Lexi Sybrowsky 3/12/18 OC TH 6840 Presentation for Fieldwork You will complete a project or presentation that benefits the clients or professionals of your fieldwork site, Some examples include a literature review on a pertinent topic, development of a group activity including directions and resources necessary to carry it out after you leave, or fabrication of a needed piece of equipment to increase occupation-based practice. It should be something tangible you can leave behind. Please discuss your idea with your fieldwork supervisor and review your idea with your FW coordinator to make sure you are on the right track before you complete it. The project will probably take between 2 and 4 hours to complete After your project is completed, please submit a one-page summary that includes the following headings. + Your name and name of the Fieldwork Placement: Lexi Sybrowsky, IMC Inpatient Rehab *+ Description of the clients served and the work that is carried out there, in your own words. (2 pts) IMC inpatient rehab sees patients with a variety of diagnoses including stroke, SCI, amputations, ‘TBI and many more, Patients that are admitted to inpatient rehab are medically stable and receive 3 hours ‘of combined therapy a day (between OT, PT and SLP). The inpatient rehab setting at IMC hospital includes the rehabilitation of patients in order for them to transition home. Occupational therapy interventions vary depending on the diagnosis, but can include ADL and IADL retraining, neuromuscular re-education, strengthening and endurance, visual perception and cognition. ‘+ How your project supports the work of the agency (3 pts) This project supports the work of this unit because of the variety of diagnoses that are seen in inpatient rehab. This intervention has research with a wide variety of diagnoses, so it could be used with a large portion of the patients on the unit. [also leaned that the inpatient rehab unit is getting some sort of ‘VR system in the next few weeks, so this research can be an introduction to the OT staff about the current evidence available regarding this intervention. + A thorough description or picture or copy of the project itself, must use at least 2 resources for evidence (demonstrate that the presentation or project is based on EBP). Be sure to give me enough information so I can grade it. (8 points) IMC’s inpatient rehab unit has an abundance of supplies, equipment and resources already available for their therapists to utilize with the patients. Because of this, I chose to do a literature review ‘on a topic that was interesting to me and something that could be utilized in this setting. I chose to research virtual reality (VR) and the overall effect it had on patients post injury. The current research available for VR shows that it is an intervention that can be used with a variety of diagnoses, including, patients that are post stroke, SCI, autism, burn victims and amputees. The research I chose to focus on can bbe categorized into three areas: stroke, spinal cord injury and traumatic brain injury, as these are some ofthe most common diagnoses I have seen in this setting. The results of my literature review are reported below. ‘Spinal Cord Injury Research A study done by Kizony, Raz, Katz, Weingarden and Weiss (2005) analyzed the effectiveness of virtual reality (VR) systems used with patients who have paraplegic spinal cord injuries (SC!) that need balance training. One of the key functional deficits related to SCI is poor balance and the lack of postural control. Typically, conventional interventions are focused on helping these individuals develop ‘compensatory strategies that can be used to maintain balance while sitting or standing, which include recruiting and activating muscles in the trunk, neck and upper limbs during times when additional balance is necessary. According to this study, these conventional interventions are “tedious, provide little ‘opportunity for grading the level of difficulty, and do not encourage dynamic postural reactions” (p. 596). Furthermore, these interventions are not motivating and don’t allow the patients to transfer the skills they are learning into real world settings. This study aimed to assess an emerging area of rehabilitation based ‘on virtual reality. The VR in this study used advanced technology to create a simulated, real-world environment that users could navigate and interact in. This VR technology provided the user with a multi- sensory experience that include visual, audio, and olfactory feedback of their performance. This study included 13 participants aged 21 to 53 with varying levels of SCIs. Participants that were recruited ranged from 3 weeks to 4 % months post injury. Results from the patient group were compared to data from a control group of 12 nondisabled participants who performed a similar protocol while sitting in a chair with their hands supported on arm rests. VR was provided to both groups within 3 different virtual environments, Birds & Balls, Soccer and Snowboard. A short description of each environment is listed below in Table 1. Participant performance was measured in terms of the rate of success (ex: number of obstacles missed during the snowboarding activity, the number of soccer balls repelled from the goal, etc.) as well as the time it took to complete the VR experience. Participants were allowed to practice for 1 ‘minute before performing the task for an additional 3 minutes while remaining seated in their wheelchairs. Results from this study show that there is potential for VR systems to be used as an additional tool during the rehabilitation process for SCI patients. Participants reported a positive response to the experience and a desire to continue to participate in VR rehab, suggesting that VR may increase motivation for participation in therapy. Additional findings from this study suggest that the clinician's ability to grade the level of difficulty within the game allowed for greater motor responses from the participants. This option of grading the game up or down allows this specific intervention to be used with a wide variety of patients with varying degrees of ability. Finally, VR rehabilitation resulted in significant improvements in participant's FIM scores, physical capacity (strength and wheelchair skills), and social Participation (as many of these gaming systems supported simultaneous or sequential play with two or more users). Overall, the results ofthis study show a correlation between static balance ability and performance within the VR game. The interactions participants experienced within the VR game appear to follow many rehab goals that include more realistic, dynamic and relevant everyday activities that utilize balance. Additional research (specifically a RCT) is necessary to continue to measure the efficacy of a VR treatment, but this study helped to establish it as an appropriate rehab intervention for this population. Table 1, Virtwal Reality Experiences Birds & Balls Users see themselves standing or sitting while different colored balls appear from the four different corners of the screen. The user is required to touch each of the balls with any body part, which causes the balls to burst or turn into birds. This particular experience has 3 levels to‘grade the activity as well as the option to change the velocity that the balls would emerge. Soccer Users appear as the goalkeeper during this experience and have to defend the goal box from soccer balls that are being shot at them from different locations. Users can use any part of their body to prevent the ball from crossing the goal line, Again, this experience has 3 levels and the option to change the velocity of action that the balls are shot at Snowboard Users see themselves on a snowboard as they ski down a mountain. As they move downhill, they need to avoid rocks and trees by leaning from side to side. This experience only has one level of difficulty that was assessed for this study. Stroke Research Another area regarding VR that has been researched is in individuals post stroke. A study done by Saposnik et. al. (2010) looked at the effectiveness, safety and availability of virtual reality on stroke rehabilitation. Two groups of participants age 18 to 85 having first-time strokes were used for this study, ‘one group of stroke patients received VR via the Nintendo Wii system, and the other group received standard care (in this case, recreational therapy). Though this study used recreational therapy as the standard care, the activities that were done with the stroke patients (leisure activities such as playing cards, bingo, Jenga, etc.) are activities that an occupational therapist could potentially use during treatment to address arm motor function. Participants were no more than 6 months post stroke, as this time limit was chosen to maximize the opportunity for motor recovery. Participants received 8 sessions of ‘60 minutes each for a total of 14 days. Primary outcome measures for the study included safety (as, defined by no intervention related adverse medical events during the study period), efficacy improvement in motor function determined by the Wolf Motor Function Test), quality of life (measured by the Stroke Impact Scale) and hand function (including strength, mobility and ability to use hands during ADLs and IADL). Results of this study found that there was a significant improvement in motor function for the participants in the VR group. The authors of this study found that there is a potential value and safety of VR game as a tool for stroke rehabilitation. Similar to the other studies on this topic, some of the limitations of this study include the small sample size and the potential bias of patients that received “new technology” instead of traditional treatment. Despite these limitations, this study found that VR is a feasible, safe and potentially effective intervention that can be used to enhance motor function recovery in stroke patients. The repetitive intense training and ability for patients to observe and practice activities with near real time feedback can help facilitate brain plasticity. Additional VR studies are necessary to prove its effectiveness long term, but this study provides hope that this technology can be used to enhance motor function and improve quality of life in stroke survivors. Saposnik and Levin (2011) conducted a meta-analysis to determine the benefit of VR technology ‘on arm motor recovery post stroke. This meta-analysis identified 12 studies with a total of 195 participants that met inclusion and exclusion criteria, This meta-analysis outlined some of the limitations of conventional treatments, including that they are time consuming, labor and resource intensive, dependent on patient compliance and have modest or delated effects that vary from patient to patient, Because of these and many other limitations, novel strategies that target motor skill development have recently emerged, including VR technology. This meta-analysis aimed to evaluate the effectiveness of VR in rehabilitation settings for upper limb function recovery post stroke. As previously mentioned, 12 studies, including 5 RCTS, with a total of 195 participants were included in this analysis. Interventions