Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke

ABSTRACT

Spatial neglect is a common and severe cognitive consequence of stroke, yet there is currently no effective rehabilitation tool. Virtual Reality (VR) telerehabilitation tools have the potential to provide multisensory and enjoyable therapies and remotely monitor adherence without the presence of a therapist at all times. Researchers and industry need to better understand end-user perspectives about these technologies to ensure these are acceptable and, ultimately, optimize adherence and efficacy. This study aims to explore end-user perspectives on the use of self-administered VR for spatial neglect in a university environment to identify barriers and facilitators prior to extending its use remotely as a telerehabilitation tool. We used a mixed-method design including focus groups, self-administered questionnaires and interviews with stroke survivors (N = 7), their carers (N = 3) and stroke clinicians (N = 6). End-user perspectives identified clarity of instructions, equipment (cost, available resources) and for some, level of experience with technology as barriers of use. Perceived facilitators were performance feedback, engagement and enjoyment, and psychological benefits associated with self-administered VR telerehabilitation. Overall, end-users were positive and interested in using VR telerehabilitation for spatial neglect. These perspectives enabled us to produce practical recommendations to inform development, enhance engagement and uptake of VR telerehabilitation and inform future studies.

KEYWORDS:

• Spatial neglect
• Virtual reality
• Telerehabilitation
• Stroke
• Qualitative

Acknowledgements

We would like to thank all the stroke survivors, carers and clinicians for their useful comments and kind cooperation during this study. We also thank the reviewers for their valuable comments and suggestions. This research was supported by the University of East Anglia Innovation Proof-of-Concept Fund 2017–2018. C-SIGHT developments were also funded by a grant to SR and VP from the National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative based at Cambridge University Hospital NHS Foundation Trust and University of Cambridge. HM is currently funded by a grant from The Stroke Association to SR, HM and VP.

Disclosure statement

Evolv Rehabilitation Technologies provided a free license of VirtualRehab to the research team during this study. The research team are collaborating with Evolv Rehabilitation Technologies in the development of c-SIGHT. No payments have been received by the research team from Evolv Rehabilitation Technologies to conduct any of this research or to develop c-SIGHT.

Additional information

Funding

This research was supported by the University of East Anglia [Innovation Proof-of-Concept Fund 2017–2018]. C-SIGHT developments were also funded by a grant to SR and VP from the National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative based at Cambridge University Hospital NHS Foundation Trust and University of Cambridge. HM is currently funded by a grant from The Stroke Association to SR, HM and VP (grant 19\100016).