Virtual Reality in Occupational Therapy

By Jonathan E. Urrely, OT-S and Carlos Martoral

Technology is a common element in our everyday lives, as almost every aspect of our existence has been transformed by smartphones, Alexas, wifi, and/or Bluetooth. According to the Occupational Therapy Practice Framework Fourth Edition (OTPF-4), virtual interventions are part of the occupational therapy process and include simulated technology for service delivery with the absence of physical contact (American Occupational Therapy Association [AOTA], 2020). But, technology is no longer only a means for facilitating occupation; it is also the target of our occupation. The OTPF-4 also identifies technology as an environmental factor, meaning managing human-made technology as an aspect of our physical and social environment, so we must learn to navigate this area to optimize the client’s occupational performance (AOTA, 2020). As our daily use of technology continues to evolve, computer-generated and virtual reality (VR) based interventions will become a more prevalent feature of occupational therapy (OT) practice.

VR is a technological interface that allows users to experience presence in a three-dimensional, computer-generated environment (Maples-Keller et al., 2017). Sensory information is delivered through a head mounted display that tracks head movement to change images in a natural way allowing for a sense of full immersion (Maples-Keller et al., 2017). VR has a number of advantages over traditional interventions since it can be used for all ages and many diagnoses to improve occupational outcomes and performance.

One way occupational therapy practitioners can harness the power of VR during treatment sessions is by allowing clients to participate in a high dosage of therapy or repetition early in recovery. According to Kiper et al. (2018), in a traditional occupational therapy session focused on upper extremity (UE) rehabilitation poststroke, clients only completed 23 to 32 UE movement repetitions during a standard session, but VR treatments produced up to 200 to 300 functional UE motions in a one-hour session. VR has been shown to encourage more repetition allowing for faster motor skill development and recovery while distracting clients from recognizing they are repeating the same motion (Kiper et al., 2018).

Another advantage of VR is it can be easily gamified. Gamification is the intentional process of transforming a task or activity into one which offers the positive experiences, skills, and practices associated with games (Hamari, 2021). Many of us have experienced the joys of a semi-immersive virtual world through the use of the Wii gaming system. Similarly, VR sessions may be tailored to promote specific functional capacities while engaging in desired occupations, like paddling a kayak in a race through the Grand Canyon, playing catch with your favorite quarterback, or perhaps building an exotic garden in a fantasy world. Each of these can improve motivation to participate in therapy and may reduce burnout throughout the therapeutic process (Metin Ökmen, B., Doğan Aslan, M., Nakipoğlu Yüzer, G. F., & Özgirgin, 2019).

However, one of the greatest benefits of VR may be the ability to use the modality with a spectrum of diagnoses over the lifespan. In 2018, a randomized control trial of adult participants demonstrated significant reductions in distress, anxiety, and avoidance of real heights following exposure to virtual heights across six, 30-minute VR sessions over two weeks (Freeman et al., 2018). Participants demonstrated decreased symptoms when placed in an actual height situation with the results carrying over on a one year follow up (Freeman et al., 2018). When offered to a population of first-time stroke survivors, virtual reality recipients demonstrated significant improvements in scores for the Fugl-Meyer Assessment and Functional Independence Measure when compared to those who received only conventional rehabilitation over four weeks (Kiper et al., 2018). The study also found these results were not dependent on the sex or age of the participants (Kiper et al., 2018). Then, children with cerebral palsy, as young as five years old, have also participated in VR treatments that have shown significant improvements on gross and bimanual motor function assessments (Metin Ökmen, B., Doğan Aslan, M., Nakipoğlu Yüzer, G. F., & Özgirgin, 2019). Researchers suggested the VR system used in the study was inexpensive considering treatment costs and families could easily obtain the tool to perform treatment regularly at home to improve carryover (Metin Ökmen, B., Doğan Aslan, M., Nakipoğlu Yüzer, G. F., & Özgirgin, 2019).

Roger A. Tabatt, a Recreational Therapist at the Orlando VA Community Living Center (CLC), recently made national headlines showcasing the benefits of VR for older veterans coping with moderate to maximum levels of PTSD secondary to their time in the service. Most veterans requested diverse exploratory environments allowing the veterans to choose from a list of environments to immerse themselves in to explore, listen, and interact with the environment. The headset had Bluetooth capabilities mirrored to a larger screen allowing a therapist to guide the session and compare results over time.

The use of VR technologies is a new and promising mode of treatment shown to improve outcomes compared to traditional approaches used in rehabilitation. Not only is it a tool for facilitation of practice, but it has become an integral part of our contexts without which interaction in our current environment is hindered. It can be utilized over a variety of diagnoses and implemented across the lifespan to simulate, immerse, expose, and encourage virtually any desired result at a relatively cost effective price. Occupational therapy practitioners should assess the feasibility of the integration of this technology into respective practices and the technical development of these tools to ensure the application elicits the desired outcomes for the client while increasing compliance and reducing monotony sometimes associated with conventional rehabilitation interventions.

References

American Journal of Occupational Therapy, 74(Suppl. 2), Article 7412410010. Retrieved from https://doi.org/10.5014/ ajot.2020.74S2001
Freeman, D., Haselton, P., Freeman, J., Spanlang, B., Kishore, S., Albery, E., Denne, M., Brown, P., & Nickless, A. (2018). Automated psychological therapy using immersive virtual reality for treatment of fear of heights: A single-blind, parallel-group, randomised controlled trial. The Lancet Psychiatry, 5(8), 625- 632. Retrieved from https://doi.org/10.1016/ S2215-0366(18)30226-8.
Hamari, J. (2021). Gamification. In The Blackwell Encyclopedia of Sociology, G. Ritzer (Ed.). https://doi. org/10.1002/9781405165518.wbeos1321
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