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Abstract

Background: After acquired brain injury (ABI), people often struggle with activities of daily living (ADL). Virtual reality (VR) offers a method for top-down ADL practice, but its implementation in ABI rehabilitation remains underexplored. Objectives: This thesis aimed to: (1) outline the existing evidence of VR devices incorporating ADLs for enhancing functional outcomes after ABI (Chapter 2); (2) investigate the implementation of a VR intervention for ABI rehabilitation (Chapter 3); (3) explore the experiences of clinicians and participants with ABI involved in the VR intervention (Chapter 4); (4) examine the occupational therapist (OT) role in delivering the VR intervention and explore the therapy dose (e.g., number of upper extremity reaches) during the intervention (Chapter 5). Methods: Study 1 used scoping review methodology. Study 2 was a pre- and post-intervention study and used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Study 3 used phenomenological qualitative methodology and study 4 was an exploratory analysis of data collected in study 2. Results: Study 1: 13 studies were included for review. Most studies used non-immersive VR devices incorporating ADLs to improve functional outcomes. Study 2: Participants included 15 adults with ABI (13 stroke, two traumatic brain injury) (mean age 46.8) and five OTs (mean age 37.8). The results showed moderate reach, improvements in outcome measures, adoption challenges and benefits, partially meeting implementation indicators, and moderate maintenance. Reach: 23% of people with ABI participated; Effectiveness: a linear mixed-effects model showed improvements in the primary outcome measure from baseline to post-intervention; Adoption: benefits included improved physical function, while challenges included technical issues; Implementation: indicators were partially met; Maintenance: 60% of clinicians reported they would use VR in future practice. Study 3: Three themes described the experience of clinicians and participants with ABI with VR, including “every little thing helps”, “moving forward in practice”, and “encountering the limits of VR”. Study 4: During the intervention, participants with ABI completed a median of 151 upper extremity reaches per session. OTs provided cues, assistance, and adjusted sessions due to technical issues or negative impacts. Significance: These findings can inform the successful implementation of VR in ABI rehabilitation.