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Lettre J, Routhier F, Giesbrecht EM, Choukou MA, Miller WC, Archambault PS. Clinical stakeholders' perspective for the integration of an immersive wheelchair simulator as a clinical tool for powered wheelchair training. Assist Technol 2023; 35:497-505. [PMID: 36701417 DOI: 10.1080/10400435.2022.2161669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/27/2023] Open
Abstract
This study aimed to investigate clinical stakeholders' acceptance of an immersive wheelchair simulator as a potential powered wheelchair skills training tool. Focus groups, conducted in four rehabilitation centers, were used to obtain a rich understanding of participants' experiences and beliefs. Then, a cross-sectional survey of the simulator acceptability for clinical practice was created. Twenty-three rehabilitation therapists and clinical program directors participated in the focus groups and thirty-three responded to the survey. Participants generally expressed that use of the simulator would be complementary to training in an actual powered wheelchair, and that it could be useful for challenging situations in rehabilitation centers (e.g. anxious clients; when there is uncertainty around their potential to drive a powered wheelchair; tasks that cannot be assessed in a real-life environment). They also provided suggestions to improve the simulator (e.g. more feedback during tasks; possibility of adjusting control settings such as speed and sensitivity; possibility of adding varied control interfaces). Feedback received from key stakeholders clearly indicated that the wheelchair simulator would be complementary to training provided in a real context of use. However, some important limitations must be addressed to improve the simulator and promote its adoption by clinical programs, therapists and clients.
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Affiliation(s)
- Josiane Lettre
- Center for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - François Routhier
- Center for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada
| | - Edward M Giesbrecht
- Department of Occupational Therapy, University of Manitoba, Winnipeg, MB, Canada
| | | | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Program and GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Philippe S Archambault
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Center for interdisciplinary research in rehabilitation of the greater Montreal, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
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Zorzi C, Tabbaa L, Covaci A, Sirlantzis K, Marcelli G. Train vs. Play: Evaluating the Effects of Gamified and Non-Gamified Wheelchair Skills Training Using Virtual Reality. Bioengineering (Basel) 2023; 10:1269. [PMID: 38002393 PMCID: PMC10669445 DOI: 10.3390/bioengineering10111269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
This study compares the influence of a gamified and a non-gamified virtual reality (VR) environment on wheelchair skills training. In specific, the study explores the integration of gamification elements and their influence on wheelchair driving performance in VR-based training. Twenty-two non-disabled participants volunteered for the study, of whom eleven undertook the gamified VR training, and eleven engaged in the non-gamified VR training. To measure the efficacy of the VR-based wheelchair skills training, we captured the heart rate (HR), number of joystick movements, completion time, and number of collisions. In addition, an adapted version of the Wheelchair Skills Training Program Questionnaire (WSTP-Q), the Igroup Presence Questionnaire (IPQ), and the Simulator Sickness Questionnaire (SSQ) questionnaires were administered after the VR training. The results showed no differences in wheelchair driving performance, the level of involvement, or the ratings of presence between the two environments. In contrast, the perceived cybersickness was statistically higher for the group of participants who trained in the non-gamified VR environment. Remarkably, heightened cybersickness symptoms aligned with increased HR, suggesting physiological connections. As such, while direct gamification effects on the efficacy of VR-based wheelchair skills training were not statistically significant, its potential to amplify user engagement and reduce cybersickness is evident.
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Affiliation(s)
- Chantal Zorzi
- School of Engineering, University of Kent, Canterbury CT1 7NT, UK; (C.Z.); (L.T.); (A.C.)
| | - Luma Tabbaa
- School of Engineering, University of Kent, Canterbury CT1 7NT, UK; (C.Z.); (L.T.); (A.C.)
| | - Alexandra Covaci
- School of Engineering, University of Kent, Canterbury CT1 7NT, UK; (C.Z.); (L.T.); (A.C.)
| | - Konstantinos Sirlantzis
- School of Engineering, Technology and Design, Canterbury Christ Church University (CCCU), Canterbury CT1 1QU, UK;
| | - Gianluca Marcelli
- School of Engineering, University of Kent, Canterbury CT1 7NT, UK; (C.Z.); (L.T.); (A.C.)
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Gefen N, Archambault PS, Rigbi A, Weiss PL. Pediatric powered mobility training: powered wheelchair versus simulator-based practice. Assist Technol 2023; 35:389-398. [PMID: 35737961 DOI: 10.1080/10400435.2022.2084183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 10/17/2022] Open
Abstract
METHOD Participants included 30 children and adolescents (23 males, 13 females) with cerebral palsy and other neuromuscular diseases, aged 6-18. Data were collected and compared at baseline and after 12 weeks of home-based practice via a powered wheelchair or a simulator. Powered mobility ability was determined by the Powered Mobility Program (PMP), the Israel Ministry of Health's Powered Mobility Proficiency Test (PM-PT) and the Assessment of Learning Powered Mobility (ALP). RESULTS All participants practiced for the required amount of time and both groups reported a similar user experience. Both groups achieved significant improvement following the practice period as assessed by the PMP and PM-PT assessments, with no significant differences between them. A significant improvement was found in the ALP assessment outcomes for the powered wheelchair group only. CONCLUSIONS This is the first study, to our knowledge, that compares two different wheelchair training methods. Simulator-based practice is an effective training option for powered mobility for children with physical disabilities aged 6-18 years old, demonstrating that it is possible to provide driving skill practice opportunities safe, controlled environments.
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Affiliation(s)
- Naomi Gefen
- Deputy Director General, ALYN Hospital, Jerusalem, Israel
| | - Philippe S Archambault
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- McGill, University of Montreal, University of Quebec in Montreal
| | - Amihai Rigbi
- Faculty of Education, Beit Berl College, Kfar-Saba, Israel
| | - Patrice L Weiss
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
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Faure C, Routhier F, Lettre J, Choukou MA, Archambault PS. Effectiveness of the miWe Simulator Training on Powered Wheelchair-driving Skills: A Randomized Controlled Trial. Arch Phys Med Rehabil 2023; 104:1371-1377. [PMID: 37209934 DOI: 10.1016/j.apmr.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of a home-based simulator training, in comparison with a videogame-based training, in terms of powered wheelchair driving skills, skills use in a real-world setting, and driving confidence. DESIGN Single-blinded randomized controlled trial. SETTING Community. PARTICIPANTS New powered wheelchair users (N=47) randomly allocated to simulator group (n=24, 2 drop-out) and control group (n=23, 3 drop-out). INTERVENTIONS The miWe wheelchair simulator (simulator group) or a kart driving videogame (control group) was setted-up at participants' homes (computer + joystick). They were instructed to use it at least 20 minutes every 2 days, during a period of 2 weeks. PRIMARY OUTCOME MEASURE(S) Assessments were done at baseline (T1) and post-training (T2) using the Wheelchair Skills Test Questionnaire (WST-Q, version 4.1), Wheelchair Confidence Scale (WheelCon), Assistive Technology Outcomes Profile for Mobility, and Life-Space Assessment (LSA). The time necessary to complete 6 WST tasks was measured with a stopwatch. RESULTS Participants of the simulator group significantly increased their WST-Q capacity score at T2 by 7.5% (P<.05), whereas the control group remained at the same score (P=.218). Participants of both groups rolled backward and went through a door significantly faster at T2 (P=.007; P=.016), but their speed did not change for the other skills. The WheelCon score significantly increased after training (+4% for the control group and +3.5% for the simulator group, P=.001). There was no T1-T2 difference between groups for the WST-Q performance scores (P=.119), the ATOP-Activity (P=.686), the ATOP-Participation scores (P=.814), and the LSA score (P=.335). No adverse events or side effects were reported during data collection or training. CONCLUSIONS Participants of both groups improved some skills and their wheelchair driving confidence. The simulator training group also demonstrated a modest post-training gain in their WST-Q capacity, but more studies would be needed to explore the long-term effects of the McGill immersive wheelchair simulator (miWe) simulator on driving skills.
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Affiliation(s)
- Céline Faure
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale du Québec, Quebec City, Canada
| | - François Routhier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale du Québec, Quebec City, Canada; Department of Rehabilitation, Université Laval, Quebec City, Canada
| | - Josiane Lettre
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale du Québec, Quebec City, Canada
| | - Mohamed-Amine Choukou
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale du Québec, Quebec City, Canada
| | - Philippe S Archambault
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada.
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Yan H, Archambault PS. Augmented feedback for manual wheelchair propulsion technique training in a virtual reality simulator. J Neuroeng Rehabil 2021; 18:142. [PMID: 34548085 PMCID: PMC8456569 DOI: 10.1186/s12984-021-00936-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Motor learning of appropriate manual wheelchair propulsion is critical, as incorrect technique elevates risk for upper extremity pain. Virtual reality simulators allow users to practice this complex task in a safe and realistic environment. Additionally, augmented feedback (AF) may be provided in order to optimize learning. The purpose of this study was to investigate the effects of providing AF with various delivery schedules on motor learning and transfer of this skill to over-ground propulsion. METHODS Thirty healthy young adults were randomly assigned to three groups. During a virtual reality propulsion training session, the high-frequency AF group received AF in the form of knowledge of performance throughout all propulsion training; the faded AF group received this AF in a faded schedule (high relative frequency of AF early in practice, with relative frequency of AF provision diminishing throughout practice); and the control group underwent training with no AF. Propulsion assessments were performed at baseline and 48 h after practice in both virtual and real environments to measure retention and transfer, respectively. RESULTS Compared to the control group, both feedback groups exhibited significant improvements in contact angle and push frequency in both environments after training. Small, non-significant between-group differences were also found between the high-frequency and faded feedback groups. CONCLUSION Virtual reality training is an effective learning intervention for acquisition, retention, and transfer of appropriate manual wheelchair propulsion technique when such training includes AF regarding propulsion biomechanics.
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Affiliation(s)
- Hui Yan
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
- Center of Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Philippe S. Archambault
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
- Center of Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Rigot SK, Worobey LA, Boninger ML, Robinson-Whelen S, Roach MJ, Heinemann AW, McKernan G. Changes in Internet Use Over Time Among Individuals with Traumatic Spinal Cord Injury. Arch Phys Med Rehabil 2021; 103:832-839.e2. [PMID: 34062118 DOI: 10.1016/j.apmr.2021.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate the changes in total internet and mobile internet use over time and determine how demographic characteristics are related to changes in internet and mobile internet use among individuals with spinal cord injury (SCI). DESIGN Cross-sectional analysis of multicenter cohort study. SETTING National SCI Database. PARTICIPANTS Persons with traumatic SCI with follow-up data collected between 2012 and 2018 (n=13,622). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Proportion of sample reporting internet use at all or through a mobile device over time and specifically in 2018. RESULTS The proportion of internet users increased from 77.7% in 2012 to 88.1% in 2018. Older participants (p<0.001), those with lower annual income (p<0.001), less education (p<0.001), non-White race or Hispanic ethnicity (p<0.001), motor incomplete tetraplegia (p=0.004), or males (p=0.035) were less likely to use internet from 2012 to 2018. By 2018, there were no longer differences in internet use based upon race/ethnicity (p=0.290) or sex (p=0.066). Mobile internet use increased each year (52.4% to 87.7% of internet users from 2012 to 2018), with a participant being 13.7 times more likely to use mobile internet in 2018 than 2012. Older age (p<0.001), income less than $50,000 (p<0.001), high school diploma or less (p=0.011), or non-Hispanic White race/ethnicity (p=0.001) were associated with less mobile internet use over time. By 2018 there were no differences in mobile internet use by education (p=0.430) and only participants with incomes greater than $75,000/year had greater odds of mobile internet use (p=0.016). CONCLUSIONS Disparities associated with internet access are decreasing likely due to mobile device use. Increased internet access offers an important opportunity to provide educational and training materials to frequently overlooked groups of individuals with SCI.
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Affiliation(s)
- Stephanie K Rigot
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Lynn A Worobey
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Rehabilitation Sciences and Technology, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Allen W Heinemann
- Shirley Ryan AbilityLab and Northwestern University Feinberg School of Medicine
| | - Gina McKernan
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
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Atoyebi OA, Labbé D, Prescott M, Mahmood A, Routhier F, Miller WC, Mortenson WB. Mobility Challenges Among Older Adult Mobility Device Users. CURRENT GERIATRICS REPORTS 2019. [DOI: 10.1007/s13670-019-00295-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bigras C, Kairy D, Archambault PS. Augmented feedback for powered wheelchair training in a virtual environment. J Neuroeng Rehabil 2019; 16:12. [PMID: 30658668 PMCID: PMC6339295 DOI: 10.1186/s12984-019-0482-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 01/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Powered wheelchair (PW) driving is a complex activity and requires the acquisition of several skills. Given the risks involved with PW use, safe and effective training methods are needed. Virtual reality training allows users to practice difficult tasks in a safe environment. An additional benefit is that augmented feedback can be provided to optimize learning. The purpose of this study was to investigate whether providing augmented feedback during powered wheelchair simulator training results in superior performance, and whether skills learned in a virtual environment transfer to real PW driving. METHODS Forty healthy young adults were randomly allocated to two groups: one received augmented feedback during simulator training while the control group received no augmented feedback. PW driving performance was assessed at baseline in both the real and virtual environment (RE and VE), after training in VE and two days later in VE and RE (retention and transfer tests). RESULTS Both groups showed significantly better task completion time and number of collisions in the VE after training and these results were maintained two days later. The transfer test indicated better performance in the RE compared to baseline for both groups. Because time and collisions interact, a post-hoc 2D Kolmogonov-Smirnov test was used to investigate the differences in the speed-accuracy distributions for each group; a significant difference was found for the group receiving augmented feedback, before and after training, whereas the difference was not significant for the control group. There were no differences at the retention test, suggesting that augmented feedback was most effective during and immediately after training. CONCLUSIONS PW simulator training is effective in improving task completion time and number of collisions. A small effect of augmented feedback was seen when looking at differences in the speed-accuracy distributions, highlighting the importance of accounting for the speed-accuracy tradeoff for PW driving.
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Affiliation(s)
- Catherine Bigras
- Integrated Program in Neuroscience, McGill University, Montreal, Canada.,Interdisciplinary Research Center in Rehabilitation (CRIR), Montreal, Canada
| | - Dahlia Kairy
- École de réadaptation, Faculté de Médecine, Université de Montréal, Montreal, Canada
| | - Philippe S Archambault
- Interdisciplinary Research Center in Rehabilitation (CRIR), Montreal, Canada. .,School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
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