Patients’ and Health Professionals’ Experiences of Using Virtual Reality Technology for Upper Limb Training after Stroke: A Qualitative Substudy

Hindawi Rehabilitation Research and Practice Volume 2018, Article ID 4318678, 11 pages https://doi.org/10.1155/2018/4318678 Research Article Patients’ and Health Professionals’ Experiences of Using Virtual Reality Technology for Upper Limb Training after Stroke: A Qualitative Substudy Hanne Pallesen ,1 Mette Brændstrup Andersen,1 Gunhild Mo Hansen,1 Camilla Biering Lundquist,1 and Iris Brunner1,2 1 Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Aarhus, Denmark Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway 2 Correspondence should be addressed to Hanne Pallesen; Received 16 October 2017; Accepted 16 January 2018; Published 8 February 2018 Academic Editor: Maria Gabriella Ceravolo Copyright © 2018 Hanne Pallesen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. In recent years, virtual reality (VR) therapy systems for upper limb training after stroke have been increasingly used in clinical practice. Therapy systems employing VR technology can enhance the intensity of training and can also boost patients’ motivation by adding a playful element to therapy. However, reports on user experiences are still scarce. Methods. A qualitative investigation of patients’ and therapists’ perspectives on VR upper limb training. Semistructured face-to-face interviews were conducted with six patients in the final week of the VR intervention. Therapists participated in two focus group interviews after the completion of the intervention. The interviews were analyzed from a phenomenological perspective emphasizing the participants’ perceptions and interpretations. Results. Five key themes were identified from the patients’ perspectives: (i) motivational factors, (ii) engagement, (iii) perceived improvements, (iv) individualization, and (v) device malfunction. The health professionals described the same themes as the patients but less positively, emphasizing negative technical challenges. Conclusion. Patients and therapists mainly valued the intensive and motivational character of VR training. The playful nature of the training appeared to have a significant influence on the patients’ moods and engagement and seemed to promote a “gung-ho” spirit, so they felt that they could perform more repetitions. 1. Introduction Stroke is one of the most frequently occurring diseases in modern society and often leads to lifelong critical disability [1, 2]. Approximately two-thirds of stroke survivors experience motor deficits of the upper limb, resulting in reduced quality of life [3]. Repetition is one of the key factors in regaining motor function after stroke [4, 5]. Studies in animals have shown that at least 400 repetitions are needed to induce plastic changes in the brain [4]. Over the last 10 years, virtual reality (VR) technology has been introduced into neurorehabilitation, in particular with the intention of facilitating motor function recovery by way of many repetitions [6]. Novel VR rehabilitation systems increase intensity and seem to offer challenging and motivating tasks [7]. Upper limb VR training provides a higher degree of activity, compared with conventional training, for severely affected subacute patients after stroke [8]. There is not yet much data on the use of VR systems for rehabilitation and/or commercial gaming devices in clinical practice for upper limb rehabilitation after stroke [9]. A British survey concluded that commercial gaming consoles are used by almost a fifth of therapists. Gaming was reported to be enjoyable, but therapists described barriers related to time, space, and cost [10]. Few studies have focused on patients’ and therapists’ perceptions of upper limb VR training [11, 12]. Participants with chronic stroke reported that the upper limb VR training was motivational; however, they expressed frustrations about technical challenges [12]. According to another study, which concentrated on the therapist perspective, VR was perceived as a useful additional treatment tool to complement conventional methods. However, it was 2 emphasized that VR could not replace the therapist’s clinical reasoning or their social interaction with the patients [11]. A growing number of studies suggest that VR for upper limb training could be beneficial in the chronic phase [13]. However, only a few minor studies have enrolled patients in the acute and subacute phases. Furthermore, none have focused on the subacute stroke patient’s experiences of VR upper limb training. Therefore, a qualitative substudy was conducted as part of the Virtual Reality for Upper Extremity after Stroke (VIRTUES) trial. This trial is registered with ClinicalTrials.gov NCT02079103. This randomized controlled multicentre trial was performed at five rehabilitation hospitals in three countries to examine the benefit of VR technology on upper limb motor recovery after stroke [14]. Over a period of four weeks, 120 patients were offered additional VR arm training in 4-5 training sessions a week, each of 45–60 minutes’ duration, led by a physiotherapist or an occupational therapist. 1.1. The VR System. The YouGrabber system (YouRehab Ltd., Switzerland) is an example of a therapeutic VR upper limb training in stroke rehabilitation. The YouGrabber system includes wearable data gloves with sensors and training software with a range of gaming options. The system offers several VR rehabilitation scenarios, providing a graded training programme of goal-oriented reaching and/or grasping exercises. YouGrabber (YG) was chosen because its range of therapy modes allows the inclusion of patients with a broad range of arm motor impairments, from mildly to severely reduced function, and because of its moderate costs, compared to other technology-based rehabilitation products [14]. YG offers participants seven different games, giving visual feedback upon attainment for each game (Airplan, Magic Finger, ToyCatching, Catch the Carrot, Tomato Juggling, and Shopping). The purpose of this article is to explore patients’ and therapists’ experiences of using a VR rehabilitation system for upper limb training after stroke. The current study focuses on experiences of VR upper limb training in the subacute phase. 2. Methods 2.1. Study Design. A qualitative approach was chosen, because the aim of the study was to illuminate the perspectives and experiences of the individual stroke patient and therapist using VR arm training in subacute rehabilitation setting in Denmark. A qualitative approach enables the researcher to enter the world of the participants and gain insight into their thoughts and feelings [15]. The interviews were inspired by the phenomenological theoretical perspective and aimed to explore the participants’ perceptions, interpretations of their own exper (...truncated)