Investigation of Virtual Reality as a new model of delivery for evidence-based stroke rehabilitation

Ellis, Fiona (2020) Investigation of Virtual Reality as a new model of delivery for evidence-based stroke rehabilitation. Doctoral thesis, University of East Anglia.

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Virtual reality-aided exercise-based training has shown promise for post-stroke upper limb motor recovery in the home. Robust studies are needed to develop evidence-based guidelines and facilitate uptake in clinical practice. Thus, a three-phase mixed methods design was used to (I) identify if VR can drive neural recovery; (II) incorporate end-users into the refinement of a device and (III) provide a robust feasibility trial within the home to inform a future clinical efficacy trial.

Phase I was a systematic review that demonstrated there is insufficient robust data to identify neurophysiological changes correlated with or accompanying a reduction in motor impairment, in response to VR. The four included studies reported a varying impact of VR on motor recovery and were of poor quality. Thus, revealing the need for research to address the mechanisms by which VR potentially drives motor recovery, and for more robust initial investigations to guide the development of clinical trials.

Phase II incorporated the views of ten stroke survivors, seven informal carers and nine clinicians into the refinement of a virtual reality device. Demonstrations of the Virtualrehab platform and a small home-trial confirmed the need for a low-cost non-immersive VR device that can deliver personalised home-based therapy. The end-users provided key recommendations for the next iteration of the device; in order to facilitate acceptability, usability and uptake of such technology.

Phase III investigated the feasibility of delivering upper limb therapy via VR, within the home of eleven stroke survivors. The 12-week intervention demonstrated that this mode of delivery was feasible and acceptable to stroke survivors; of note was the 87.5% therapy adherence. The results identified practical challenges for delivering and investigating VR within the home; particularly recommendations for collecting neural and behavioural outcomes. Thus, providing results to inform a future dose-optimisation study and then a clinical efficacy trial.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User: Chris White
Date Deposited: 14 Jul 2021 13:52
Last Modified: 14 Jul 2021 13:52


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