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Komariah M, Amirah S, Abdurrahman MF, Handimulya MFS, Platini H, Maulana S, Nugrahani AD, Mulyana AM, Qadous SG, Mediani HS, Mago A. Effectivity of Virtual Reality to Improve Balance, Motor Function, Activities of Daily Living, and Upper Limb Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. Ther Clin Risk Manag 2024; 20:95-109. [PMID: 38375076 PMCID: PMC10875340 DOI: 10.2147/tcrm.s432249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/03/2024] [Indexed: 02/21/2024] Open
Abstract
Background Cerebral palsy (CP) is the most common motor disorder in childhood. CP limits movement, which can interfere with children's daily activities. As a technology that provides intensive mass practice to children, virtual reality (VR) can create an interactive and motivating environment. With the intensity set by the therapist and feedback that can be used to produce individualized therapy, VR has great potential to improve CP patients' quality of life, especially in a safe, enjoyable, and playful environment. Purpose This systematic review and meta-analysis sought to determine the effectiveness of VR for children with CP. Methods We conducted a comprehensive literature search based on the PRISMA guidelines through PubMed, Scopus, Embase, Wiley, and ProQuest to assess the efficacy of VR in managing children with CP up to 15 September 2022. Risk assessment of bias was performed using Cochrane RoB 2. Results Nineteen randomized controlled trials with 467 and 427 patients with CP were included in the intervention and control groups in qualitative and quantitative analyses. Participants consisted of cerebral palsy with hemiplegia (n=7), diplegia (n=2), a combination of both (n=4), and undefined (n=13). From all studies conducted, VR showed significant results where VR could improve balance (MD: 2.71[1.95, 3.48]; p < 0.00001), motor function (MD: 3.73 [1.67, 5.79]; p = 0.0004), and activity daily living (MD: 10.05 [2.89, 17.22]. However, VR showed not effective in improving upper limb function. Conclusion With its advantages and excellent effectiveness, VR may improve functional mobility and the quality of life of children with CP.
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Affiliation(s)
- Maria Komariah
- Department of Fundamental Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 45363, Indonesia
| | - Shakira Amirah
- Faculty of Medicine, Universitas Indonesia, Depok, West Java, 16424Indonesia
| | | | | | - Hesti Platini
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 45363, Indonesia
| | - Sidik Maulana
- Master of Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia
| | - Annisa Dewi Nugrahani
- Maternal Fetal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
| | - Aep Maulid Mulyana
- Master of Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, 45363, Indonesia
| | - Shurouq Ghalib Qadous
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Henny Suzana Mediani
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, West Java, 45363, Indonesia
| | - Arpit Mago
- Department of Clinical Medicine, Jawaharlal Nehru Medical College, Belagavi, Karnataka, 590010, India
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Chung OS, Johnson AM, Dowling NL, Robinson T, Ng CH, Yücel M, Segrave RA. Are Australian Mental Health Services Ready for Therapeutic Virtual Reality? An Investigation of Knowledge, Attitudes, Implementation Barriers and Enablers. Front Psychiatry 2022; 13:792663. [PMID: 35185649 PMCID: PMC8854652 DOI: 10.3389/fpsyt.2022.792663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/14/2022] [Indexed: 12/18/2022] Open
Abstract
Therapeutic virtual reality (VR) has the potential to address the challenges of equitable delivery of evidence-based psychological treatment. However, little is known about therapeutic VR regarding the perspectives and needs of real-world service providers. This exploratory study aimed to assess the acceptability, appropriateness, and feasibility of therapeutic VR among clinicians, managers, and service staff working in mental healthcare and explore potential implementation barriers and enablers. Eighty-one staff from a network of private psychiatric hospitals in Victoria, Australia (aged M + SD: 41.88 + 12.01 years, 71.6% female; 64% clinical staff) completed an online survey, which included the Acceptability of Intervention Measure (AIM), Appropriateness of Intervention Measure (IAM), and Feasibility of Intervention Measure (FIM). While 91% of participants had heard about VR technology, only 40% of participants had heard of therapeutic VR being used in mental healthcare, and none had used therapeutic VR in a clinical setting. Most participants perceived VR to be acceptable (84%), appropriate (69%), and feasible (59%) to implement within their role or service and envisioned a range of possible applications. However, participants expressed concerns regarding safety, efficacy, and logistical challenges across clinical settings. Findings suggest a strong interest for therapeutic VR among Australian mental health providers working in the private system. However, dissemination efforts should focus on addressing identified barriers to ensure mental health providers are adequately informed and empowered to make implementation decisions.
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Affiliation(s)
- Olivia S Chung
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Alisha M Johnson
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Nathan L Dowling
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, VIC, Australia
| | - Tracy Robinson
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, NSW, Australia
| | - Chee H Ng
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, VIC, Australia
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Rebecca A Segrave
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
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Cullen AJ, Dowling NL, Segrave R, Carter A, Yücel M. Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder. J Anxiety Disord 2021; 80:102404. [PMID: 33894550 DOI: 10.1016/j.janxdis.2021.102404] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Abstract
Exposure and response prevention (ERP) is the current first-line psychological treatment for Obsessive-compulsive disorder (OCD). However, substantial inter-individual variability exists in treatment outcomes, including inadequate symptom improvements, and notable refusal and attrition rates. These are driven, in part, by impracticalities in simulating intrusive thoughts within clinical settings. Virtual reality (VR) offers the potential of overcoming these limitations in a manner that allows for finely controlled anxiety-provoking scenarios to be created within supportive clinical settings. To validate the potential of VR for treating contamination-based OCD, 22 patients undertook a VR ERP session and a matched session of the current gold-standard of in vivo ERP. In VR, patients were immersed within a contamination environment that permitted flexible delivery of customisable, graded exposure tasks. The VR environment utilised HTC Vive hardware, to allow for patients to both interact with, and physically move through the environment. Subjective and objective measures of distress were recorded, including heart and respiration rates. These measures indicate virtual and in vivo ERP sessions provoke consistent anxiety profiles across an exposure hierarchy. Virtual exposure was advantageous for engagement and adherence to tasks, and the therapeutic alliance was upheld. VR is a promising mechanism for ERP in contamination OCD.
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Affiliation(s)
- Alison J Cullen
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia; The Melbourne Clinic Professorial Unit, Salisbury Street, Richmond, Victoria, Australia.
| | - Nathan L Dowling
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia; The Melbourne Clinic Professorial Unit, Salisbury Street, Richmond, Victoria, Australia
| | - Rebecca Segrave
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia
| | - Adrian Carter
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia.
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Chung OS, Robinson T, Johnson AM, Dowling NL, Ng CH, Yücel M, Segrave RA. Implementation of Therapeutic Virtual Reality Into Psychiatric Care: Clinicians' and Service Managers' Perspectives. Front Psychiatry 2021; 12:791123. [PMID: 35058823 PMCID: PMC8764380 DOI: 10.3389/fpsyt.2021.791123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: Virtual reality (VR) has emerged as a highly promising tool for assessing and treating a range of mental illnesses. However, little is known about the perspectives of key stakeholders in mental healthcare, whose support will be critical for its successful implementation into routine clinical practise. This study aimed to explore the perspectives of staff working in the private mental health sector around the use of therapeutic VR, including potential implementation barriers and facilitators. Methods: Semi-structured qualitative interviews were conducted with cross-disciplinary clinicians (n = 14) and service managers (n = 5), aged 28-70 years working in a major private mental health hospital in Victoria, Australia. Transcripts were analysed using general inductive coding to allow themes to naturally emerge. Results: Three major themes were identified: clinical factors (four subthemes), organisational factors (five subthemes), and professional factors (three subthemes). The themes encompassed enabling factors and potential barriers that need to be addressed for successful implementation of VR. Clinical factors highlighted the influence of knowledge or perceptions about appropriate clinical applications, therapeutic efficacy, safety and ethical concerns, and patient engagement. Organisational factors emphasised the importance of service contexts, including having a strong business case, stakeholder planning, recruitment of local opinion leaders to champion change, and an understanding of resourcing challenges. Professional factors highlighted the need for education and training for staff, and the influence of staff attitudes towards technology and perceived usability of VR. Conclusions: In addition to enabling factors, potential implementation barriers of therapeutic VR were identified, including resourcing constraints, safety and ethical concerns, negative staff attitudes towards technology and VR system limitations. Future dissemination should focus on addressing knowledge and skills gaps and attitudinal barriers through development of clinical guidelines, training programs, and implementation resources (e.g., adoption decision tools, consultation opportunities).
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Affiliation(s)
- Olivia S Chung
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Tracy Robinson
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, NSW, Australia
| | - Alisha M Johnson
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Nathan L Dowling
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, VIC, Australia
| | - Chee H Ng
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, VIC, Australia
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Rebecca A Segrave
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
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