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

Danielle E Levac,Patricia Miller,Heidi Sveistrup,Hillel Finestone,Jocelyn E Harris,Stephanie M N Glegg,Heather Colquhoun,Vincent Depaul,Diana Velikonja,Jeffrey M Haddad

doi:10.1371/journal.pone.0168311

Abstract

PurposeTherapists 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.MethodA 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.ResultsThe 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.ConclusionThe 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.

Highlights

Best-practice rehabilitation interventions after stroke should incorporate practice conditions known to promote the neuroplastic processes underlying motorlearning [1]
On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to motor learning strategies (MLSs) use was noted (p = 0.092)
While therapists stated in the focus group that they focused on transferring skills practiced during Interactive Rehabilitation Exercise System (IREX) sessions to real-life activities, this MLS was infrequently observed in the videotaped sessions, with a mode of 0 at both time points on the MLSRI-20

Summary

Introduction

Best-practice rehabilitation interventions after stroke should incorporate practice conditions known to promote the neuroplastic processes underlying motor (re)learning [1]. Therapists can structure these practice conditions through their use of motor learning strategies (MLS): observable therapeutic actions in which therapists consider task and client-specific factors to select and to apply evidence-based practice and feedback variables for optimal motor learning [2]. In the acute and subacute stages of stroke recovery, therapists can use MLS to provide augmented feedback and to structure the abundant practice of motivating, meaningful tasks within an enriched environment [3,4]. The abundance of MLS options, the inability of experts to come to consensus about MLS definitions and use [8] and the limited educational resources to support therapists in their use [7] all limit MLS application in clinical practice

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