Virtual Rehabilitation Innovations for Motivation V1
Research type
Research Study
Full title
VR4REHAB-MOTIVATION FOR REHABILITATION: Proof of concept evaluation of virtual reality innovations for therapy for young people with brain injury
IRAS ID
275096
Contact name
Dido Green
Contact email
Sponsor organisation
Royal Free London NHS Foundation Trust
Clinicaltrials.gov Identifier
Duration of Study in the UK
0 years, 6 months, 31 days
Research summary
Summary of Research
Children and young people with movement difficulties such as Cerebral Palsy and Acquired Brain Injury report that traditional therapies are highly repetitive and laborious. This influences enjoyment and participation in regular therapy programmes and may result in reduced adherence to therapy or exercise regimes, limiting effectiveness. This study will build on our previous work to explore the potential use of Virtual−Reality (VR) technologies in rehabilitation; particularly systems that can be used at home to increase accessibility and reduce need to attend clinics for therapy.The VR4REHAB InterReg NWE funded programme has involved the co/creation of Virtual Reality systems/games with computer scientists, health professionals and stakeholders. During our co-production events in 2018, young people desired the use of commercial games for therapeutic purposes. As part of this work we have enabled connections between affordable computer technologies: the Raspberry Pi, VR headsets and freely available commercial games. This clinical trial is designed as an Action Research study in two Phases.Phase 1 will test out the usability/accessibility of the system via a 2-hour patient-therapist workshop.Feedback will contribute to information for instruction leaflets for access and usability and determine whether further modifications are required for coding and training information for therapists to be able to set up the system to meet individual requirements. Information gathered during the workshop will also inform on need for any links required from the computer scientists for backup. Phase II will test out the feasibility of use within a home/school setting as a Proof-of-Concept study. Phase 2, will inform on trial design for a larger randomized controlled trial. The VR system will be provided to each participant for a 2-week home- or school- based trial. User evaluation and performance data and therapist evaluations will be collected and compared to baseline data to provide information on usability, accessibility, acceptability, adaptability and accommodability.Summary of Results
Intervention programmes for children and young people (CYP) with motor disorders often require extensive repetition of exercises which some CYP may find tedious or difficult to adhere to. This study investigated how provision of virtual interfacing access to commercially produced Virtual Reality (VR) games via affordable technologies can provide a motivating environment for the practice of therapeutic activities. Secondary outcomes considered whether it is possible to improve reaching and hand movements as well as gain an understanding of the ages of CYP likely to benefit from participation in home-based VR therapy programmes.A ’Proof-of-Concept’ study explored the feasibility of using affordable miniature computers (Raspberry Pi’s at £35 approximately) and Oculus Quest VR headsets to provide accessible resources for VR games promoting practice and use of the upper limb. A case series method included 4 CYP with motor impairments due to Cerebral Palsy or brain injury and 4 CYP without movement difficulties. A 2-week home-based trial, considering usage and experience, was modified due to COVID-19 restrictions. Individual perspectives were gathered from likert and semistructured questions from the Co-Produced User Evaluation form and user experience diaries. Additional measures included the Functional Reach Test and Goal Attainment Scaling (GAS: motor disorder group only). Descriptive statistics and associations between participation (frequency and duration of use). Coding and thematic analysis identified themes which were mapped against motivational constructs of autonomy, relatedness and self-efficacy/competence.
Results and discussion
Four main themes emerged from the data; persistence, enjoyment, skill acquisition and technology access reflecting key motivational constructs of relatedness and competence with autonomy influenced by access: “Amazing” and parents of CYP with movement difficulties: ” The kids are all so happy”. Comments from one parents of 10 year old male with left sided hemiplegia on initial set up in relation to potential to enhance competency: “He has never moved like this before”; “Once he was in the games, we couldn’t get him to stop”.Results and discussion
COVID-19 restrictions required amendments to protocol and delayed start of trial. Findings show comments from CYP without movement difficulties reflecting engagement and enjoyment: “Amazing” and parents of CYP with movement difficulties: ”The kids are all so happy”. Comments from parents of a 10 year old male with left sided hemiplegia following initial set up: “He has never moved like this before”; “Once he was in the games, we couldn’t get him to stop”. Findings related to feasibility to impact on upper limb skill show all but one CYP with and without movement impairments, to increase their arm reach. Five of six stated goals were shown to be achieved better or much better than expected. Two children reported a headache after playing more than 20minutes on the system. Difficulties were experienced by therapists in setting up the technologies and resolving glitches during the projectConclusions
Preliminary findings reflect potential for an affordable and accessible VR system utilizing commercially produced games to be enjoyable and motivating. Findings suggest this combined approach may impact positively on upper limb skill, daily actcivities and perceived competencies. More difficulties were experienced in setting up the technologies and resolving glitches in a timely manner, exacerbated by difficulties in travel of our researcher during the pandemic.
References
[1] Green D, et a; (2020) Coproducing Virtual Reality Technologies for Rehabilitation.IEEEXplore online pub https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbepqT31Io9mBKmWOVaNlnSizmZ9nZMeWeVhsZlBhe6aHZrIo86olfkxtI9qLTNeJVg-3D-3D66VX_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YKqKJgPOX3IVwUwOi8MpQzycA0YYOLbpSKgxT7yF3WSu6vj1sKPADpn2vZ9PxKV24x6v0polmgvvsDKUdoQInpgcIaxrSWIHpKPTbxdtI2pBQWJ8B8Z0zVZDaY6orjFw9lL5Fk6SMzNRLi1l8UUnvC37N5edoODwaHtrXA2qZdWyw-3D-3D&data=05%7C01%7Capprovals%40hra.nhs.uk%7C8df55d151adf457c8f4d08da5f58ad0e%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637927131701392625%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=6KP2llJrbUSSBPKMYljXv29FeqT6OJd3%2FDk4uX7eSyI%3D&reserved=0 doi:10.1109/ICVR46560.2019.8994337REC name
London - Central Research Ethics Committee
REC reference
20/LO/0470
Date of REC Opinion
25 Jun 2020
REC opinion
Further Information Favourable Opinion