Integrating Neuro Technology into the Clinic: a proposed tool for promoting the clinical integration of neuro rehabilitation technology

Advanced neuro rehabilitation technology is becoming more common in upper extremity stroke rehabilitation. It uses the occupational therapy approach of restoration or remediation of function. Advanced neuro rehabilitation technology includes devices such as functional electrical stimulation, robotics, sensor-based technology and virtual reality gaming. Many of these types of devices are based on principles of neuroplasticity and motor learning, and as such, offer an intervention approach that involves high intensity repetitive movement training in engaging environments with performance feedback (Levin, Weiss & Keshner, 2015; Mehrholz, Hadrich, Platz, Kugler & Pohl, 2012); Winstein et al., 2016). Despite emerging evidence-based literature on the efficacy of using neuro rehabilitation technology for upper extremity rehabilitation post-stroke, there is very limited research on how to effectively implement and deploy technology into typical occupational therapy service delivery. Integrating Neuro Technology into the Clinic is a resource tool and mentoring program informed by evidence and grounded in theory. It was designed to encourage clinics to take an active role in adapting the program and evolving the content to support clinicians in using technology to meet their individual clinic goals as their needs change over time. The overall aim of Integrating Neuro Technology into the Clinic is to increase clinicians use of technology for clinically meaningful outcomes and to assist with improving perceived self-efficacy in the appropriate application of the technology. Integrating Neuro Technology into the Clinic consists of a resource binder of education modules and resources and a 13-week occupational therapist led peer mentoring program focusing on technology use and knowledge translation. Integrating Neuro Technology into the Clinic was created to encourage the use of advanced neuro technology in occupational therapy service delivery. The long-term outcomes of this project will contribute to emerging knowledge on technology use in occupational therapy practice and hopefully influence improved technology integration in occupational therapy practice

The Potential of Virtual Reality in Social Skills Training for Autism: Bridging the Gap Between Research and Adoption of Virtual Reality in Occupational Therapy Practice

Impairments in social functioning greatly hinder children and youth with autism spectrum disorder (ASD) from responding appropriately and adapting to various social situations. As a result, individuals with ASD get fewer opportunities for social inclusion, physical well-being, and forming interpersonal relationships. Virtual reality (VR) has been studied extensively in this area, where a large body of evidence shows that VR is a promising tool for social skills training (SST) in individuals with ASD. With the flexibility and projected effectiveness that VR offers, it can provide more opportunities to learn and practice strategies for recognizing daily challenges that involve forming social relationships and associated reasoning. This paper discusses the gap between the effectiveness of VR-based SST and its adoption in occupational therapy (OT) practice. There is a significant dearth of resources for the development of occupational therapists to effectively administer these interventions. Such resources that summarize empirically supported VR interventions to teach social skills to people with autism would be very valuable in training therapists who wish to employ them. Using theory-driven approaches, this paper intends to empower occupational therapists in becoming efficient and confident in using this technology for addressing social skills deficits in people with ASD

Using Xbox kinect motion capture technology to improve clinical rehabilitation outcomes for balance and cardiovascular health in an individual with chronic TBI

Background Motion capture virtual reality-based rehabilitation has become more common. However, therapists face challenges to the implementation of virtual reality (VR) in clinical settings. Use of motion capture technology such as the Xbox Kinect may provide a useful rehabilitation tool for the treatment of postural instability and cardiovascular deconditioning in individuals with chronic severe traumatic brain injury (TBI). The primary purpose of this study was to evaluate the effects of a Kinect-based VR intervention using commercially available motion capture games on balance outcomes for an individual with chronic TBI. The secondary purpose was to assess the feasibility of this intervention for eliciting cardiovascular adaptations. Methods A single system experimental design (n = 1) was utilized, which included baseline, intervention, and retention phases. Repeated measures were used to evaluate the effects of an 8-week supervised exercise intervention using two Xbox One Kinect games. Balance was characterized using the dynamic gait index (DGI), functional reach test (FRT), and Limits of Stability (LOS) test on the NeuroCom Balance Master. The LOS assesses end-point excursion (EPE), maximal excursion (MXE), and directional control (DCL) during weight-shifting tasks. Cardiovascular and activity measures were characterized by heart rate at the end of exercise (HRe), total gameplay time (TAT), and time spent in a therapeutic heart rate (TTR) during the Kinect intervention. Chi-square and ANOVA testing were used to analyze the data. Results Dynamic balance, characterized by the DGI, increased during the intervention phase χ 2 (1, N = 12) = 12, p = .001. Static balance, characterized by the FRT showed no significant changes. The EPE increased during the intervention phase in the backward direction χ 2 (1, N = 12) = 5.6, p = .02, and notable improvements of DCL were demonstrated in all directions. HRe (F (2,174) = 29.65, p = \u3c .001) and time in a TTR (F (2, 12) = 4.19, p = .04) decreased over the course of the intervention phase. Conclusions Use of a supervised Kinect-based program that incorporated commercial games improved dynamic balance for an individual post severe TBI. Additionally, moderate cardiovascular activity was achieved through motion capture gaming. Further studies appear warranted to determine the potential therapeutic utility of commercial VR games in this patient population. Trial registration Clinicaltrial.gov ID - NCT0288928

Therapeutic potential and ownership of commercially available consoles in children with cerebral palsy

Introduction: We conducted a survey amongst families of children with cerebral palsy (CP) to ascertain the ownership and therapeutic use and potential of commercial games consoles to improve motor function. Method: 300 families in southeast England were identified through clinical records,and were requested to complete an anonymised questionnaire. Results: A total of 61 families (20% response) returned a completed questionnaire with 41 (68%) males and 19 (32%) females with Cerebral Palsy, with a mean age of 11Y5M (SD 3Y 7M). The large majority of families, 59 (97%), owned a commercial console and the child used this for 50-300 minutes a week. Returns by severity of motor impairment were: Gross Motor Function Classification System (GMFCS) I (21%), II (31%), III (13%), IV (15%), V (18%). Consoles were used regularly for play across all GMFCS categories. Conclusion: The potential of games consoles, as home-based virtual reality therapy (VRT), in improving the motor function of children with cerebral palsy should be appropriately tested in randomised controlled trial. Wide ownership, and the relative ease with which children engage in the use of commercial-based VRT systems suggests potential as a means of augmenting therapy protocols,taking advantage of interest and participation patterns of families. What the study has added: This study shows that there is wide ownership/use of commercial games consoles amongst children with CP; and this offers great potential to test therapeutic efficacy of home-based virtual reality therapy to improve motor function in children. Key messages: Children with Cerebral Palsy frequently access and use commercial consoles during play at home. Consoles are used by children across severity of gross motor function levels. Some families had utilized the consoles for therapeutic purposes, with anecdotal improvements in motor function. Opportunity exists for using commercial consoles within home based therapy protocols and for recreational participation across all GMFCS levels

Using a Knowledge-Translation Approach to Advance Evidence-Supported Cognitive Rehabilitation Practices in an Interdisciplinary Rehabilitation Setting

There is an identified 17-year gap in implementing evidence into practice. Courage Kenny Rehabilitation Institute (CKRI) has the goal of updating their cognitive rehabilitation guidelines by 2023. This project aimed to provide the materials and supports necessary for CKRI to develop, implement, and have follow-up for new evidence-based interventions in their cognitive rehabilitation practice for people with acquired brain injuries and thus improve patient outcomes. A needs assessment, development of an evidence summary, implementation and provision of support were completed to address this need. An evidence table and summary, two presentations, and five intervention-specific handouts were created to support the outcomes of this doctoral project. The five members of the advisory team completed a survey following the delivery of materials in which they reported feeling that interventions were supported by evidence, that the OTD process was effective, deliverables will support their practice, and that they received adequate support. Recommendations for next steps for CKRI are to complete a system-wide survey identifying current rehabilitation practices across CKRI sites as well as interest items identified by therapists, based on the evidence and feasibility of implementation

An Immersive Virtual Reality Treatment Learning Module for UNLV Occupational Therapy Students

Virtual reality refers to the technology used to create multi-sensory, three-dimensional environments its users can interact with. Occupational therapists may find virtual reality-based therapy appealing as it allows them to access many virtual environments and tasks that would be difficult to recreate in traditional settings. Despite literature suggesting their willingness to use it in practice, there is an evidence-to-practice gap caused by low self-efficacy and knowledge of how to operate and apply it. The author created a learning module for occupational therapy students to see how it affects perceived clinical competency. The results of the learning module showed statistically significant improvements in self-efficacy, attitudes toward using virtual reality-based therapy, and knowledge after taking this learning module. This project contributes to what is known about how learning modules can affect perceived clinical competency in using virtual reality-based therapy

Knowledge Translation Approaches in Occupational Therapy: A Scoping Review

A gap exists between what is known in occupational therapy and how occupational therapists practice. Knowledge translation approaches have been designed to bridge the gap between research and practice. Currently there is limited literature exploring the knowledge translation approaches being implemented specifically within occupational therapy. Therefore, a scoping review was completed to provide an overview of the existing literature on knowledge translation approaches in occupational therapy. Three electronic databases were searched. All peer-reviewed quantitative and qualitative articles which met the inclusion criteria were reviewed. A data extraction table aided the analysis and synthesis of the literature. The initial search returned 565 articles, of which 59 were selected based on the inclusion criteria. Comprehensive screening of the 59 articles resulted in 16 peer-reviewed articles being included in the review. A range of knowledge translation methods have been used in occupational therapy including face-to-face education sessions, online resources, and clinical audits of documentation with feedback to the therapists. A small number of studies used a knowledge translation framework to guide the knowledge translation approach. Findings from this study highlighted that knowledge translation approaches are useful for overcoming challenges and changing practice. In particular, a knowledge translation framework may be useful to guide the design and implementation of a knowledge translation initiative. Although there were a number of knowledge transfer strategies used in the studies, face to face education was used most often. However, a combination of transfer strategies had the most lasting impact on practice change. Including participants’ perspectives in the planning, delivery, and evaluation was beneficial. More research is needed to identify how the use of a theoretical framework might support positive outcomes for knowledge translation