Facilitating the Implementation of Virtual Reality-Based Therapies in Pediatric Rehabilitation.

Aims: Evaluate the impact of a multifaceted knowledge translation (KT) strategy for the implementation of virtual reality (VR) intervention by rehabilitation clinicians in a pediatric hospital setting.Methods: Eleven therapists were recruited and completed a questionnaire on perceptions on VR usage. A multifaceted KT strategy was implemented over five months. VR usage was tracked and clinician perceptions were reassessed. Baseline characteristics were summarized using descriptive statistics and a Wilcoxon signed rank sum test evaluated changes pre- and post-KT.Results: Perceived ease of use, behavioral control, self-efficacy, and barriers to use improved significantly post-KT; however, intention to use did not. Usage was higher pre-KT than the last two months of KT. Pre-KT, barriers included system setup and use, knowledge of games, and lack of resources, whereas post-KT, they were the lack of appropriate patients and patient-specific experience. KT supports and patient engagement were reasons for continued use.Conclusions: This study highlights the importance of supporting clinicians when implementing VR in clinical rehabilitation. Clinicians benefit from experiential and individualized learning opportunities, peer-led coaching, and hands-on training. Whether these strategies translate to increased usage and how usage is influenced by environmental factors (i.e. lack of appropriate clients) warrants additional research.

Should we be more on the ball? The efficacy of accommodation training on lumbar spine posture, muscle activity, and perceived discomfort during stability ball sitting.

OBJECTIVE: The aim of this study was to evaluate the efficacy of a 9-day accommodation protocol on reducing perceived discomfort while sitting on a stability ball (SB); trunk muscle activity levels and lumbar spinal postures were also considered. BACKGROUND: Previous studies have compared SB sitting with office chair sitting with few observed differences in muscle activity or posture; however, greater discomfort during SB sitting has been reported. These findings may indicate an accommodation period is necessary to acclimate to SB sitting. METHOD: For this study, 6 males and 6 females completed two separate, 2-hr sitting sessions on an SB. Half the participants completed a 9-day accommodation period between the visits, whereas the other half did not use an SB during the time. On both occasions, self-reported perceived discomfort ratings were collected along with erector spinae and abdominal muscle activity and lumbar spinal postures. RESULTS: Discomfort ratings were reduced in female participants following the accommodation; no effects on muscle activation or lumbar spine postures were observed. CONCLUSION: Accommodation training may reduce perceived low-back discomfort in females.Trunk muscle activity and lumbar spine postures during seated office work on an SB did not differ between groups; however, greater sample power was required to conclusively address these variables. APPLICATION: Regarding whether to use an SB in place of a standard office chair, this study indicates that females electing to use an SB can decrease discomfort by following an accommodation protocol; no evidence was found to indicate that SB chair use will improve trunk strength or posture, even following an accommodation period.

Reliability of the motor learning strategy rating instrument for children and youth with acquired brain injury.

PURPOSE: To evaluate reliability and feasibility of the Motor Learning Strategy Rating Instrument (MLSRI) in children with acquired brain injury (ABI). The MLSRI quantifies the extent to which motor learning strategies (MLS) are used within physiotherapy (PT) interventions. METHODS: PT sessions conducted by ABI team physiotherapists with a convenience sample of children with ABI (4-18 years) were videotaped and independently scored later by two raters trained in MLSRI use. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) estimated intra- and inter-rater reliability. RESULTS: Eighteen PT sessions were evaluated. Intra- and inter-rater reliability ICCs for total score were 0.86 (95% CI: 0.66-0.94) and 0.50 (95% CI: 0.08-0.78), respectively. MLSRI category ICCs were 0.56-0.86 (intra-rater) and 0.16-0.84 (inter-rater). CONCLUSIONS: Intra-rater reliability of MSLRI total score was excellent. Moderate inter-rater reliability may partially be due to inconsistent item interpretation between raters. Revisions and further reliability testing are required before recommending the MLSRI for clinical and research use.