Exploring the Use of Virtual Reality Applications in Patients With a Diagnosis of Motor Neurone Disease
Phase: NA
Conditions: Motor Neuron Disease
Sponsor: Lancashire Teaching Hospitals NHS Foundation Trust

Protocol version 1, 07-01-20 
Topic: Exploring the use of Virtual Reality applications in 
patients with a diagnosis of motor neurone disease 
 
BACKGROUND: 
The potential benefit from using technology to improve health has been an area of growing 
interest within healthcare workers and researchers. This study aims to explore the use of 
virtual reality technology in improving health and wellbeing in people with a diagnosis of 
motor neurone disease (MND).  
MND is a chronic progressive neurological condition which affects 1-5 people per 100,000 of 
population. It affects people generally in adulthood and more specifically within the 50-70 
years of age. Motor Neurone disease is no longer considered to be a condition that affects 
the motor system alone. Extra motor clinical pathology, routinely observed in 
histopathological examinations, has been found with a preference for prefrontal, frontal and 
temporal cortices (Baumer et al, 2014). This is consequently associated with dysexecutive 
syndrome, behavioural impairment and, in up to 15% of cases, with overt frontotemporal 
dementia (Abrahams et al, 2014).    
Due to the progressive nature of the condition, an individual with MND has to continue to 
adapt to the losses brought about by the condition. A study by Soofi et al., (2018) describes 
how people with MND perceive having a choice of rehabilitation interventions as important 
for them to have a sense of control over their life.  It is believed that psychological, spiritual 
and social wellbeing is important for people with MND rather than a focus on physical 
functioning alone. Studies examining the role of psychological interventions in MND have 
found benefits from interventions such as meditation for promoting wellbeing in patients 
and their carers. Foley., (2007) highlighted the need for palliative care interventions to 
improve wellbeing in people with MND. Additionally, a study by Marconi et al., (2016), 
found that meditation helped promote a better acceptance of the condition.   Furthermore, 
Pagnini et al., (2017) found that meditation training improved quality of life in people with 
MND.  
More recently, the use of virtual reality (VR) technology is being recognised in the field of 
health management. Virtual reality refers to a technology that uses interactions between an 
individual and a computer generated environment which stimulates different sensory 
modalities such as visual and auditory (Dascal et al., 2017). This is accessed most commonly 
via the use of head mounted- goggles or headsets.  Most of the studies published till date, 
have targeted the areas of pain management, eating disorders and cognitive or motor 
rehabilitation (Dascal et al, 2017). Schmitt et al., (2011) and Patterson et al., (2010) have 
suggested that the entertaining or stimulating effect of VR is useful in redirecting the 

Protocol version 1, 07-01-20 
patient’s attention away from distressing experiences such as those of anxiety and pain. The 
potential benefit of VR technology to enhance recovery after central nervous system injury 
continues to be an area of growing interest and one that has room for further exploration. 
The use of VR has not been explored in motor neurone disease, a terminal condition, where 
individuals experience severe distressing symptoms from anxiety, respiratory distress or 
positional discomfort. Additionally, there remains limited evidence for its use in other long 
term conditions such as Multiple System Atrophy, Parkinson’s disease or Multiple Sclerosis. 
Although there have been studies that look at interventions that support quality of life in 
motor neurone disease (Soofi et al., 2018; Pagnini et al., 2017; Marconi et al, 2016), these 
have not involved the use of VR technology. This study will try to explore the use of VR in 
this client group with a view to documenting what clients find useful, whether it affects their 
care needs, whether it helps with enhancing wellbeing and reducing anxiety.  
Care of individuals with a diagnosis of motor neurone disease, is based on supportive 
interventions that help to improve quality of life. This study examines the role of VR and its 
impact on the quality of life in this client group. It is hoped that if this intervention is found 
beneficial in this client group then it may pave the way for its use in other similar long term 
conditions where supportive interventions are beneficial.  
 
METHOD:  
30 patients with a diagnosis of MND, who consent to taking part, will be included in the 
study based on a set of Inclusion/Exclusion criteria.  
Inclusion Criteria:  
1) Diagnosis of MND 
2) Sufficient cognitive ability to understand instructions with regards using the VR kit 
3) Has sufficient motor ability/dexterity to use the kit or a carer who will be able to 
assist with the use of the kit.  
4) Can tolerate light and have sufficient head control to wear the head set. 
5) Can understand English 
Exclusion Criteria: 
1) Poor cognition – inability to understand instructions regarding the use of VR. 
2) Unable to tolerate light/unable to wear the head set 
3) Light sensitive epilepsy, severe vertigo or dizziness. 
4) Does not understand English 
Patients will be referred to the study by members of the MND Care team. Patients meeting 
the Inclusion criteria and those who consent to participating will be recruited into the study. 

Protocol version 1, 07-01-20 
Each of these patients will be assessed on a set of tests before and after the intervention 
period of 4 weeks. At the end of the intervention period, there will be a short interview to 
document the usage and perceived benefits (or not) of the device.  
1. A test of cognition- ECAS 
2. PHQ-9 for depression 
3. GAD-7 for Anxiety 
4. Edinburgh Mental Wellbeing scale 
5. ALS-FRS 
6. A daily diary for the client/carer to document the time for which the VR device was 
used.  
The intervention period will be for 4 weeks where patients will be required to use the VR set 
for 2 hours in the day. During the implementation phase, support will be provided with 
regards any distressing symptoms or intolerance to the sensory stimulation some patients 
may potentially develop, due to the introduction of this technology. If the individual 
continues to be unhappy, the VR set use will be discontinued and the patient will be 
excluded from the study. Those patients who successfully complete the 4 week intervention 
will be reassessed on the questionnaires and will have an interview to document the impact 
of VR use on them and their quality of life.  
RESULTS: 
The data from the study will be analysed using a combination of qualitative analysis and 
statistical testing. The outcome of the research will be disseminated to patients and their 
carers and to the wider public using other methods of dissemination such as research 
journal publication and research reports.  
 
REFERENCES: 
Abrahams, S., Newton, J., Niven, E., Foley, J. and Bak, T.H. (2014) ‘Screening for cognition 
and behaviour changes in ALS’ Amyotrophic Lateral Sclerosis & Frontotemporal 
Degeneration; 15(1–2): 9–14.  
Dascal, J., Reid, M., Ishak, W.W., Spiegal, B., Recacho, J., Rosen, B. and Danovitch, I. (2017) 
‘’Virtual reality and medical inpatients’’ Innovations in Clinical Neurosciences; 14(1-2): 14-21. 
Foley, G. (2007) ‘What are the care needs for people with Motor Neurone Disease and how 
can occupational therapists respond to meeting these needs’ British Journal of Occupational 
Therapy; 70(1): 32-34.  
Pagnini., F., Marconi., A., Tagliaferni., G.M., Manzoni., R., Gatto., V., Fabiani., V., Gregnano., 
G., Rossi., G., Volpato, E., Banfi, P., palmieri., A., Graziano. F., Castelnuova., G., Corbo., M., 

Protocol version 1, 07-01-20 
Molinari., E., Rival., N., Sansona., V., Lunetta., C., (2017) ‘’ Meditation training for people 
with amyotrophic lateral sclerosis: a randomised clinical trial’’ European Journal of 
Neurology, 24: 578-586.   
Marconi, A., Gragnano, G., Lunetta, C., Gatto, R., Fabiani, V., Tagliaferri, A., Rossi, G., 
Sansone, V. and Pagnini, F. (2016) ‘The experience of meditation for people with 
amyotrophic lateral sclerosis and their caregivers – a qualitative analysis’ Psychology, Health 
and Medicine; 21(6); 762-768. 
Soofi, A.Y., Bello-Haas, V.D., Kho, M.E. and Letts, L. (2018) ‘The impact of rehabilitative 
interventions on quality of life: a qualitative evidence synthesis of personal experiences of 
individuals with amyotrophic lateral sclerosis’ Quality Of Life Research, 27: 845-856.