Using Virtual Reality for Rehabilitation of Upper Limbs at Home Trial
Condition: Upper Limb Injury; Virtual Reality; Rehabilitation; Paediatric
MeSH terms: Arm Injuries
Study type: Interventional

Summary: 
      The IVR games have been enhanced to include more levels. The new aspects to be tested in this
      study are new IVR exercises that would be made upper limb rehab designed for children for
      home use, as repeated sessions with progression through different levels could improve the
      prospect of good functional recovery. A new wireless headset has recently become available,
      which will enable the IVR to be run without the need for separate equipment, thereby making
      home use possible as no complicated set-up will be required.

      This project aims to explore the feasibility, acceptability and perceived effectiveness of an
      improved suite of Immersive Virtual Reality (IVR) system suitable for Upper Limb Motor
      Impairment (ULMI) rehabilitation for children at home. A multidirectional perspective has
      been adopted, including patients, caregivers, and clinical staff.

      The aims and objectives of the clinical feasibility trial are:

        -  to investigate the potential of IVR for ULMI rehabilitation (range of motion recovery)
           at home compared to usual physical therapy in a small sample of paediatric patients.

        -  to measure the impact of the interventions from a mixed methods (quantitative and
           qualitative) and a multidirectional perspective (patients, clinicians, family members).
    

Detailed description: 
      This project builds upon a previous MRC 'Confidence in Concept' feasibility project which
      developed Virtual Reality (VR) games for participants at Sheffield Children's Hospital to do
      arm rehabilitation movements such that they become so engrossed in the IVR they become much
      less aware of any pain or discomfort linked to the exercises.

      Patients (and carer where appropriate) would be involved in the design of the scenarios, the
      protocol, patient information sheets, and the project steering group. Research nurses will
      download anonymised usage data from the VR headset used at home and interview participants.
      All data will feed into an evaluation which will demonstrate the concept and acceptability of
      using IVR at home.

      Procedure Patients usually have a 20-30 minutes appointment during which the OT/PT reviews
      their previously prescribed home exercise regime with them, measures ROM, and explains and
      discusses new home exercises. For the purpose of the trial, patients had their usual OT/PT
      appointments but were asked to use the IVR games to do the prescribed home exercises. Before
      consenting to participate, each patient was offered a 5-10 minute experience of the game to
      familiarise themselves with how it worked and to check for problems. Written and verbal
      consents were taken from parents and children.

      The pre-trial PedsQL was administered in the initial OT/PT appointment. Children were then
      asked to use the IVR system for approximately 15 minutes twice a day. Trial participation
      lasted three weeks during the prescribed treatment weeks.

      Following the at-home trial, patients and parents returned the equipment to the clinic in the
      final appointment and the SUS and the post-trial Peds QL were administrated by OT/PT in
      person. In addition, they participated in semi-structured interviews as described above.

      At the end of the trial, an interview (10 minutes) with the OT was conducted by a research
      nurse.
    

Intervention name(s): Virtual Reality Upper Limb Motor Impairment Rehabilitation
Intervention type(s): Device
Intervention description(s): Patients wore a VR headset while undergoing their physical rehabilitation at home
Other intervention name(s): No intervention
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Intervention model description: This study aimed to explore:
patients, clinicians, family members perceptions of the effect of IVR on ULMI rehabilitation (range of movement (ROM) recovery)
patient perceptions of the usability, quality of live, acceptability, engagement with and enjoyment of IVR scenarios;
occupational therapies perceptions about the usability and implications of the IVR technology within a patient rehabilitation at home.
Methods: This was a small-scale mixed methods (quantitative and qualitative) study.
Patients: paediatric patients recruited from Sheffield Children's Foundation Hospital Trust in England, UK, their parents, and an occupational therapist (OT) from the Sheffield Children's Foundation Hospital Trust for Burns, Plastics, and Orthopaedics participated in the study
Masking: None (Open Label)
Primary purpose: Supportive Care