Abstract
This study investigated the feasibility of virtual reality (VR) as a therapeutic intervention for two pediatric populations: cerebral palsy and autism. OTs, children with autism, and their caregivers trialed VR and subsequently participated in either a focus group or a semistructured interview. Data analysis revealed several themes regarding the use of VR with these populations. Positive results indicate the need for future development of pediatric-specific VR programs.
Primary Author and Speaker: Jennilee Dodds
Additional Authors and Speakers: Allison Ellington
The purpose of this study was to investigate the feasibility of virtual reality (VR) as a therapeutic intervention to improve activity of daily living (ADL) participation for two pediatric populations: cerebral palsy (CP) and autism spectrum disorder (ASD). Previous trials pertaining to the use and efficacy of VR show promising results (Bryanton et al., 2006; Hopkins et al., 2011); however, there has yet to be widespread adoption of this emerging intervention. Standard, existing occupational therapy interventions are evidence-based; however, each intervention has inherent logistical drawbacks that make it difficult for clinicians to implement.
A mixed-methods, phenomenological approach was utilized to collect data from clinicians, children with ASD and their caregivers. Children were included in the study if they were between ages 5-18 years old, had an upper extremity (UE) motor impairment or ASD, could speak and understand the English language, and were able to provide responses to questions. Caregivers were included in the study if they provided care to a child with UE motor impairment and/or ASD, could speak or understand the English language, and could provide answers to questions. Clinicians were included in the study if they had at least three months prior experience working with children with UE motor impairments and/or ASD, were licensed to practice OT, and could speak and understand the English language. A convenient sample of six participants from the child and caregiver participant pool was recruited. A convenient sample of 11 OT clinicians was also recruited.
Prior to engaging children and their caregivers with VR, data was collected in the form of a technology survey given to caregivers. Then, six children with ASD and their caregivers used SaeboVR in their homes for 1-2 weeks. Following the trial period, children and their caregivers participated in semi-structured interviews to gain their thoughts regarding the supports and barriers of using virtual reality with this population. After transcribing the interviews, the researcher utilized an open coding method to analyze the data (Elo & Kyngas, 2008).
In the clinican portion of this study, data was initially collected in the form of a general technology acceptance survey. Then, 11 pediatric OTs attended an in-service and trialed SaeboVR. Following the in-service, OTs participated in a focus group discussing the feasibility of using VR with these pediatric populations. The researcher transcribed the focus group data and utilized an open coding method to analyze the data. Primary themes were identified by thoroughly reading the data, labeling themes, and finding supporting evidence among the transcribed text.
Analysis of interview and focus group data revealed generally favorable themes regarding the use of SaeboVR to improve ADL participation. Children and caregivers felt that SaeboVR was engaging and motivating, but could incorporate fine motor tracking and more opportunities for social interaction. Similarly, clinicians found that SaeboVR was a measureable tool that should incorporate more child-centered games and fine motor sensors.
The narrative data highlights current reasons to be optimistic about the future of VR for children with CP and ASD. Specifically, both caregivers and clinician participants reported a likely increase in a child’s engagement and attention during VR game play. It is pertinent that participants reported an increased interest in attending to VR when compared to traditional OT approaches. In a previous study, children with ASD who attended to VR for 30-50 minutes improved their social skills (Mitchell et al., 2007). Therefore, motivation to engage in therapeutic VR for extended periods of time could result in positive changes for these children.
Bryanton, C., Bosse, J., Brien, M., Mclean, J., McCormick, A., & Sveistrup, H. (2006). Feasibility, motivation, and selective motor control: Virtual reality compared to conventional home exercise in children with cerebral palsy. Cyberpsychology & Behavior, 9(2), 123-128.
Hopkins, I. M., Gower, M. W., Perez, T. A., Smith, D. S., Amthor, F. R., Wimsatt, F. C., & Biasini, F. J. (2011). Avatar assistant: Improving social skills in students with an ASD through a computer-based intervention. Journal of Autism and Developmental Disorders, 41 (11), 1543-1555.
Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62 (1), 107-115.
Ravi D. K., Kumar N., Singhi P. (2016). Effectiveness of virtual reality rehabilitation for children and adolescents with cerebral palsy: An updated evidence-based systematic review. Physiotherapy. http://dx.doi.org/10.1016/j.physio.2016.08.004