Virtual Rehabilitation Innovations for Motivation
Condition: Virtual Rehabilitation; CP (Cerebral Palsy); Brain Injuries; Young Adult; Children
MeSH terms: Brain Injuries; Cerebral Palsy
Study type: Interventional

Summary: 
      Children and young people with movement difficulties such as Cerebral Palsy (CP) and Acquired
      Brain Injury (ABI) report that traditional therapies are highly repetitive and labourious.
      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 the team's 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. During the co-production events
      of the VR4REHAB Inter Regional North West Europe (NWE) funded programme in 2018, young people
      desired the use of commercial games for therapeutic purposes. This work has enabled
      connections between affordable computer technologies: the Raspberry Pi, VR headsets and
      freely available commercial games.

      This 2-Phased project is therefore exploring the potential of commercially available virtual
      reality (VR) systems consoles and games for use in rehabilitation programmes. The
      Investigators hope to gain information on:

        1. Whether commercially produced VR games can provide a motivating environment to support
           adherence to therapy

        2. Whether it is possible to improve reaching and grasp-release hand movements through this
           method

        3. Gain an understanding of the ages of children and young people most likely to benefit
           from home-based VR therapy User evaluation and performance data and therapist
           evaluations will be collected and compared to baseline data to provide information on
           usability, accessibility, acceptability and adaptability.
    

Detailed description: 
      Aim: The focus of this Proof-of-Concept feasibility study investigates the potential of
      commercially available virtual reality (VR) games and equipment for therapeutic use for upper
      limb rehabilitation; considering in particular the role of motivation and engagement when
      using the system to support adherence to therapy protocols.

      Rationale - Effective rehabilitation requires appropriate dosage and intensity and be
      meaningful to daily life, but traditional therapeutic modalities struggle to achieve optimum
      input and gains following successful intensive intervention programmes are often not
      maintained. Commercial VR products are designed with high level gaming methods to engage
      participants in the games. Commercial VR products therefore offer potential as therapeutic
      adjuncts to gain appropriate practice of sufficient intensity and duration but may need some
      adjustments. Adjustments in this instance refer to changing the speed at which the game plays
      and which combinations of devices compliant with European Union standards (CE) can be
      connected.

      The Investigators will evaluate whether young people with Cerebral Palsy (CP) or Acquired
      Brain injury (ABI) can be engaged in VR games for upper-limb movement using VR systems,
      potential for therapeutic benefit and also consider clinical feasibility in relation to
      utility, particularly in respect to the costs involved (i.e. labour, training, workplace
      set-up). The Co-Production Group (C-PG) group identified a 2-Phase study in order to assess
      for any modifiable alterations and prepare training manual prior to a short feasibility
      trial. This clinical trial is designed as an Action Research study in two Phases:

      Phase 1 of the study. Participants will engage in a 2-hour workshop to test out the VR system
      and games in order to gather responses to the game speeds and devices (including method of
      access). Feedback will contribute to information for instruction leaflets for access and
      usability and determine whether further adjustments are required and additional training
      information needed for therapists to be able to set up the system to meet individual
      requirements. Information gathered during the workshop will also inform on the links and
      support required from the computer scientists for backup.

      Phase 2 of the study, 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 and adaptability.

      Evidence from preliminary, albeit small single-subject design studies, suggests that children
      and adults with movement impairments may improve upper limb performance (speed, fluency and
      accuracy) with some transfer to clinical measures of upper limb and hand skills. It is not
      known if children with CP/ABI can improve upper limb movement performance and function nor
      whether gains transfer into improved hand skills in daily life although it anticipated that
      benefits to function will be achieved for many children. An exploration of this point will be
      considered as secondary outcomes to inform on dose and duration for a future definitive
      clinical trial.
    

Intervention name(s): Home-School based VR system trial
Intervention type(s): Other
Intervention description(s): Commercially available VR games operated Raspberry pi micro computer and Oculus Quest VR headsets provided for 2 weeks at dose and intensity selected by participants.
Intervention model: Single Group Assignment
Intervention model description: Action Research Proof of Concept study in 2-Phases. Phase 1, 2-hour workshop: Phase 2 2-week within subject trial.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Virtual Rehabilitation; Cerebral palsy; Acquired brain injury; children and young people