Promoting Therapists' Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation

PLoS One. 2016 Dec 19;11(12):e0168311. doi: 10.1371/journal.pone.0168311. eCollection 2016.

Abstract

Purpose: Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use.

Method: A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision.

Results: The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists' clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach.

Conclusion: The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.

MeSH terms

  • Aged
  • Attitude of Health Personnel
  • Evidence-Based Medicine / education
  • Female
  • Humans
  • Male
  • Middle Aged
  • Physical Therapy Specialty / education*
  • Problem-Based Learning
  • Self Report
  • Stroke Rehabilitation / methods*
  • Translational Research, Biomedical / education
  • Virtual Reality Exposure Therapy / methods*

Grants and funding

This project has been generously funded, by a grant from the Ontario Ministry of Health and Long-Term Care, administered and supported by the Ontario Stroke Network (www.ontariostrokenetwork.ca), to DEL, SMNG, HS, HC, PM, HF, VD, and JEH. The views expressed do not necessarily reflect those of the Ministry or the Ontario Stroke Network. Dr. Levac’s postdoctoral fellowship was supported by the Canadian Institutes of Health Research, the Canadian Child Health Clinician Scientist Program and NeuroDevNet.