Feasibility of incorporating functionally relevant virtual rehabilitation in sub-acute stroke care: perception of patients and clinicians

Abstract

Purpose: To determine user satisfaction and safety of incorporating a low-cost virtual rehabilitation intervention as an adjunctive therapeutic option for cognitive-motor upper limb rehabilitation in individuals with sub-acute stroke.

Methods: A low-cost upper limb virtual rehabilitation application incorporating realistic functionally-relevant unimanual and bimanual tasks, specifically designed for cognitive-motor rehabilitation was developed for patients with sub-acute stroke. Clinicians and individuals with stroke interacted with the intervention for 15–20 or 20–45 minutes, respectively. The study had a mixed-methods convergent parallel design that included a focus group interview with clinicians working in a stroke program and semi-structured interviews and standardized assessments (Borg Perceived Exertion Scale, Short Feedback Questionnaire) for participants with sub-acute stroke undergoing rehabilitation. The occurrence of adverse events was also noted.

Results: Three main themes emerged from the clinician focus group and patient interviews: Perceived usefulness in rehabilitation, satisfaction with the virtual reality intervention and aspects to improve. All clinicians and the majority of participants with stroke were highly satisfied with the intervention and perceived its usefulness to decrease arm motor impairment during functional tasks. No participants experienced major adverse events.

Conclusions: Incorporation of this type of functional activity game-based virtual reality intervention in the sub-acute phase of rehabilitation represents a way to transfer skills learned early in the clinical setting to real world situations. This type of intervention may lead to better integration of the upper limb into everyday activities.

Implications for Rehabilitation

• • Use of a cognitive-motor low-cost virtual reality intervention designed to remediate arm motor impairments in sub-acute stroke is feasible, safe and perceived as useful by therapists and patients for stroke rehabilitation.

•    • Input from end-users (therapists and individuals with stroke) is critical for the development and implementation of a virtual reality intervention.

Keywords:

• Stroke
• virtual reality exposure therapy
• upper extremity
• rehabilitation
• occupational therapy
• feasibility

Disclosure statement

The authors report no conflicts of interest

Additional information

Funding

The development of the virtual reality intervention was supported by the Canada Foundation for Innovation. MD was supported by the Fonds de la Recherche du Québec en Santé (FRQS) 2016–2019, the 2014–2015 Doctorate Student Fellowship from the Rehabilitation Living Lab, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, and the David G. Guthrie Fellowship from the Faculty of Medicine, McGill University. MFL holds a Tier 1 Canada Research Chair in Motor Recovery and Rehabilitation. Also supported by the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal.