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Introduction. The influence of environmental (affective) stimuli on emotion, task performance and participation has been insufficiently investigatedfor children with cerebral palsy (CP), although there is evidence that the effect is considerable. The association between heart rate variability (HRV) and cognitive/affective variables has been previously substantiated. Objective.To harness the well-known assets of virtual reality (VR) to measure emotional aspects of performance among children with and without CP during a customized, virtual meal-making task (VMM).  Methods. Following an initial study demonstrating the VMM’s usability and sensitivity, 15 children with CP and 19 typically developing peers prepared 7 meals. Except for the baseline meal, a single visual stimulus (negative, positive, or neutral from theInternational Affective Picture System) was displayed. Electrocardiogram and skin conductance (SCR) were recorded synchronously with affective stimuli to monitor HVR changes in time and frequency domains. Results. All children found the VMM to be engaging but those with CP attained significantly lower performance scores. There was a significantly higher LF:HF ratio for the CP group compared to controls during meal preparation when a negative stimulus was displayed. The SCR during passivedisplay of pictures was significantly higher for negative than positive stimuli. For children with CP, state and trait anxiety were correlated to autonomic responses and task performance. Sensory profiles for both groups significantly correlated with autonomic responses and performance. Conclusion. The VMM has been demonstrated to be a feasible paradigm to study affective visual stimuli and autonomic responses during a functional task for children with CP.

Cerebral palsy; virtual reality; affective stimuli; Heart rate variability