Upper Limb Impairment and the potential role of Virtual Reality in the Rehabilitation of the Upper Limb in Multiple Sclerosis: views of specialist clinicians and people with MS.

Abstract

Background: Finding enjoyable and effective long-term approaches to rehabilitation for improving upper limb (UL) function for people with multiple sclerosis (pwMS) is challenging. Using virtual reality (VR) could be a solution to this challenge however; there is a lack of reporting on pwMS' and clinicians' views on VR-based approaches and recommendations for games for rehabilitation. Objective: To identify common UL problems and their related current therapeutic approaches in pwMS and 2) to explore the opinions of pwMS and specialist clinicians' on VR and suggestions for development and design of VR games. Methods: Separate focus groups were conducted with pwMS, recruited through the MS Society UK's research network, and clinicians, recruited through the UK's Therapists in MS network. Ten pwMS (two focus groups) and eight clinicians (five physiotherapists, two occupational therapists and one MS-nurse, two focus groups) were involved. Focus groups were recorded and transcriptions analyzed using theme-based content analysis (TBCA). Results: People with MS commonly reported their UL problems interfered with activities of daily living (ADL) and resulted in the loss of meaningful hobbies such as writing. Many pwMS neglected UL exercise and found strategies for adapting to the UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a solution, being convenient for pwMS to access and could provide a more engaging and disguised approach to exercise. There were shared concerns with cybersickness and disengagement with using VR approaches. Both groups agreed games should be meaningful and adaptable for users, but suggested different VR activities, with clinicians suggesting games directly reflecting ADL and pwMS more abstract activity. Conclusions: VR was well received by both pwMS and clinicians for UL rehabilitation. Recommendations are made for the development of VR rehabilitation games which are personalized and customizable for the varying ability of pwMS.