Uso de la realidad virtual en terapia ocupacional: estudio transversal en centros de neurorrehabilitación de Alicante / Use of virtual reality in occupational therapy: a cross-sectional study in neuro-rehabilitation centers in Alicante

OBJETIVOS: el uso de la realidad virtual representa un enfoque metodológico prometedor como intervención terapéutica en neurorrehabilitación. En este estudio se analizó el uso de la RV en terapia ocupacional con pacientes neurológicos. MÉTODOS: se llevó a cabo un estudio descriptivo transversal con terapeutas ocupacionales de centros de neurorrehabilitación de la provincia de Alicante, entre febrero y mayo de 2017. La información se recogió online con un cuestionario de 36 preguntas. RESULTADOS: De 23 participantes, la mayoría eran mujeres (82.6%) y con edad media de 31.4 (DE: 4.1) años. La mitad (52.2%) usaba la realidad virtualcomo herramienta de tratamiento, principalmente con personas de 46-65 años (75.0%), con daño cerebral adquirido (75.0%) y alteraciones cognitivas (91.7%). Las áreas principales de intervención fueron: atención (83.3%), visión (75.0%), miembro superior (75.0%), comunicación verbal (66.7%), alimentación (50.0%), compras (41.7%) y participación social con amigos (41.7%). Los sistemas de RV más utilizados fueron la plataforma NeuronUp (50.0%) y el ordenador y/o tableta junto con los dispositivos Kinect y Wii (33.3%). CONCLUSIONES: Sólo la mitad de lo/as terapeutas ocupacionales usaban la realidad virtual como complemento al tratamiento convencional. Son necesarios más estudios sobre el uso de estas técnicas en terapia ocupacional con personas con afecciones neurológicas

OBJECTIVE: We aimed to analyze the use of virtual reality among occupational therapists working with neurological patients. Methods. A descriptive cross-sectional study was conducted on occupational therapists working in neurorehabilitation centers in the Alicante province between February and May 2017. The information was collected using an online questionnaire made up of 36 questions. RESULTS: Of the 23 participants, the majority of them were women (82.6%) with an average age of 31.4 years (SD: 4.1). Approximately half of them (52.2%) used virtual reality as a treatment tool, mainly with adults aged 46-65 (75.0%) affected by acquired brain damage (75.0%) and with cognitive alterations (91.7%). The intervention areas targeted were: attention (83.3%), vision (75.0%), upper limb mobility (75.0%), verbal communication (66.7%), eating (50.0%), shopping (41.7%), and social participation with friends (41.7%). The most used virtual reality systems in occupational therapy treatments were the NeuronUp platform (50.0%) and Xbox Kinect (R) / Nintendo Wii (R) (33.3%) used with a computer or a tablet. CONCLUSIONS: Only half of the occupational therapists in the study used virtual reality as a complementary tool for conventional treatment. Further studies exploring the use of these techniques in occupational therapy with people affected by neurological conditions are required

Exploring Relational Dialogue in Solution-Focused Coaching Sessions: An Analysis of Co-Construction and Reflection.

Purpose: To examine solution-focused coaching (SFC) as a means to enhance clinicians' professional development. Methods: Six pediatric rehabilitation clinicians (three physical, two occupational, and one behavior therapist) each received two SFC sessions targeting clinical listening goals. Conversational intervals were noted in session transcriptions. Frequencies of relational strategies and conversational intervals were calculated. The meaning of intervals > 10 s was examined. Results: The most frequent relational strategies indicated that SFC facilitates reflection and critical thinking, and encourages action. An appreciable number of long intervals (>10 s) occurred, indicating substantial reflection by participants. These were embedded in relational dialogue sequences involving coach questions and formulations, and participant pauses. Conclusions: The findings support the use of SFC as a professional development tool and substantiate the view that SFC 'works' through the coach's use of relational strategies designed to facilitate collaborative conversations that build solutions through an emphasis on reflection and action.

Peer-led, transformative learning approaches increase classroom engagement in care self-management classes during inpatient rehabilitation of individuals with spinal cord injury.

OBJECTIVE: Evaluate effects of revised education classes on classroom engagement during inpatient rehabilitation for individuals with spinal cord injury/disease (SCI/D). DESIGN: Multiple-baseline, quasi-experimental design with video recorded engagement observations during conventional and revised education classes; visual and statistical analysis of difference in positive engagement responses observed in classes using each approach. PARTICIPANTS/SETTING: 81 patients (72% male, 73% white, mean age 36 SD 15.6) admitted for SCI/D inpatient rehabilitation in a non-profit rehabilitation hospital, who attended one or more of 33 care self-management education classes that were video recorded. All study activities were approved by the host facility institutional review board. INTERVENTION: Conventional nurse-led self-management classes were replaced with revised peer-led classes incorporating approaches to promote transformative learning. Revised classes were introduced across three subject areas in a step-wise fashion over 15 weeks. OUTCOME MEASURE: Positive engagement responses (asking questions, participating in discussion, gesturing, raising hand, or otherwise noting approval) were documented from video recordings of 14 conventional and 19 revised education classes. RESULTS: Significantly higher average (per patient per class) positive engagement responses were observed in the revised compared to conventional classes (p=0.008). CONCLUSION: Redesigning SCI inpatient rehabilitation care self-management classes to promote transformative learning increased patient engagement. Additional research is needed to examine longer term outcomes and replicability in other settings.

European core curriculum in neurorehabilitation.

To date, medical education lacks Europe-wide standards on neurorehabilitation. To address this, the European Federation of NeuroRehabilitation Societies (EFNR) here proposes a postgraduate neurorehabilitation training scheme. In particular, the European medical core curriculum in neurorehabilitation should include a two-year residency in a neurorehabilitation setting where trainees can gain practical experience. Furthermore, it should comprise six modules of classroom training organized as weekend seminars or summer/winter schools. In conclusion, after defining the European medical core curriculum in neurorehabilitation, the next activities of the EFNR will be to try and reach the largest possible consensus on its content among all national societies across Europe in order to further validate it and try to extend it to the other, non-medical, professionals on the neurorehabilitation team in line with their core curricula defined by each professional association.

Impact of the Brain Injury Family Intervention (BIFI) training on rehabilitation providers: A mixed methods study.

BACKGROUND: The psychological impact of TBI is vast, leading to adverse effects on survivors and their caregivers. Unhealthy family functioning may be mitigated by therapeutic strategies, particularly interdisciplinary family systems approaches like the well-documented Brain Injury Family Intervention (BIFI). Little is known about the experience of providers who offer such interventions. OBJECTIVE: This mixed methods study aims to demonstrate that a structured three-day training on the BIFI protocol improves providers' knowledge and confidence in working with survivors and families, and that this outcome is sustainable. METHODS: Participants were 34 providers who participated in an intensive training and completed a web-based survey at four points of time. Quantitative data were analyzed via Wilcoxon signed-rank tests and binomial test of proportions. Qualitative data were analyzed according to rigorous coding procedures. RESULTS: Providers' knowledge of brain injury and their ability to conceptualize treatment models for survivors and their families increased significantly and mostly remain consistent over time. Qualitative data point to additional gains, such as understanding of family systems. CONCLUSIONS: Past studies quantify the BIFI as an evidence-based intervention. This study supports the effectiveness of training and serves as first to demonstrate the benefit for providers short- and long-term.

The impact of Professional Boundaries for Health Professionals (PBHP) training on knowledge, comfort, experience, and ethical decision-making: a longitudinal randomized controlled trial.

PURPOSE: A randomized controlled trial was conducted to evaluate the impact of Professional Boundaries for Health Professionals (PBHP) training program on the knowledge, comfort, experience, and ethical decision-making of multidisciplinary practitioners facing client-practitioner boundary dilemmas. METHODS: In all, 36 rehabilitation practitioners from an Australian state-wide spinal cord injuries service were assigned to experimental and control groups. The Boundaries in Practice (BIP) Scale measured outcomes at four points: pre, post, 3 months, and 1 year. The control group received the training after 3 months. Nonparametric Friedman's two-way analysis of variance was used to examine the trajectories over time. RESULTS: Analysis was conducted using the data of 10 experimental and 13 control group participants who responded at four data collection points. The experimental group showed significant improvement in knowledge (χ2 = 10.673, p = 0.014) and comfort (χ2 = 9.727, p = 0.021) managing professional boundaries post-training. The control group showed no significant change in knowledge or comfort. No significant change was seen in experience across either experimental (χ2 = 3.609, p = 0.307) or control group (χ2 = 7.800, p = 0.050). Ethical decision-making improved in the control group (χ2 = 13.188, p = 0.004) following training, however remained unchanged in the experimental group. CONCLUSIONS: The findings do not definitively support this training approach. Ethical decision-making may improve more substantially within the practice context and organizational culture change. Multifaceted approaches are indicated. Implications for Rehabilitation Ethical dilemmas related to boundaries between clients and practitioners are a frequent occurrence in the rehabilitation setting. In a relatively small sample, the current randomized trial provided inconclusive evidence on the benefit of a 1-day needs-oriented training program to improve knowledge, comfort, and ethical decision-making. Randomized trials of education and training for rehabilitation practitioners are fraught with challenges in the clinical environment of the rehabilitation setting. Multifaceted training approaches, management support and training as well as changes to policy and organizational context in the rehabilitation setting may be needed to more holistically address the issues surrounding professional boundaries in the rehabilitation setting.

Healthcare students' experiences of an interprofessional, student-led neuro-rehabilitation community-based clinic.

Student-led clinics are becoming more prominent as educators seek alternate models of clinical education for health professionals. The purpose of this study was to evaluate healthcare students' experiences of an interprofessional student-led clinic for clients with neurological conditions. Thirteen students representing occupational therapy, physiotherapy, and speech pathology were recruited for the study. A sequential mixed-methods evaluation was employed and the results from the Interprofessional Education Scale and focus group revealed that the students experienced positive perceptions of working collaboratively with other professions, forming good relationships with others, as well as an increased respect for the roles of other professions. The findings suggest that providing a capstone opportunity, where students can work as part of an interprofessional team with a real client, in a format they may come across in future clinical practice, may be beneficial in providing them with essential interprofessional skills as new graduate health professionals.

Interprofessional educational experience to assist in student readiness toward neurorehabilitation.

Occupational and physical therapy professionals are natural partners in neurorehabilitation especially in the acute stages of recovery. To enhance student-learning experiences from both disciplines, we have developed an interprofessional (IP) learning unit that was embedded in neurorehabilitation tracks of each respective program. The primary goal of this project was to examine interprofessional attitudes and perception toward interprofessional learning and practice. A total of 117 occupational therapy (53) and physical therapy (64) students completed an IP case-based learning module with the goal of developing an IP care plan typically seen in neurorehabilitation. Using a sequential explanatory mixed methods design, we collected data pre- and postintervention using the Readiness for Interprofessional Learning Survey (RIPLS). We also utilized a postintervention questionnaire and focus groups intended to solicit information regarding IP competencies. At pretest, students had high ratings on the RIPLS that led to minimal changes at posttest (p = .157). However, common threads from the questionnaire and focus groups showed positive effects on student learning and attitudes toward interprofessionalism. Students reported positive experiences with the IP module. An IP case-based educational module has the potential to facilitate professional development and readiness for future IP practice. Students from different disciplines appreciate the value of IP education (IPE) in reinforcing their professional identity and understanding the professional contributions of others. Our findings are consistent with literature on best practices for IPE.