Denise Reid

The influence of virtual reality play on children's motivation

Purpose. This study explored the degree of motivation children exhibit during virtual reality (VR) play sessions. Method. Sixteen children with cerebral palsy aged 8 to 12 years participated. They were observed during a variety of VR environments that were video recorded. The Pediatric Volitional Questionnaire (PVQ) was used to measure childrens motivation. The PVQ provides insights into childrens inner motives as well as how the virtual environment enhances or attenuates childrens motives. Nine VR environments were randomly selected to score with the PVQ. Results. Data were analyzed and descriptive statistics were calculated for modes and medians of total volition scores for each VR environment. Different environments produced varying levels of volitional behaviour. The features of environments that produced higher levels of volition included challenge, variability and competition. Practice Implications. The overall volitional scores of children with cerebral palsy in the current study indicate that VR play is a motivating activity and thus has potential as a successful intervention tool.

Benefits of a virtual play rehabilitation environment for children with cerebral palsy on perceptions of self-efficacy: a pilot study

This paper presents the results of a clinical trial of a virtual reality play-based intervention. The results of three single case studies are presented. The virtual reality intervention used the Mandala ® Gesture Xtreme technology. It was applied to three school-aged children with cerebral palsy. A pre-test-post-test design was used. The relevant outcome of interest was self-efficacy as measured with the Canadian Occupational Performance Measure (COPM). Group scores on the COPM indicated clinically significant changes in self-efficacy for all children. Two of the participants demonstrated the greatest changes in both perceived performance abilities and satisfaction with performance with respect to task specific domain areas. Qualitative comments from the participants revealed a high degree of motivation, interest, pleasure, and opportunity for engagement in play, activities not previously engaged in. Overall, this pilot study suggests the viability of a virtual reality play-based intervention as part of the rehabilitation process for children with cerebral palsy. These results form the basis of a larger scale randomized clinical trial.

Virtual Reality in Pediatric Neurorehabilitation: Attention Deficit Hyperactivity Disorder, Autism and Cerebral Palsy

This paper presents the current status and use of virtual reality (VR) for children with attention deficit hyperactivity disorder (ADHD), autism and cerebral palsy. This literature review explores how VR systems have been used as treatment tools to address the primary impairments of these disorders. Three major classes of VR display systems are identified that can be characterized by the type of human-computer interaction provided: (1) feedback-focused interaction, (2) gesture-based interaction, and (3) haptic-based interaction. The demonstrated effectiveness and potential effectiveness of each class are discussed in the context of remediating the primary impairments of children with ADHD, autism and cerebral palsy. Three major themes for future research are discussed to support continued research interest in using VR in pediatric neurorehabilitation.

Living in a restricted occupational world: The occupational experiences of stroke survivors who are wheelchair users and their caregivers

Background. In order to meet the responsibilities of understanding and enabling occupation, occupational scientists and therapists must conduct research that is framed within an occupational perspective. Purpose. This paper reports the results of a qualitative investigation of the occupational experiences of stroke survivors (n=16) who use wheelchairs and their primary caregivers (n=15). Results. Inductive analysis of data collected via in-depth interviews resulted in two major themes related to occupation, specifically: living in a restricted occupational world and challenges to participation in occupation. These results highlight the overall experience labeled occupation by default, and the intricate interconnections or spill-over effect between the occupations of stroke survivors and caregivers. Practice Implications. In addition to providing empirical support for the importance of having a sense of control over occupation and the connection between occupation and identity, the results have implications for practice aimed at enabling occupation and directions for future research. As well, the results illustrate that occupational therapy services need to extend beyond wheelchair prescription in order to enable occupation with clients.

Development of a multidisciplinary feeding profile for children who are dependent feeders

The multidisciplinary feeding profile (MFP) is the first statistically based protocol for the quantitative assessment of feeding disorders in severely disabled children. This assessment can be completed in 30–45 min with foods and facilities that are available in homes, hospitals, and chronic care units. This paper describes the state of current testing methods, the parameters of successful feeding activity, the development of the test protocol, and the results of statistical analyses.

Mindfulness and flow in occupational engagement: presence in doing.

Background. Flow is a psychological state that might be viewed as desirable, and it occurs when a person is aware of his or her actions but is not being aware of his or her awareness. Mindfulness is viewed not as the achievement of any particular state, but as intentional awareness of what is, being aware of awareness. Purpose. To examine theoretical perspectives and empirical research on flow and mindfulness, and offer suggestions about the relevance of these concepts to occupational engagement. Key issues. Both flow and mindfulness involve being present, actively engaged, and attentive. The experience and practice of flow and mindfulness are relevant to the experience of occupational engagement. Implications. Understanding flow and mindfulness may help occupational therapists improve the therapeutic occupational engagement process with their clients through enhancing depth and meaning of occupational experiences, as well as health and well-being.

THE EFFECTS OF THE SADDLE SEAT ON SEATED POSTURAL CONTROL AND UPPER‐EXTREMITY MOVEMENT IN CHILDREN WITH CEREBRAL PALSY

A repeated‐measures experimental cross‐over study was conducted with school‐aged children with spastic cerebral palsy (spastic CP) to compare the effects of flat‐bench versus saddle‐bench seating on postural control and reaching motions. The saddle bench allowed significantly better postural control as measured by the clinical rating scale Sitting Assessment for Children with Neuromotor Dysfunction and by a study‐defined variable. Spinal Extension. No statistically significant differences were found for any other variables using aggregate data‐analysis techniques. However, the group results and those of single‐subject data analysis suggest that the saddle seat may help such children to develop and maintain seated postural control and upper‐extremity movement patterns.

The Experience of Senior Stroke Survivors: Factors in Community Participation among Wheelchair Users

Purpose. This qualitative study investigated the lived experience of senior stroke survivors who used prescribed wheelchairs in their home and community. Methods. The study involved semi-structured, in-depth interviews that were conducted with 10 participants, aged 70 to 80, who had used a wheelchair for a mean of 5.6 years. All participants used manual wheelchairs and two additionally used a power wheelchair and a scooter. Results. A constant comparative inductive method of analysis of the data yielded several themes which are examined within the International Classification of Functioning, Disability and Health framework of body functions and structure, activity limitations, participation, and contextual factors. Overall, the wheelchair, manual or power, was an enabler of community participation among the participants. However, the wheelchairs use also created problems, such as limiting destinations and creating increased dependence on others. Practice Implications. A balance scale model was proposed to facilitate an understanding of how the factors affecting community participation interact in this population. This model can assist occupational therapists who prescribe wheelchairs for stroke clients for use in the community.

Impact of wheeled seated mobility devices on adult users' and their caregivers' occupational performance: a critical literature review.

The prescription of wheeled seated mobility devices for clients with mobility impairment is a growing area in occupational therapy practice. The goal is to enhance client participation in occupation through technical intervention. This critical review examines the body of knowledge concerning the impact and effectiveness of the provision of wheeled seated mobility on the occupational performance of wheelchair users and their caregivers. The scope and gaps in the literature are defined to identify areas for future research. While the focus is on the methodological issues of the research reports, the relevance of findings to occupational therapy practice will also be reviewed. The results of the 46 studies in this review indicate that the majority of research conducted thus far have methodological limitations, which limits the extent to which this body of research can be drawn upon to provide evidence for the effectiveness of wheeled mobility systems. While most of the studies reviewed addressed constructs of relevance to occupational therapy practice, there was an emphasis on performance components and inadequate attention to engagement in occupations. This review is an important first step in building the ability of occupational therapists to demonstrate effectiveness in wheeled seating interventions.

Exploring the relationship between occupational presence, occupational engagement, and people's well‐being

This article examines the broad concepts of occupational presence, occupational engagement, and peoples well‐being. Occupational presence is viewed as a mediating variable between occupational engagement and well‐being. The proposal made is that occupational engagement can influence an occupational presence state in people, which in turn can influence their well‐being. Occupational presence is conceptualized as a psychological state of consciousness of being aware of self, engaged in occupation in place. Conscious awareness or mindfulness, and choice are considered to be important factors that contribute to an occupational presence experience. Occupational engagement is conceptualized as being occupied with doing an occupation and is viewed as a powerful determinant of a persons well‐being. Factors that enable or interfere with an occupational presence experience are discussed. Task demands, personal expectations, familiarity, anxiety, and opportunities to have control and make occupational choices all influence occupational presence. A model supported by preliminary research is proposed to guide future research. Ongoing research will contribute to the development of the theoretical concept of occupational presence, and explore the relationships between occupational presence, occupational engagement and well‐being.