• An evaluation of virtual reality technology as an occupational therapy treatment tool in spinal cord injury rehabilitation

      McNamara, Angela Dr.; O’Raw, Paul (2006)
      The introduction of virtual reality (VR) games as an occupational therapy (OT) treatment tool is an attempt to use technology as purposeful activity that is more relevant to a modern patient population than traditional art and craft based activities. It is unclear however if VR games are suitable for clinical applications and the current project examines the usability of video-capture VR games in spinal cord injury (SCI) rehabilitation. Participants were 10 male acute SCI patients with complete and incomplete SCI (C5 – L2), and ages ranging from 23 – 56 years (mean = 40.5 years; SD = 14.07). Time post injury was 3 – 6 months (mean = 4 months; SD = 1.25). The first study examined console-based VR games. Participants engaged with three different VR game types: a purely physical game, a physical and cognitive game, and a purely cognitive game. Patients were interviewed about their experience using a 45 point usability questionnaire, and the attending therapists completed a similar survey. Both patients and therapists agreed that VR games increase motivation to attend therapy, and motivate patients to perform past their perceived limits of movement and endurance. The VR games used did not overexert patients and did not cause any extra pain or discomfort. Results suggest that patients with limited experience of computer technology, and over a wide range of ages and social backgrounds, could use the VR games successfully and independently. The second study looked at an equivalent PC-based VR game to determine if there are advantages in using this platform. Participants engaged in a purely physical VR game and were interviewed using a questionnaire as before. The attending therapists completed a similar feedback form. Results showed the PC based VR game was equivalent to the console game in functionality and ease of use, but had the advantage of being more portable and easier to set up and operate. These findings support the idea that VR games are an appropriate and useful compliment to conventional OT. In addition, patients found that having their image and real-time movements displayed onscreen was useful feedback to correct posture and direct upper limb movements.
    • An investigation into the functional outcomes of individuals with paraplegia, resulting from spinal cord injury, following discharge from a rehabilitation setting

      McNamara, Angela Dr.; Held, Lisa (2005)
      The purpose of this study was to investigate if changes occurred in the functional independence of spinal cord injured (SCI) patients, following discharge from a rehabilitation setting. The research was carried out on patients with a paraplegic injury, who underwent rehabilitation in the spinal injury unit of a Dublin based rehabilitation hospital. Eight male subjects residing in the Republic of Ireland were recruited to the study between October 2004 and May 2005. Two measures of functional independence, a mood outcome measure and semi-structured interviews were carried out at two separate stages. The first, in the hospital one to five days prior to discharge. The second in the home of the subject six to eight weeks following discharge. Studies investigating the experience of spinal injured patients soon after discharge are very limited. Research to date indicates that the functional independence of those with spinal cord injury improves after a period of one year and longer at home. Results in this study showed that functional independence as measured using the Functional Independence Measure (FIM), decreased following discharge and the change was statistically significant (p=0.041). A decrease was also noted on the Spinal Cord Independence Measure (SCIM), but this was not shown to be statistically significant (p=0.075). Mood was measured using the Centre for Epidemiological Studies Depression Scale (CES-D) and an overall improvement in mood following discharge was observed. The qualitative data obtained through the semi-structured interviews, yielded rich information on the subjects views of the pre and post discharge phase. Six factors which could be associated with changes in functional independence were identified; environmental, lack of appropriate equipment, social support, lack of services, pre-discharge preparation and pain. Exploring the experiences and functional changes of individuals with spinal cord injury following discharge has implications for pre discharge rehabilitation and follow-up. Changes in line with other models of rehabilitation in Australia and America may provide a more transitional period to allow persons with SCI to be well prepared for the physical and emotional challenges presented to them in the community.
    • An investigation into the occupational status of persons with incomplete spinal cord injury

      McNamara, Angela Dr.; Logan, Catherine; National Rehabilitation Hospital (2005)