JMIR Publications

ABSTRACT

Background:

Over the last decade, virtual reality (VR) has emerged as a cutting-edge technology in stroke rehabilitation. VR is defined as a type of computer-user interface that implements real-time simulation of an activity or environment allowing user interaction via multiple sensory modalities. In a stroke population, VR interventions have been shown to enhance motor, cognitive, and psychological recovery when utilized as a rehabilitation adjunct. VR has also demonstrated non-inferiority to usual care therapies for stroke rehabilitation.

Objective:

The proposed pilot study aims to: (1) Determine the feasibility and tolerability of using a therapeutic VR platform in an inpatient comprehensive stroke rehabilitation program; (2) Estimate the initial clinical efficacy (effect size) associated with the VR platform using APPS for pain distraction and upper extremity exercise for post-stroke neurologic recovery.

Methods:

This study be conducted in the Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP) at the James A. Haley Veterans’ Hospital (JAHVH). Qualitative interviews will be conducted with 10 CIIRP clinical staff members to assess the feasibility of the VR platform from the clinician perspective. A prospective within-subject pre-post pilot design will be used to examine tolerability of the VR platform and clinical outcomes (upper extremity neurologic recovery, hand dexterity, pain severity) among 10 inpatients in the CIIRP. A VR platform consisting of commercially available pain distraction and upper extremity APPs will be available at the participants’ bedside for daily use during their CIIRP inpatient stay (approximately 4-6 weeks). Clinician interviews will be analyzed using qualitative descriptive analysis. Cohen’s d effect sizes with corresponding 95% confidence intervals will be calculated for upper extremity neurologic recovery, hand dexterity, and pain. The proportion of participants that achieve minimum clinically important difference after using the VR platform will be calculated for each clinical outcome.

Results:

N/A

Conclusions:

Our next step is to conduct a large multi-site clinical trial that will incorporate the lessons learned from this feasibility pilot study to test the efficacy of a VR intervention in inpatient rehabilitation and transition to home environments. When VR is used in patients’ rooms it serves to provide additional therapy and may reduce clinician burden. VR also presents an opportunity similar to home-based practice exercises. VR can be implemented in both clinical settings and in people’s own homes, where engagement in ongoing self-management approaches is often most challenging. This unique experience offers the potential for seamless transition from inpatient rehabilitation to the home.