Background: The global incidence of spinal cord injury (SCI) is between 10 and 80 new cases per million people each year. This equates to between 250,000 and 500,000 injuries worldwide, per year. In the UK approximately 4400 people per year sustain a SCI. People with tetraplegia report upper limb function as their highest priority for improvement after SCI. Using immersive virtual reality (VR) headsets, physical rehabilitation exercises can be completed in engaging digital environments. Immersive VR therefore has the potential to increase the amount of therapy undertaken, leading to improvements in arm and hand function. There is little evidence supporting immersive VR as exercise in SCI, especially while spinal cord-injured patients are undergoing acute rehabilitation. In spinal cord injury research, co-design of new interventions is not a widely adopted approach, yet people with tetraplegia want to contribute with their expert knowledge on their experiences of SCI.
Objectives: To explore the lived experiences of people with tetraplegia and specialist SCI therapists related to acute upper limb rehabilitation and identify design considerations for VR-based interventions targeting the upper limb.
Methods: Seven focus groups were conducted online using Microsoft Teams: four with people with tetraplegia (n = 15, age range 36-65 years) and three with occupational therapists and physiotherapists specialising in SCI rehabilitation (n = 11). Participants were asked to discuss their experiences and expertise about acute SCI upper limb rehabilitation and their opinions and ideas on the use of VR for upper limb rehabilitation. The transcripts were analysed using content analysis enabling the proposition of design characteristics of a VR-based intervention for upper limb exercise.
Results: The study identified five major themes describing the clinical features, treatment, and recovery of spinal cord injured people during the acute stage of SCI, their motivations for participating in therapy, and suggestions for the design of a VR intervention in treating the upper limbs following SCI.
Conclusions:
The themes identified in this study allow the elicitation of software requirements for a bespoke immersive VR platform for upper limb rehabilitation following SCI. They can also contribute to the better understanding of the advantages of using VR as an adjunct to upper limb rehabilitation, as well as features of VR-based interventions to avoid. Additionally, participants used their expertise to suggest factors that would enable the development of a usable and effective intervention as well as identifying potential pitfalls and software features to avoid during the intervention development. These findings can be used to design accessible VR applications for use by people with tetraplegia and their therapists.