Correspondence to Sila Yilmaz; [email protected]
STRENGTHS AND LIMITATIONS OF THIS STUDY
A key strength of this study is its multidisciplinary nature, conducted in collaboration with professionals from various healthcare fields.
The use of fully immersive virtual reality provides realistic yet safe training conditions.
The relatively large sample size is another significant strength.
A notable limitation is the potential for unexpected dropouts, given the vulnerable nature of the target population.
Introduction
The WHO defines an accident as ‘an event occurring suddenly and unintentionally due to negligence, carelessness, inattention or incompetence, leading to material and/or moral losses’.1 Accidents are generally classified into categories such as traffic accidents, occupational accidents, home accidents (eg, poisonings, fires, falls, cuts, electrical accidents), industrial accidents, sports injuries and school accidents (eg, drowning, falls, etc.). Home accidents represent a major public health concern, not only because they are largely preventable, but also due to their impact on health services, daily life and the economy.2
One of the major challenges in the care of children with special needs is their vulnerability to accidents resulting from uncontrolled and unpredictable movements. Home-based accidents such as falls, burns, poisoning, drowning and choking are common among these children. These incidents pose serious threats not only to children’s physical and psychological well-being but also to families and society by increasing both social and economic burdens. Compared with their typically developing peers, children with special needs experience higher rates of emergency department visits due to such accidents. Therefore, raising awareness and providing first aid training for both prevention and early intervention is of critical importance.3 4
Children with special needs are more vulnerable to environmental hazards due to cognitive, physical or sensory limitations, placing them at significantly higher risk of home accidents. Recent studies consistently report that children with special needs experience household injuries at rates considerably higher than their peers without disabilities. In a population-based study from Hubei, China, children with special needs were 4.5 times more likely to experience home injuries than their non-disabled peers (10.2% vs 4.4%). Most incidents occurred indoors during leisure activities, with falls being the leading cause of injury.5 A meta-analysis by Shi et al reported that children with special needs are approximately 1.86 times more likely to experience injuries compared with their peers without disabilities. The study also emphasised that adolescents with special needs represent a critical subgroup for targeted injury prevention strategies.6 Calver et al reported in a cohort-based study that children with intellectual and developmental disabilities had approximately 1.8 times higher rates of both intentional and unintentional injuries compared with their non-disabled peers.7 In a recent population-based cohort study, children with ADHD (Attention Deficit Hyperactivity Disorder) had an 18% higher risk of injury-related emergency visits compared with their typically developing peers, while those with autism spectrum disorder alone did not show increased injury risk.8 These findings highlight the heightened susceptibility of children with special needs to home accidents and reinforce the urgent need for targeted preventive interventions and caregiver education to mitigate these risks.
In this study, the term ‘children with special needs’ refers to individuals diagnosed with a range of neurodevelopmental and motor conditions, including cerebral palsy, autism spectrum disorder, Down syndrome, genetic syndromes and developmental delay. While these diagnoses differ in aetiology and presentation, they often present overlapping challenges related to balance, coordination and safety awareness, which may increase the risk of home accidents. This inclusive definition reflects the actual population served by the Barrier-Free Life Application and Research Centre, where mixed-diagnosis groups are commonly encountered. Therefore, instead of narrowing the sample to a single diagnostic category, the study was intentionally designed to represent the diverse profiles seen in real-world community settings. This approach allows for broader applicability of findings while acknowledging the shared safety risks across these conditions.
Balance impairments are a key contributor to fall risk in children with special needs. These impairments often stem from sensorimotor dysfunctions or limited environmental experiences, leading to reduced postural control and compromised static and dynamic balance. Improving motor development and balance is essential to help children safely participate in daily activities.9
Technological advances have led to the incorporation of computer-assisted tools such as virtual reality into rehabilitation and educational programmes. Virtual reality provides visual and auditory biofeedback, enabling active participation in simulated real-life scenarios. By stimulating multiple senses at once, this method improves both engagement and long-term retention.3 10
There is a small but growing number of pioneering studies exploring the use of virtual reality technology for parent and family education. In the Parent-Child Interaction Therapy-Virtual Reality study designed by Scherpbier et al, a virtual reality-based protocol was developed to support parents in rehearsing positive parenting skills through simulated parent-child interactions, enhancing the effectiveness of Parent-Child Interaction Therapy by integrating immersive technology.11 Similarly, Kokorelias et al conducted a scoping review on virtual reality and augmented reality applications for family caregivers of individuals with dementia, reporting enhanced empathy and reduced caregiver stress.12 A pilot study in palliative care settings found that nature-based virtual reality experiences promoted psychological relaxation and were perceived as beneficial mental support.13 According to the pilot randomised-controlled trial protocol by Wong & Qin, a virtual reality-based social skills training programme for children with ADHD was designed to allow parents to observe and assess behavioural changes in their children.14 While these studies demonstrate virtual reality’s promise in caregiver education, there remain very few structured virtual reality headset-based interventions, focusing on parents of children with special needs and aiming to improve parental knowledge and caregiving processes. This study seeks to address this gap by offering a novel, immersive virtual reality-based education model tailored to this under-researched family population.
This study aims to assess the effects of a virtual reality-based home accident control simulation combined with first aid training on the awareness and initial responses to home accidents of parents of children with special needs, using a single-group pre-post quasi-experimental design. The intervention also aims to provide essential first aid and transfer skills to promote appropriate caregiver responses in accident situations. Additionally, the study will evaluate children’s balance and gait to determine their risk of falls in relation to home safety. Evaluating children’s balance and gait offers insight into their fall risk, which is one of the most frequent and serious types of home accidents. Analysing these findings together may help reveal whether parents of children at higher fall risk are more aware and cautious, or whether limited awareness is contributing to the child’s increased vulnerability. Therefore, balance and gait assessments will be analysed in relation to the parents’ home accident awareness scores collected pre- and post-intervention.
In the short term, the intervention is expected to increase parental awareness and preparedness for home accidents, foster safer home environments and build confidence in emergency response. In the longer term, it may help reduce accident incidence, improve caregiver response, enhance children’s autonomy and participation in daily activities and increase caregiver confidence while reducing stress in safety-related situations. Despite potential concerns regarding the accessibility of virtual reality technology, the implementation of this model at the Barrier-Free Life Application and Research Centre is expected to reach caregivers from a wide range of socioeconomic backgrounds. The immersive nature and rapid deployability of virtual reality scenarios eliminate the need for physical training spaces, making it a practical and scalable solution even in settings with limited resources. To the best of our knowledge, this study is the first to implement this specific multidisciplinary training model, offering a novel perspective in the field of injury prevention.
Methods and analysis
Study design, setting, and participants
This quasi-experimental study will be conducted between June and December 2025, following an exploratory framework to assess within-subject changes after a novel, single-session intervention. A single-group pre-post design was chosen due to logistical constraints and the real-world service delivery context of the Barrier-Free Life Application and Research Centre, and therefore no separate comparator group was included. The training has been designed exclusively for the purposes of this study and will be delivered within the facilities of the Barrier-Free Life Application and Research Centre, but it is not part of the centre’s routine educational support programme for families of children with special needs. Introducing a waitlist control or delayed intervention group is deemed ethically inappropriate, as it would prevent some families from receiving potentially beneficial training, conflicting with the centre’s commitment to equitable access to services. Furthermore, the relatively small number of eligible participants makes random allocation to multiple groups impractical. To ensure methodological rigour in the absence of a control group, we will implement a within-subject comparison approach, applying standardised delivery procedures and consistent outcome measures at both time points. This pragmatic design enhances ecological validity and reflects the conditions under which such interventions are typically delivered in community-based settings.
Blinding procedures will not be applied, as all participants will receive the same intervention. To minimise potential observer or confirmation bias arising from the research team conducting the outcome assessments, structured questionnaires specifically developed for this study will be used, and identical procedures will be followed for all participants at both time points.
The sample will consist of 100 volunteer parents of children with special needs, recruited from a Barrier-Free Life Application and Research Centre. Informed consent will be obtained in writing by members of the research team prior to participation. Participants will be included in the study if they meet all of the following criteria: being able to understand and speak Turkish; being a parent of a child with special needs aged 10–17 years registered at a Barrier-Free Life Application and Research Centre and able to participate in the planned balance and gait assessments (ie, able to stand with or without minimal support and perform basic ambulatory tasks such as short-distance walking); scoring in the A+ category on the System Usability Scale, with a percentile rank between 96 and 100; and volunteering to participate in the study. Exclusion criteria will include failure to meet one or more of the inclusion criteria. The age range is restricted to 10–17 years to correspond with early and middle adolescence, a period in which developmental capacities such as attention and executive functioning are more comparable, thereby ensuring greater homogeneity in the sample.15
Given the wide variation in participants’ educational and digital backgrounds, the System Usability Scale will be administered during eligibility screening, immediately after a brief guided virtual reality demonstration. While typically used post-intervention, here it will assess real-time usability, specifically participants’ immediate ability to interact with the virtual reality system. This approach avoids excluding individuals based solely on prior experience or background and instead ensures meaningful engagement during the intervention. Those scoring below a predetermined threshold will be excluded to maintain intervention consistency and data quality.
A high System Usability Scale score threshold (96th–100th percentile) will be applied to ensure that participants can comfortably and consistently navigate the virtual reality environment. This conservative threshold was intentionally selected to minimise the risk of usability-related challenges compromising learning outcomes and to ensure uniform delivery of the intervention. It was deemed necessary to safeguard data integrity and internal validity in this initial efficacy-focused study.
As the primary outcome tool (Home Accident Awareness Questionnaire for Parents of Children with Special Needs) is newly developed for this study due to the lack of appropriate validated instruments for this population, no prior data were available to estimate effect size. Therefore, a formal power analysis could not be conducted. The sample size of 100 was determined pragmatically based on the expected availability of eligible families and is considered sufficient for exploratory within-subject analyses.
Although participants will be recruited from a single centre, the Barrier-Free Life Application and Research Centre provides services to families from a wide range of socioeconomic and diagnostic backgrounds. To capture sample heterogeneity, data on parent age, gender, education level and child diagnosis will be collected through a demographic form. These characteristics will be reported descriptively to aid interpretation and inform future replication efforts.
Intervention
Initially, the Descriptive Information Form and the Home Accident Awareness Questionnaire for Parents of Children with Special Needs will be administered to the parents as pre-tests. Following this, 100 participants will individually experience the same virtual reality-based scenarios specifically designed to simulate and raise awareness of common home accidents.
For logistical convenience, the total sample (n=100) will be divided into four sequential subgroups of approximately 25 participants. Each subgroup will complete the study procedures over two consecutive days. On Day 1, pre-test assessments and the virtual reality-based home accident scenarios will be administered, followed by balance and gait assessments for the children. On Day 2, parents will receive training in first aid and safe transfer techniques and then complete the post-test assessments. Data collection is expected to be finalised within 8 working days, spread across several weeks, ensuring the feasibility of completing the study within the planned timeframe.
To ensure consistency in training and data collection across all participant subgroups, all intervention and assessment procedures will be carried out by a fixed interdisciplinary team consisting of one nurse and two physiotherapists. The nurse will be responsible for the first aid training and for administering pre- and post-test questionnaires. The two physiotherapists will share responsibilities for delivering the virtual reality-based accident education, balance evaluations and safe transfer training. Task allocation will remain fixed across all participant groups, ensuring consistency in training delivery.
Virtual Reality Control Simulation: The virtual reality control simulation used in this study was specifically developed for this project as part of a university-supported scientific research initiative (BAP Project Code: GAP-2024–002). The scenario content and structure were designed through evaluation meetings conducted by the research team under the guidance of a public health nursing specialist with prior experience in developing public health programmes, safety education and studies on home accidents. The software was technically developed by a professional engineer working in collaboration with the research team, based on predefined safety scenarios and functional specifications. The virtual reality environment simulates a typical home setting with 13 interactive risk areas. Although the software has not undergone formal validation in prior studies, its design was guided by expert input and tailored to the characteristics of the target population. This study will also serve as a preliminary step in evaluating the feasibility and effectiveness of this simulation for broader use in public health education. If found to be effective, it may contribute to the development of future programmes aimed at preventing home accidents among vulnerable groups.
The scenarios will be presented through virtual reality goggles in a simulated home environment designed to highlight potential accident risks. Each participant will take part in a 10 min virtual reality simulation set in a one-bedroom apartment. Depending on their preference, they can begin in either the living room or the main corridor. Using a handheld pointer, they will identify hazardous areas within the home, selecting from a total of 13 potential risk zones. If a participant believes the home to be safe, they may choose the ‘I think the home is safe’ option to finish the task. At the end of the simulation, a summary screen will display both identified and missed hazards. Optionally, the simulation may proceed with brief illustrative scenes demonstrating the consequences of missed hazards. The simulation session ends after this feedback phase. All participants will be observed in person during the intervention sessions to ensure protocol adherence. Participants may discontinue the intervention at any point on request or if any discomfort is reported.
In the next stage, the balance abilities of children with special needs, whose parents completed the virtual reality simulation, will be assessed using the Children’s Balance Assessment Form, the Tinetti Balance and Gait Assessment and the Nintendo Wii Fit Balance Board. Subsequently, each group of parents will receive first aid training delivered by nurses and transfer training provided by physiotherapists.
The structure and duration of both the nurse-led first aid training and the physiotherapist-led transfer training are based on predefined educational modules that were developed by the research team specifically for this study. These modules were designed in alignment with the objectives of the intervention and the needs of families of children with special needs participating in the study at the Barrier-Free Life Application Centre. The first aid training, delivered by a licensed nurse, is structured around different home-based accident scenarios including falls, burns, cuts, poisoning, choking and electrocution. Each scenario includes simulated risk situations followed by demonstration and practice of appropriate first aid responses (eg, bleeding control, burn management, cardiopulmonary resuscitation for children). The total duration of the session is approximately 90 min and includes interactive discussions, demonstrations and question-answer components. The content is designed to reflect commonly accepted paediatric first aid practices, but it is not based on any formal national or international certification framework. The transfer training, delivered by the study’s physiotherapists, is designed to teach parents safe techniques for supporting their children during daily mobility-related tasks. It addresses physical assistance strategies during walking, transitions (eg, sitting, standing, lying) and positioning during balance loss. The session also includes ergonomic strategies for caregivers and environmental adjustments to reduce fall risks at home. This training lasts approximately 90 min and includes hands-on practice using scenario-based activities with supervision from physiotherapists. The training content was developed in-house based on commonly observed needs and movement characteristics of children with cerebral palsy, developmental delays and other neurodevelopmental conditions commonly encountered in the centre. These components are not part of a national certification programme but were created through a practice-based, multidisciplinary approach tailored to the characteristics and needs of the study population.
Data collection will include pre- and post-intervention parental awareness scores obtained from the Home Accident Awareness Questionnaire for Parents of Children with Special Needs, children’s balance and gait outcomes from functional assessments and System Usability Scale scores collected during eligibility screening. These data will be used to evaluate changes over time, examine the relationship between child-specific fall risk and parental awareness and assess the usability and accessibility of the virtual reality-based intervention.
Due to the minimal-risk nature and single-session design of the study, no restrictions on concomitant care were required. Adverse events are not expected; however, appropriate precautions will be in place to manage any rare instances of discomfort. Since both the intervention and assessments will be completed in a single visit, no additional procedures for participant retention or follow-up are necessary. Likewise, no post-trial care or compensation is planned.
Safety Considerations and Adverse Effects Management: During the virtual reality-based simulation, participants will be monitored closely for signs of discomfort or adverse effects such as dizziness or motion sickness. Sessions will take place in a well-ventilated, quiet room, with participants seated throughout the experience to minimise risk. If any symptoms occur, the session will be paused or discontinued immediately, and the participant will be offered water and a rest break. A trained health professional will be present at all times to manage any adverse effects and provide appropriate support. These precautions align with best practices for virtual reality use in non-clinical populations. Notably, the physiotherapist delivering the virtual reality education has clinical experience in vestibular rehabilitation, which enhances her ability to recognise and manage symptoms such as dizziness or motion sensitivity during the simulation.
Box 1 presents the home accident scenarios developed for the study, while the research stages are illustrated in figure 1.
Box 1
Home accident scenarios used in the virtual reality simulation
Trips and falls on the carpet.
Leaving knives on the counter.
Leaving pans on the stove.
Chemicals on the lower shelves of the cabinet.
Medicines kept in easily accessible compartments of the refrigerator.
Drilling or cutting tools left on the floor or mounted on the wall.
A child sleeping unprotected on the couch.
Inadequate lighting in the room.
Lack of non-slip mats on the bathroom floor.
Low balcony railings.
Furniture (eg, armchairs, chairs and tables) placed in front of open or openable windows.
Exposed sockets and cables.
Large furniture and electronic devices not fixed to the wall.
Outcome measures of the study
As a screening tool, the System Usability Scale, a standardised 10-item Likert-type questionnaire, will be used during the eligibility process to assess participants’ perceived usability. All eligible participants will complete a 26-item descriptive information form developed by the research team, which includes questions on parents’ socio-demographic characteristics, details about their child, and their first aid knowledge.
The original forms and tools will be administered in Turkish in this study, as this is the native language of participants. For transparency and accessibility, English versions of the System Usability Scale, the Home Accident Awareness Questionnaire for Parents of Children with Special Needs and the Children’s Balance Assessment Form are provided as Supplemental Material (online supplemental Material 1).
Primary outcome measures
Home accident awareness questionnaire for parents of children with special needs
This 28-item questionnaire was developed by the interdisciplinary research team based on a review of relevant literature on home accident prevention in children with special needs. It was specifically designed for this study due to the lack of validated tools appropriate for the target population, which includes children with special needs across a broad age range. Most existing tools focus on families with typically developing children or on younger age groups, limiting their applicability. The questionnaire assesses parental awareness and safety practices related to common home accidents. The items address various safety domains, including fall prevention, choking hazards, poisoning, burns, sharp-object injuries and basic first aid. They are not grouped into formal subscales. Each item is rated on a 0–10 Visual Analogue Scale, where 0 represents ‘Never’ and 10 represents ‘Always’. Higher scores indicate stronger awareness and more consistent preventive behaviour. A total awareness score will be calculated as the mean of all item responses, with higher totals reflecting greater overall awareness. Although formal psychometric testing has not been conducted at this stage, the tool was developed by the interdisciplinary research team and reviewed under the supervision of a professor specialised in public health nursing, with attention to clarity, content relevance and feasibility within the study context.
Secondary outcome measures
Children’s balance assessment form
This form, developed by the researchers based on the existing literature to evaluate the fall history and balance status of children with special needs, will be completed by parents. It collects basic socio-demographic information about the child, including age, height, weight, body mass index, diagnosis and education level. Additionally, it contains five questions with yes/no or present/absent response options regarding the child’s fall history, walking characteristics, balance difficulties and rehabilitation background.
Tinetti balance and gait assessment
The assessment includes 13 items for balance and 9 items for gait, scored on a 3-point scale (0–2), resulting in a maximum balance score of 26 and a maximum gait score of 9, with a total possible score of 35. A score of 18 or below indicates a high fall risk, 19–24 moderate risk and above 24 low risk.16
Devices used for data collection
Nintendo wii fit balance board for balance assessment
The Nintendo Wii Fit Balance Board, integrated with the BeCure Balance Assessment System, will be used to evaluate static and dynamic postural balance. Developed in collaboration with physiotherapists and engineers, the system objectively measures static balance, weight distribution, postural sway and proprioception.17
Although not originally developed as a clinical tool, the Nintendo Wii Fit Balance Board has been validated in paediatric rehabilitation contexts. Previous randomised controlled trials have demonstrated its feasibility and effectiveness for improving balance and functional outcomes in children with cerebral palsy, a population with neurodevelopmental and sensorimotor impairments. Specifically, Tarakci et al conducted a randomised controlled trial with 30 children with mild cerebral palsy and found that Wii Fit–based training, when combined with conventional neurodevelopmental treatment, led to significant improvements in balance, functional mobility and independence in daily activities compared with standard training alone. Similarly, Jelsma et al reported that 3 weeks of Wii Fit training significantly improved balance scores in children with spastic hemiplegic cerebral palsy, with many participants preferring the interactive gaming sessions over conventional physiotherapy.18 19
To comprehensively assess balance and fall risk in children with special needs, we employed a combination of complementary tools to capture both subjective parental perspectives and objective physical performance. The Children’s Balance Assessment Form is a context-based instrument developed by the research team to collect caregiver-reported information on the child’s fall history and balance-related observations. To complement this and to also evaluate balance during walking, we used the Tinetti Balance and Gait Assessment, which, although originally developed for older adults, has been used in several paediatric rehabilitation contexts involving children with motor impairments such as cerebral palsy.16 To further illustrate its applicability in motor impairments, Souza et al applied the Tinetti Balance and Gait Assessment in a dual-task training study with children with autism spectrum disorder, a population in which motor impairments are commonly observed, using it as a tool to assess balance and gait performance in this paediatric population.20 The Tinetti Balance and Gait Assessment’s ability to capture both static and dynamic balance makes it particularly relevant for identifying fall risk in children with complex movement challenges. In addition, we integrated the Nintendo Wii Fit Balance Board as an interactive tool for dynamic postural control assessment. It offers visual feedback and quantifiable balance data in a gamified, child-friendly format, increasing both motivation and compliance. Wii Fit results will be used descriptively and triangulated with clinical scores to explore consistency across methods. This multi-method approach enhances ecological validity and allows for triangulation of results across caregiver perceptions, clinical observation and technology-based measures.
The selected outcome measures are clinically relevant, as they assess both parents’ awareness of home safety risks and children’s balance and mobility status, two critical factors in preventing home accidents among children with special needs.
Statistical analysis
A target sample size of 100 participants was pragmatically determined, based on resource availability, feasibility and expected recruitment capacity at the study site. All data will be entered manually into a secure SPSS Statistics for Windows, V. 22.0 database by members of the research team without any identifying information. The dataset will be reviewed by a second team member to minimise data entry errors. The final dataset will be accessible only to authorised personnel. Descriptive statistics including percentage, mean, SD and median will be used to summarise the data. The Kolmogorov-Smirnov test will be performed to assess normality of distribution.
The 28-item Home Accident Awareness Questionnaire uses a 0–10 rating scale for each item, structured similarly to a Visual Analogue Scale, where 0 indicates ‘Never’ and 10 indicates ‘Always’. A total awareness score will be computed as the mean of all items. The difference between pre- and post-intervention mean scores will be tested for statistical significance using a paired samples t-test or a Wilcoxon signed-rank test, depending on data distribution. Additionally, items may be grouped thematically into categories such as fall prevention, poisoning prevention, choking prevention and general home safety behaviours for exploratory subscale analyses, if appropriate. First aid awareness is assessed through behaviour-based items addressing emergency-related risks, rather than through a separate knowledge test.
For other between-group comparisons (eg, based on demographic subgroups), the χ2 test will be used for categorical variables, and independent samples t-test or Mann-Whitney U test will be used for continuous variables. Exploratory subgroup analyses may be considered if justified by the data.
Pearson correlation analysis will be conducted if the data meet the assumptions of normality; otherwise, Spearman correlation analysis will be used. Correlation analyses will be conducted to examine the relationship between children’s balance and gait scores (Children’s Balance Assessment Form, Tinetti Balance and Gait Assessment and Nintendo Wii Fit Balance Board) and the parents’ home accident awareness scores obtained from the Home Accident Awareness Questionnaire for Parents of Children with Special Needs collected both pre- and post-intervention. These analyses will help determine whether parental awareness levels align with the child’s fall risk. No additional analyses are planned, but exploratory analyses may be conducted if justified by the data. Results will be presented as mean and standard deviation (mean±SD), and the level of significance will be set at p<0.05. The dependent variables of the study consist of the participants' mean scores on the Home Accident Awareness Questionnaire for Parents of Children with Special Needs, the Tinetti Balance and Gait Assessment and the Nintendo Wii Fit Balance Board Balance Assessment. The independent variables include participants’ descriptive characteristics. Participants with missing outcome data will be excluded from the relevant analyses.
Ethics and dissemination
Ethical approval for the study was obtained from the Ethics Committee of Istanbul Topkapi University on 19 April 2025 (approval no: 2500009514). The findings of the study will be disseminated through academic conferences and peer-reviewed journals. No public access to the dataset is planned due to confidentiality considerations.
Patient and public involvement
Patients and the public will not be involved in the design, conduct, reporting or dissemination plans of this research.
Discussion
This study protocol proposes an innovative educational approach that utilizes a virtual reality-based scenario application to address home accident risks, a method being implemented for the first time in this context. In line with adult learning principles, the intervention is designed as a hands-on, experiential learning model by simulating a real home environment through virtual reality technology. Considering that children with physical and intellectual disabilities are at a higher risk of home accidents due to their functional limitations, it is anticipated that caregivers may benefit from practising awareness and preparedness in a safe, simulated environment. Learning through virtual scenarios, rather than encountering risks in real life, is expected to enhance competence and confidence. Furthermore, this system aims to eliminate the need for a physical training space and may represent a technology-driven learning model aligned with 21st-century educational innovations.
A study conducted in Turkey in 2010 investigated first aid interventions performed by families for children aged 0–14 following burn injuries.21 The authors reported that a large proportion of children received inappropriate treatments such as the application of yoghurt, toothpaste, tomato paste, ice, raw egg white or potato. Such findings illustrate a widespread reliance on unscientific and potentially harmful home remedies for burn treatment and underscore the need for improved parental education about evidence-based first aid practices. Similarly, Alhadrami et al assessed families’ awareness and knowledge levels regarding preventive measures for home accidents involving children and found that participation in first aid courses and health education programmes was positively associated with higher awareness.22 These previous studies provide important context and highlight the relevance of developing structured and evidence-based educational interventions. Building on this background, the present protocol aims to investigate whether a virtual reality-based scenario application, combined with first aid and transfer training, can enhance caregivers’ awareness and preparedness in a safe and controlled environment.
In addition to assessing changes in parental awareness, comparing these scores with children’s balance and gait status is expected to provide valuable insights into whether parents of children with higher fall risk demonstrate greater safety awareness. Such comparisons may also reveal potential mismatches between actual risk and perceived awareness, which could inform the development of future educational and support strategies for families.
This study has several notable strengths. It is the first to propose a virtual reality-based training intervention to increase parental awareness of home accident risks in children with special needs. By combining caregiver-focused education with an evaluation of children’s balance and gait, the study adopts a multidimensional approach that may provide a more comprehensive understanding of risk and prevention. The use of fully immersive virtual reality technology also creates an ethically safe and controlled environment in which participants can practise without exposing children to real dangers. Nevertheless, several limitations should be acknowledged. The virtual reality simulation does not incorporate all sensory modalities, such as smell and taste, which may reduce the completeness of the real-world experience. Furthermore, the effective use of virtual reality requires adequate intellectual and attentional capacity, and children or caregivers with significant cognitive limitations may not benefit fully from the intervention.
As with many educational interventions, blinding will not be feasible due to the nature of the study design, which may introduce observer or confirmation bias. To minimize this risk, standardised procedures and data analysis conducted by a researcher independent of the intervention team will be applied. In addition, as this is a single-centre study, the generalisability of the findings may be limited. Finally, the current protocol does not include a formal measure of participant satisfaction, although incorporating such feedback tools may be considered in future applications to improve user experience.
Overall, this virtual reality-based intervention is expected to contribute to reductions in home accident incidence by enhancing caregiver preparedness and confidence. Creating safer and more responsive home environments may, in turn, promote greater autonomy and mobility for children with special needs. Despite potential concerns regarding accessibility, the implementation of this model is expected to successfully engage caregivers from diverse socioeconomic backgrounds. This suggests that virtual reality-based training may serve as an inclusive and scalable approach, even in settings with limited resources. To improve accessibility and scalability, future adaptations of this model could include mobile-based applications or integration into public institutions, such as schools and rehabilitation centers, thereby broadening its reach.
Contributors TO (Istanbul Topkapi University) is the guarantor of this study and contributed to the development and critical evaluation of the research idea and coordinated communication with the participating centers. GEG (Kocaeli Health and Technology University) was involved in the critical review and revision of the manuscript. TE (Istanbul Topkapi University), SY (Istanbul Medipol University) and ES (Kocaeli Health and Technology University) contributed to the literature review and manuscript drafting and will participate in data collection and entry during the implementation. Language editing was provided solely to improve grammar and clarity of the manuscript text.
Funding This study was financially supported by the Scientific Research Projects Commission of Istanbul Topkapi University (Project Code GAP-2024-002). The sponsor had no role in the study design, data collection, data analysis, interpretation or the decision to publish. The official trial sponsor listed in the ClinicalTrials.gov record is Istanbul Medipol University, in line with the institutional affiliation of the principal investigator. The designated contact for sponsor-related correspondence is Sıla Yılmaz ([email protected]).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
1 Bertan M, Güler Ç. Public Health, Basic Information. Ankara: Güneş Kitabevi, 1995:265–472.
2 Bertan M, Çakır B. Accidents from a public health perspective. In: Bertan M, Güler Ç, eds. Public Health Basic Book. Ankara: Güneş Kitabevi, 1997.
3 Aral N, Gürsoy F, Aysu B. Investigation of the opinions of mothers with children with special needs on home accidents. Erzincan Univ J Soc Sci Inst 2020;13:229–41. doi:10.46790/erzisosbil.774080
4 Bayram T, Ilgi̇n C, Kulbay H, et al. The Factors Associated with Mothers’ Preventive Measures Against Home Accidents: A Descriptive Study from Istanbul, Turkey. Clinical and Experimental Health Sciences 2019;9:151–6. doi:10.33808/clinexphealthsci.564220
5 Zhu H, Xia X, Xiang H, et al. Disability, home physical environment and non-fatal injuries among young children in China. PLoS One 2012;7:e37766. doi:10.1371/journal.pone.0037766
6 Shi X, Shi J, Wheeler KK, et al. Unintentional injuries in children with disabilities: a systematic review and meta-analysis. Inj Epidemiol 2015;2:21. doi:10.1186/s40621-015-0053-4
7 Calver J, Balogh R, Rudoler D. Incidence of injury in children and adolescents with intellectual and developmental disability. J Saf Res 2021;77:56–60. doi:10.1016/j.jsr.2021.02.009
8 Shmueli D, Razi T, Almog M, et al. Injury Rates Among Children With Autism Spectrum Disorder With or Without Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open 2025;8:e2459029. doi:10.1001/jamanetworkopen.2024.59029
9 Baltacı G, ed. Exercise Therapy in Sports Injuries. Hipokrat Kitabevi, 2016.
10 Laver K, Ratcliffe J, George S, et al. Is the Nintendo Wii Fit really acceptable to older people? A discrete choice experiment. BMC Geriatr 2011;11:1–6:64. doi:10.1186/1471-2318-11-64
11 Scherpbier ICA, Abrahamse ME, Belleman RG, et al. Implementation of Virtual Reality to Parent-Child Interaction Therapy for Enhancement of Positive Parenting Skills: Study Protocol for Single-Case Experimental Design With Multiple Baselines. JMIR Res Protoc 2022;11:e34120. doi:10.2196/34120
12 Kokorelias KM, Chiu M, Paul S, et al. Use of Virtual Reality and Augmented Reality Technologies to Support Resilience and Skill-Building in Caregivers of Persons With Dementia: A Scoping Review. Cureus 2024;16:e64082. doi:10.7759/cureus.64082
13 Patano A, Alanazi M, Lehto R, et al. A nature-immersive virtual reality intervention to support hospice family caregivers: Qualitative findings from a pilot study. Asia Pac J Oncol Nurs 2024;11:100616. doi:10.1016/j.apjon.2024.100616
14 Wong KP, Qin J. Effectiveness of Social Virtual Reality Training in Enhancing Social Interaction Skills in Children With Attention-Deficit/Hyperactivity Disorder: Protocol for a Three-Arm Pilot Randomized Controlled Trial. JMIR Res Protoc 2023;12:e48208. doi:10.2196/48208
15 Aziz M, Chemnad K, Al-Harahsheh S, et al. Depression, stress, and anxiety versus internet addiction in early and middle adolescent groups: the mediating roles of family and school environments. BMC Psychol 2024;12:184. doi:10.1186/s40359-024-01659-z
16 Ağırcan D. Adaptation, validity, and reliability of the tinetti balance and gait assessment in turkish [master’s thesis]. Denizli, Pamukkale University, Institute of Health Sciences, 2009
17 Emir A. Investigation of postural balance and upper extremity functionality in individuals with intellectual disabilities [master’s thesis]. Istanbul, Istanbul Medipol University, Institute of Health Sciences, 2018
18 Tarakci D, Ersoz Huseyinsinoglu B, Tarakci E, et al. Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy. Pediatr Int 2016;58:1042–50. doi:10.1111/ped.12942
19 Jelsma J, Pronk M, Ferguson G, et al. The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy. Dev Neurorehabil 2013;16:27–37. doi:10.3109/17518423.2012.711781
20 Souza FHN de, Lisboa AKP, Maia MDFT, et al. Effects of dual task training on gait temporal-spatial parameters of children with autism. mtprehabjournal 2018;15:1–5. doi:10.17784/mtprehabjournal.2017.15.527
21 Karaoz B. First-aid home treatment of burns among children and some implications at Milas, Turkey. J Emerg Nurs 2010;36:111–4. doi:10.1016/j.jen.2009.12.018
22 Alhadrami LM, Habib HS, Osman BK, et al. Maternal Knowledge and Awareness of Preventive Measures for Domestic Accidents Among Children in Jeddah, Saudi Arabia. Cureus 2024;16:e71226. doi:10.7759/cureus.71226
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.. This work is licensed under the Creative Commons Attribution – Non-Commercial License http://creativecommons.org/licenses/by-nc/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Details
; Sever Ebru 4 ; Eryigit Tuba 5 1 Department of Physiotherapy and Rehabilitation , Faculty of Health Sciences, Kocaeli Health and Technology University , Kocaeli , Turkey
2 Department of Nursing , Faculty of Health Sciences, Istanbul Topkapi University , Istanbul , Turkey
3 Physiotherapy and Rehabilitation Doctorate Program , Graduate School of Health Sciences, Istanbul Medipol University , Istanbul , Turkey, Department of Physiotherapy and Rehabilitation , Faculty of Health Sciences, Istanbul Medipol University , Istanbul , Turkey
4 Department of Physiotherapy and Rehabilitation , Faculty of Health Sciences, Kocaeli Health and Technology University , Kocaeli , Turkey, Physiotherapy and Rehabilitation Doctorate Program , Graduate School of Health Sciences, Istanbul Medipol University , Istanbul , Turkey
5 Department of Nursing , Faculty of Health Sciences, Istanbul Topkapi University , Istanbul , Turkey, Nursing Doctorate Program , Institute of Health Sciences, Eskisehir Osmangazi University , Eskisehir , Turkey