid":false,"given":"Won-Jae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Physical & Rehabilitation Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8186-5345","authenticated-orcid":false,"given":"Min-Keun","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Physical & Rehabilitation Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.ncl.2014.05.002","article-title":"Duchenne and Becker muscular dystrophies","volume":"32","author":"Flanigan","year":"2014","journal-title":"Neurol. 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