Rehabilitation Engagement Research Articles

The Caring Life Course Theory: Opening new frontiers in care-A cardiac rehabilitation example.

To operationalize the Caring Life Course Theory (CLCT) as a framework for improving cardiac rehabilitation (CR) engagement and informing ways to address disparities in rural, low socio-economic areas. A secondary analysis of data collected from 15 CR programmes to identify CR patterns through the CLCT lens using a mixed-methods approach. All analytical processes were conducted in NVivo, coding qualitative data through thematic analysis based on CLCT constructs. Relationships among these constructs were quantitatively assessed using Jaccard coefficients and hierarchical clustering via dendrogram analysis to identify related clusters. A strong interconnectedness among constructs: 'care from others', 'capability', 'care network' and 'care provision' (coefficient = 1) highlights their entangled crucial role in CR. However, significant conceptual disparities between 'care biography' and 'fundamental care' (coefficient = 0.4) and between 'self-care' and 'care biography' (coefficient = 0.384615) indicate a need for more aligned and personalized care approaches within CR. The CLCT provides a comprehensive theoretical and practical framework to address disparities in CR, facilitating a personalized approach to enhance engagement in rural and underserved regions. Integrating CLCT into CR programme designs could effectively address participation challenges, demonstrating the theory's utility in developing targeted, accessible care interventions/solutions. Explored the challenge of low CR engagement in rural, low socio-economic settings. Uncovered care provision, transitions and individual care biographies' relevance for CR engagement. Demonstrated the potential of CLCT to inform/transform CR services for underserved populations, impacting practices and outcomes. EQUATOR-MMR-RHS. A consumer co-researcher contributed to all study phases.

O216: RECOVER REALITY - Recover after injury or surgery to the brain and spine with virtual Reality: Feasibility Trial Results and Effectiveness Trial Protocol

Abstract Aim Neurorehabilitation is fundamental to improve outcomes for patients recovering from injury or surgery to the central nervous system. Access to neurorehabilitation is limited by resource shortages, the consequences of which are unfulfilled therapy needs, longer hospital stays and detrimental effects on quality of life. Virtual reality (VR) could be used to augment neurorehabilitation in a self-directed, safe, virtual environment. The aim of this study is to investigate the feasibility of a VR rehabilitation programme in an acute neurosurgical inpatient environment to improve neurorehabilitation. Method A single group, feasibility study was conducted in a tertiary UK neurosurgical department. Patients aged 16 and over who had undergone a neurosurgical intervention for brain tumours were eligible. Participants were offered a VR session at least once per day for the first 14 days post-surgery/injury or until discharge, whichever comes first, with reasons for non-engagement collected. Primary outcomes were feasibility outcomes, and secondary outcomes included rehabilitation engagement and length of stay. Results Thirty-five participants were recruited. One withdrew due to headaches. None of the VR applications failed but connectivity to accompanying tablet was latent in 50% of cases. Majority of patients were able to use VR from day 2 post-op or injury. The Hopkins Rehabilitation Engagement scale and Simulation Sickness Questionnaires were feasible instruments to measure outcomes. Conclusions Feasibility was confirmed in this study. A multi-centre, prospective, randomised, controlled, unblinded, parallel-group trial of virtual reality enhanced neurorehabilitation versus standard neurorehabilitation for improving recovery after neurotrauma or neurosurgery has now been designed.

Exploring the Role of Therapeutic Alliance and Client Functioning in Vocational Rehabilitation Engagement Among Clients with Mental Disabilities

Exploring the Role of Therapeutic Alliance and Client Functioning in Vocational Rehabilitation Engagement Among Clients with Mental Disabilities

Getting the message across; a realist study of the role of communication and information exchange processes in delivering stroke Early Supported Discharge services in England.

Stroke early supported discharge (ESD) involves the co-ordinated transfer of care from hospital to home. The quality of communication processes between professionals delivering ESD and external stakeholders may have a role to play in streamlining this process. We explored how communication and information exchange were achieved and influenced the hospital-to-home transition and the delivery quality of ESD, from healthcare professionals' perspectives. Six ESD case study sites in England were purposively selected. Under a realist approach, we conducted interviews and focus groups with 117 staff members, including a cross-section of the multidisciplinary team, service managers and commissioners. Great variation was observed between services in the type of communication processes they employed and how organised these efforts were. Effective communication between ESD team members and external stakeholders was identified as a key mechanism driving the development of collaborative and trusting relationships and promoting coordinated care transitions. Cross-boundary working arrangements with inpatient services helped clarify the role and remit of ESD, contributing to timely hospital discharge and response from ESD teams. Staff perceived honest and individualised information provision as key to effectively prepare stroke survivors and families for care transitions and promote rehabilitation engagement. In designing and implementing ESD, early stakeholder involvement ensured the services' fit in the local pathway and laid the foundations for communication and partnership working going forward. Findings highlighted the interdependency between services delivering ESD and local stroke care pathways. Maintaining good communication and engagement with key stakeholders may help achieve a streamlined hospital discharge process and timely delivery of ESD. ESD services should actively manage communication processes with external partners. A shared cross-service communication strategy to guide the provision of information along to continuum of stroke care is required. Findings may inform efforts towards the delivery of better coordinated stroke care pathways.

When stroke survivors' self-ratings are inconsistent with the ratings of others: a cohort study examining biopsychosocial factors associated with impaired self-awareness of functional abilities.

Background Stroke survivors' self-ratings of functional abilities are often inconsistent with ratings assigned by others (e.g. clinicians), a phenomenon referred to as 'impaired self-awareness' (ISA). There is limited knowledge of the biopsychosocial contributors and consequences of post-stroke ISA measured across the rehabilitation journey. This multi-site cohort study explored biopsychosocial correlates of ISA during subacute rehabilitation (inpatient) and at 4 months post-discharge (community-dwelling). Methods Forty-five subacute stroke survivors participated (Age M (s.d.) = 71.5 (15.6), 56% female), and 38 were successfully followed-up. Self-assessments were compared to those of an independent rater (occupational therapist, close other) to calculate ISA at both time points. Survivors and raters completed additional cognitive, psychological and functional measures. Results Multivariate regression (multiple outcomes) identified associations between ISA during inpatient admission and poorer outcomes at follow-up, including poorer functional cognition, participation restriction, caregiver burden, and close other depression and anxiety. Regression models applied cross-sectionally, including one intended for correlated predictors, indicated associations between ISA during inpatient admission and younger age, male sex, poorer functional cognition, poorer rehabilitation engagement and less frequent use of non-productive coping (adjusted R 2 = 0.60). ISA at community follow-up was associated with poorer functional cognition and close other anxiety (adjusted R 2 = 0.66). Conclusions Associations between ISA and poorer outcomes across the rehabilitation journey highlight the clinical importance of ISA and the value of assessment and management approaches that consider the potential influence of numerous biological and psychosocial factors on ISA. Future studies should use larger sample sizes to confirm these results and determine the causal mechanisms of these relationships.

Factors Influencing Triage to Rehabilitation in Functional Movement Disorder.

Treatment of functional movement disorder (FMD) should be individualized, yet factors determining rehabilitation engagement have not been evaluated. Subspecialty FMD clinics are uniquely poised to explore factors influencing treatment suitability and triage. To describe our approach and explore factors associated with triage to FMD rehabilitation. We conducted a retrospective chart review of 158 consecutive patients with FMD seen for integrated assessment by movement disorders neurology and psychiatry, with the purpose of triage to rehabilitation. Demographic and clinical variables were compared between patients triaged to therapy versus no therapy, and logistic regression was used to explore factors predictive of triage outcome. Change in primary outcome scores were analyzed. Sixty-six patients (42%) were triaged to FMD therapy from July 2019 to December 2021. Patients triaged to therapy were more likely to have a constant movement disorder, gait disorder and/or tremor, hyperarousal, readiness for change, and people pleasing traits. Patients triaged to no therapy demonstrated persistent diagnostic disagreement, an inability to appreciate motor symptom inconsistency, low self-agency, a propensity to dissociate, and cluster B traits. 90% of patients triaged to rehabilitation had improved outcomes. The ability to "opt-in" to FMD rehabilitation relies on different factors than those relevant to establishing a diagnosis. Unlike many other neurological disorders, a triage and treatment planning step is recommended to identify those likely to meaningfully engage at that time. Holistic assessment through a transdisciplinary lens, and working collaboratively with the patient is essential to prioritize symptoms, determine engagement, and identify treatment targets.

RECOVER REALITY FEASIBILITY TRIAL: INVESTIGATING THE FEASIBILITY OF IMMERSIVE TECHNOLOGIES TO ENHANCE NEUROREHABILITATION EDUCATION AFTER NEUROSURGERY FOR BRAIN CANCER

Abstract AIMS Neurorehabilitation is fundamental to better outcomes for those recovering from neurosurgery for brain cancer. Access to this essential therapy is limited by resource shortages and unfulfilled therapy needs lead to longer hospital stays. Immersive technologies such as virtual reality (VR) could be used to augment neurorehabilitation in a self-directed, safe, virtual environment. The aim of this study is to demonstrate the feasibility of a VR rehabilitation programme in an acute neurosurgical inpatient environment to augment neurorehabilitation. METHOD A single group, feasibility study was conducted in a tertiary UK neurosurgical department. Patients aged 16 and over who had undergone a neurosurgical intervention for brain tumours were eligible. Participants were offered a VR session at least once per day for the first 14 days post-surgery/injury or until discharge, whichever comes first, with reasons for non-engagement collected. Primary outcomes were feasibility outcomes, and secondary outcomes included rehabilitation engagement and length of stay. RESULTS Data collection is ongoing. At submission we have n=6 participants who used the VR. A seventh participant who was screened for inclusion declined, citing anxiety over causing headaches as the reason. All six participants used the VR on either post operative day 2 or day 3. Although offered VR on the immediate day after surgery, participants declined due to nausea or pain. CONCLUSIONS If this present study demonstrates feasibility of using VR in patients after neurosurgery for brain cancer, a randomised clinical effectiveness study with health-economics analysis will follow to inform widespread adoption into practice.

Cardiac rehabilitation engagement and associated factors among heart failure patients: a cross-sectional study

BackgroundChronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation is suboptimal, a frequently low engagement in rehabilitation programs has been found globally.ObjectiveTo quantify diverse CR-engaged processes and elucidate associated factors of the various levels of CR engagement in CHF patients.MethodsDischarged patients admitted from cardiology departments between May 2022 to July 2022 were enrolled by mobile phone text messaging, CHF patients from same department between August 2022 to December 2022 were enrolled by face-to-face. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®). We obtained sociodemographic characteristics and clinical data from medical records. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases.ResultsA total of 684 patients were included in the study. 52.49% patients were in the Adhesion phase. At the multivariate level, compared with the blackout phase process anxiety, monthly income (RMB yuan) equal to or more than 5,000 were the most important factor impacting CHF patients CR engagement. Compared with the Blackout phase, regular exercise or not, severe depression, previous cardiac-related hospitalizations 1 or 2 times, Age influenced patient CR engagement in the Arousal phase. Besides, compared with the Blackout phase, outcome anxiety and activation level were independent factors in the Eudaimonic Project phase.ConclusionThis study characterized CR engagement, and explored demographic, medical, and psychological factors—with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The associated factors of CR engagement were not identical among different phases. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.

Erratum to Investigating Reliability, Validity, and Measurement Invariance of the Eight-Item Vocational Rehabilitation Engagement Scale With a Sample of Multilingual Clients

Erratum to Investigating Reliability, Validity, and Measurement Invariance of the Eight-Item Vocational Rehabilitation Engagement Scale With a Sample of Multilingual Clients

Investigating Reliability, Validity, and Measurement Invariance of the Eight-Item Vocational Rehabilitation Engagement Scale With a Sample of Multilingual Clients

Background: Vocational rehabilitation (VR) engagement is a vital component for successful rehabilitation outcomes. Purpose: The purpose of this study is threefold: First, we investigated the item clarity of the Vocational Rehabilitation Engagement Scale (VRES); second, we explored the factorial structure; third, we examined the measurement invariance of the VRES across gender and education level for culturally diverse and bilingual clients in public VR program (i.e., clients speak English as a second language). Given the positive effects of client engagement in health and rehabilitative care on outcomes, it is important to validate this brief instrument to measure VR engagement for culturally diverse and bilingual clients. Method: Data, collected from 16 VR clients who completed the original VRES in the focus group, were subjected to content analysis, and data, collected from 264 clients who completed the eight-item VRES and Working Alliance Inventory Short Form (WAI-S), were subjected to confirmatory and multigroup confirmatory factor analysis (MGCFA). Results: Based on the feedback from the focus group, the first item was revised to increase clarity. However, the preliminary results indicated that the revised item had very low community value, and therefore, we removed the item from the subsequent analysis. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) results provided support for a unidimensional structure for the eight-item VRES. Measurement invariance across gender and education level was achieved after correlating error terms. The scale had strong reliability, and scores from the VRES were significantly moderately correlated with working alliance. Conclusion: The eight-item VRES is a reliable and valid measurement tool to use with culturally diverse and multilingual participants.

Stalking and the impact of labelling “There’s a difference between my offence and a stalker”

PurposeThis paper aims to consider stalking as an offending behaviour and the prevailing narratives associated with this offending behaviour given the increased attention of society and criminal justice. The stereotypes and labels associated with the offending behaviour often sensationalise aspects of those who engage in stalking. Frequently, individuals are portrayed as disturbed, psychopathic, mentally ill, violent and culturally deviant. Sometimes stalking behaviour is perversely downplayed as romantic perseverance. The impact of the stalker label extends outward from the act of marking legal and societal transgression, which impacts upon prospects for rehabilitation and desistance through the shaping of assumptions and maintenance of disempowering connotations.Design/methodology/approachThis paper considers the impact of the stalking label as a therapeutic-, and perhaps rehabilitation-interfering problem for those who have stalked, drawing on recent research by Wheatley, Winder and Kuss (2020a).FindingsIt discusses the wide-ranging implications of labelling in this context and considers therapeutic approaches for intervention that may encourage rehabilitation engagement, mitigate shame and support desistance from a strengths-based perspective.Originality/valueThis paper draws on recent research exploring stalking case narratives of their own experiences of what drives stalking behaviour, existing labelling literature, and on specialist practitioners’ experiences of working with this group, to influence future thinking and research to address nuances highlighted.

Cognitive impairment predicts engagement in inpatient stroke rehabilitation.

Patient engagement during inpatient rehabilitation is an important component of rehabilitation therapy, as lower levels of engagement are associated with poorer outcomes. Cognitive deficits may impact patient engagement during inpatient stroke rehabilitation. Here, we assess whether patient performance on the cognitive tasks of the 30-min National Institute of Neurologic Disorders and Stroke - Canadian Stroke Network (NINDS-CSN) screening battery predicts engagement in inpatient stroke rehabilitation. Prospective data from 110 participants completing inpatient stroke rehabilitation at an academic medical center were utilized for the present analyses. Cognitive functioning was assessed at inpatient stroke rehabilitation admission using the NINDS-CSN cognitive battery. Patient engagement was evaluated at discharge from an inpatient rehabilitation unit using the Hopkins Rehabilitation Engagement Rating Scale. The results demonstrate that the NINDS-CSN cognitive battery, specifically subtests measuring executive functioning, attention and processing speed, predicts patient engagement in inpatient stroke rehabilitation. Cognitively impaired patients undergoing rehabilitation may benefit from modifications and interventions to increase engagement and improve functional outcomes.

99 ASSESSMENT AND MANAGEMENT OF PAIN IN OLDER ADULTS WITH ACUTE FRACTURE ADMITTED UNDER AN ORTHOPAEDIC SERVICE

Abstract Background Older adults with acute fractures often have suboptimal pain control, in particular those with cognitive impairment. Effective pain management improves rehabilitation engagement and earlier discharge from acute care. Our study aimed to evaluate pain management of older adults with acute fracture admitted under an orthopaedic service in a tertiary hospital. Methods Prospective review of patients over 65 years with an acute fracture admitted under an orthopaedic service. Review of chart, medication prescription and pain status. Data included type of fracture, comorbidities, cognitive status and analgesia prescribed. Data analysed using Excel. Results 40 inpatients included. Median age 82 years (range 65-93 years), 70% female. 53% had cognitive impairment, ranging from mild to severe dementia. 75% had >5 regular medications pre-admission. 80% had >5 comorbidities. Two-thirds (73%) had an acute hip fracture. Most (80%) inpatients had a surgical intervention, the remaining were managed conservatively. Analgesia prescriptions included paracetamol for almost all patients (95%), non-steroidal anti-inflammatory drugs for 3 (8%) and regular opioids in only 3 (8%). 43% of patients reported pain at time of data collection. 13% had analgesia changed in the 24 hours beforehand. Pain adversely affected function in 205 and mobility in 28%. 2 patients were unable to verbalise pain however no pain scales or visual assessments were used. Documentation of pain assessment was best by nurses (100%) followed by doctors (60%) and allied health professionals (40%). Conclusion Older adults with acute fracture are often multimorbid with cognitive impairment. This patient population are often untreated for pain with suboptimal pain assessment and analgesia review or prescriptions. Consequently we developed a pain policy for use on our orthopaedic service as a guide for effective pain assessment and management for older adults with acute fracture.

Psychometric evaluation of the Hopkins Rehabilitation Engagement Rating Scale in postacute physical therapy services.

Evaluate the reliability and validity of the Hopkins Rehabilitation Engagement Scale (HRERS) in a postacute rehabilitation sample. We hypothesized that HRERS items would comprise a single factor, and would demonstrate adequate internal consistency and temporal stability, and significant relationships with key constructs. Research Method and Design: Retrospective medical record review between 2016 and 2017 of older veterans (N = 107) admitted to a community living center postacute care (CLC-PAC) rehabilitation hospital unit to address targeted physical therapy rehabilitation goals. Inclusion criteria included availability of two HRERS administrations at Time 1 (admission) and Time 2 (approximately one-month follow-up or physical therapist/CLC-PAC discharge). Across timepoints, HRERS items reflect a single factor of engagement, and the scale has good internal consistency at admission (Time 1, α = .759) and follow-up (Time 2, α = .877). The temporal stability of HRERS across ratings was r = .56 (p < .001). Increased pain rating (r = -.309, p < .01) and depressive symptoms (-.287, p < .01) at admission correlates with subsequent physical therapist (PT) engagement (HRERS Time 2). Low admission PT engagement correlates with less frequent PT attendance (r = -.242, p < .01) and greater number of consults placed during the CLC stay (r = -.222, p < .05). HRERS is a reliable and valid measure of PT engagement in older CLC-PAC Veterans. Findings support the administration of the HRERS at more than one timepoint during rehabilitation to inform interventions targeting select behavioral health factors such as pain and depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Level of Exercise Participation in Individuals with Traumatic Spinal Cord Injury During Inpatient Rehabilitation: A Cross-sectional Study.

The outcome of exercises depends on participants' level of exercise participation. We aimed to investigate the level of exercise participation in individuals with traumatic spinal cord injury during inpatient rehabilitation. All participants with traumatic spinal cord injury undergoing inpatient physiotherapy at a rehabilitation center were recruited. Participants with hearing/visual problems were excluded. Hopkins Rehabilitation Engagement Rating Scale and Pittsburgh Rehabilitation Participation Scale were used to evaluate exercise participation levels. One-way ANOVA and unpaired t-test were used to compare level of participation between groups. Pearson's correlation and Chi-square tests were used to evaluate correlation and association. Thirty-five participants with mean age 37.1 ± 11.7 years completed the study. Hopkins Rehabilitation Engagement Rating Scale and Pittsburgh Rehabilitation Participation Scale demonstrated a low level of exercise participation in 31.4 % and 42.9 % participants respectively. Participants with an incomplete injury had high exercise participation levels compared to complete injuries. There were significant group differences (p < 0.001, effect size = 0.8) between complete and incomplete injuries and among various levels of injuries. The level of exercise participation was significantly associated with injury levels and type (p < 0.001, Phi = 0.7 to 0.9). The exercise participation level was high for incomplete compared to complete injuries in Nepalese individuals with traumatic spinal cord injury. The demographic and socio-economical factors were not associated with level of exercise participation.

Unmet Rehabilitation Needs Indirectly Influence Life Satisfaction 5 Years After Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study

ObjectiveTo describe the association between unmet rehabilitation needs and life satisfaction 5 years after traumatic brain injury (TBI). DesignProspective observational cohort. SettingFive Veterans Affairs (VA) Polytrauma Rehabilitation Centers. ParticipantsVA TBI Model Systems participants (N=301); 95% male; 77% white; average age, 39±14y). InterventionsNot applicable. Main Outcome MeasuresSatisfaction With Life Scale (SWLS). ResultsAverage SWLS score was 22±8. Univariable analyses demonstrated several statistically significant predictors of life satisfaction, including employment status, participation, psychiatric symptom severity, past year mental health treatment, and total number of unmet rehabilitation needs (all P<.05). Multivariable analyses revealed that depression and participation were each associated with life satisfaction. An ad hoc mediation model suggested that unmet rehabilitation needs total was indirectly related to life satisfaction. Total unmet rehabilitation needs ranged from 0-21 (mean, 2.0±3.4). Correlational analyses showed that 14 of the 21 unmet rehabilitation needs were associated with life satisfaction. ConclusionsFindings support the need for rehabilitation engagement in later stages of TBI recovery. Ongoing assessment of and intervention for unmet rehabilitation needs in the chronic phase of recovery have the potential to mitigate decline in life satisfaction.

Evaluation of an occupation-based metacognitive intervention targeting awareness, executive function and goal-related outcomes after traumatic brain injury using single-case experimental design methodology

ABSTRACT Self-awareness is commonly impaired after traumatic brain injury and impacts on rehabilitation engagement and community re-integration outcomes. Interventions which incorporate metacognitive strategy instruction have the potential to improve rehabilitation engagement and outcomes. This study aimed to determine whether an occupation-based intervention incorporating metacognitive strategy instruction resulted in goal achievement and improved online awareness and executive function performance during goal-related tasks. A single-case experimental design using a multiple-baseline design across behaviours was used with two participants with severe traumatic brain injury to evaluate the effectiveness of the 6-week intervention. Repeated measures of goal-related performance, percentage of self-corrected errors and executive function were made via independent analysis of video footage and documentation logs. Data analysis involved 2SD bandwidth analysis and overlap data, reliable change index and evaluation of goal achievement across phases. There were improvements in self-corrected errors for one participant, which were maintained. Significant reductions in anxiety (RCI = ±5.98) were evident for both participants, with a significant reduction in stress (RCI = ±7.05) for one participant following the intervention. The occupation-based intervention incorporating metacognitive strategy instruction led to improvements compared to baseline performance in some targeted goals, online awareness and executive function performance during goal-related tasks and reduced stress and anxiety.

Evaluation of Constructs Based on Self-Determination Theory and Self-Efficacy Theory as Predictors of Vocational Rehabilitation Engagement for People With Physical and Sensory Disabilities

Although gainful employment is associated with health and well-being, people with chronic illness and disability may be ambivalent about the prospects of working. As a result, those who might benefit from vocational rehabilitation (VR) services do not always fully engage in those services. Limited motivation toward participating may be due to factors related to self-determination and autonomous choice. Rehabilitation counseling researchers are beginning to test Deci and Ryan’s self-determination theory (SDT), along with Bandura’s self-efficacy theory (SET), as a work motivation model in VR. The purpose of the present study was to evaluate SDT and SET constructs as predictors of VR engagement in a sample of VR clients, using hierarchical regression analysis. After controlling for the effects of demographic variables and person–environment (P-E) contextual factors, SDT and SET predictors were found to account for an increase of 40% in the variance explained in VR engagement. Working alliance was the single strongest predictor of VR engagement, followed by job performance self-efficacy and autonomy supportive climate. Interventions to enhance counselor skills to promote working alliance, in addition to vocational training to increase job performance self-efficacy of rehabilitation clients, may strengthen motivation to engage in VR services, leading to better employment outcomes.

Evaluation of the acceptability and usability of the MAGIC-GLASS virtual reality solution as part of the care pathway in people with acute, sub-acute and chronic stroke: a study protocol

Background: Intensive rehabilitation is one of the most important aspects of care for people with stroke, and there is evidence that it leads to better recovery and higher levels of independence. However, pressure on resources in government funded secondary and primary healthcare settings means that for many people with stroke, intense rehabilitation is not available. Effective and efficient ways of increasing rehabilitation intensity, engagement, and motivation for rehabilitation are needed; as well as innovative treatment approaches that enable people with stroke to self-manage this rehabilitation. Technology offers a solution; virtual reality (VR) computer games have the potential to enhance engagement, improve adherence, and outcomes in stroke rehabilitation therapy. However, their integration into current health care pathways needs to be tested.Aims: The aim of the trial is to test the feasibility of incorporating VR computer games into a stroke rehabilitation system called ‘MAGIC-GLASS’, and its integration into the current care pathway for people with stroke.Design: Multicenter, prospective uncontrolled, pre-post intervention study.Setting: Participants will be recruited from Stroke Services, GP Practices or via Stroke Support Groups, and the intervention will be carried out in the hospital setting, or at home after discharge.Population: Adults (≥18 years) who have had a stroke.Interventions: Magic Glass is a clinician facilitated VR-based stroke rehabilitation system. Clinical facilitation includes a minimum of one initial face-to-face contact followed by up to 13 weekly/fortnightly remote contacts (to month six) with a clinician.Outcomes: The usability and acceptability of the intervention; process and resource requirements for the new care pathway; changes in clinical outcomes and potential cost-effectiveness of the solution will be measured to assess change from baseline to six months post intervention.Sample size: In order to have 50 patients in the subgroups identified (time since stroke; severity of stroke; age) we plan to recruit 300 participants, 150 in Northern Ireland and 150 in Italy. Fifty is considered the optimal sample size for this feasibility analysis.Duration: 18 months. Follow up will be post intervention (up to six months post entry into the study). The nested qualitative study will start once the first cohort of participants has completed and will continue throughout the intervention period.

Wearable Brain–Computer Interface Instrumentation for Robot-Based Rehabilitation by Augmented Reality

An instrument for remote control of the robot by wearable brain–computer interface (BCI) is proposed for rehabilitating children with attention-deficit/hyperactivity disorder (ADHD). Augmented reality (AR) glasses generate flickering stimuli, and a single-channel electroencephalographic BCI detects the elicited steady-state visual evoked potentials (SSVEPs). This allows benefiting from the SSVEP robustness by leaving available the view of robot movements. Together with the lack of training, a single channel maximizes the device’s wearability, fundamental for the acceptance by ADHD children. Effectively controlling the movements of a robot through a new channel enhances rehabilitation engagement and effectiveness. A case study at an accredited rehabilitation center on ten healthy adult subjects highlighted an average accuracy higher than 83%, with information transfer rate (ITR) up to 39 b/min. Preliminary further tests on four ADHD patients between six- and eight-years old provided highly positive feedback on device acceptance and attentional performance.