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. 2025 Jan 15;15(1):e083120.
doi: 10.1136/bmjopen-2023-083120.

Factors influencing virtual reality use in paediatric acquired brain injury upper limb rehabilitation: a qualitative study

Chandrasekar Rathinam  1   2 , William Farr  3 , Daniel Ray  4 , Rajat Gupta  5   4
Affiliations

Factors influencing virtual reality use in paediatric acquired brain injury upper limb rehabilitation: a qualitative study

Chandrasekar Rathinam et al. BMJ Open. .

Abstract

Objective: Upper limb movement difficulties in children with acquired brain injury (ABI) result in longer recovery times compared with lower limb. Intensive neurorehabilitation promotes a good long-term functional outcome. Virtual reality (VR) and video game technologies are invaluable adjuncts to traditional neurological rehabilitation as they help to motivate, engage and gain children's compliance in goal-directed therapy. However, this technology is not routinely used in the National Health Service, UK; it requires embedding to benefit children and their families. VR implementation in rehabilitation practice requires development. The associated influencing factors require further exploration before routine use can be established. This project aimed to understand the factors influencing the use of VR in upper limb rehabilitation in children.VR implementation in rehabilitation practice requires development. The associated influencing factors require further exploration before routine use can be established. This project aims to understand the factors influencing the use of VR in upper limb rehabilitation in children.

Design: An interpretative qualitative study used focus groups and 1:1 semi-structured interviews conducted in person and online to explore participants' experiences. These were analysed for inductive overarching themes, particularly focusing on the views of professionals and young people regarding the use of VR in upper limb rehabilitation.

Setting: Two neurorehabilitation services located in two children's hospitals in England, UK.

Participants: Three physiotherapists, five occupational therapists, a play worker and four members from the Young Persons' Advisory Group took part. Four focus groups with 2-4 participants in each group and two 1:1 semi-structured interviews were conducted. Thematic analysis was used to create the model participants described as the factors that influenced the use of VR in neurorehabilitation.

Results: Five closely related major themes and thirty associated subthemes were developed: training, knowledge, promotion, consideration of barriers and family factors. There is a lack of knowledge and understanding about the use of VR, its limitations, and the clinicians' motivation to use it. Training packages with available VR equipment, clinical indicators and scientific evidence are required. Staff need frequent training, logistics (uninterrupted Wi-Fi, software, hardware) and simple instruction manuals.

Conclusion: To introduce VR into the routine rehabilitation of children with ABI, investment in improving knowledge, frequent training and positive behaviour change among health professionals is needed.

Keywords: Developmental neurology & neurodisability; QUALITATIVE RESEARCH; REHABILITATION MEDICINE; Virtual Reality.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. Model of factors influencing virtual reality use for upper limb rehabilitation for children with acquired brain injury.
Figure 2
Figure 2. 4i model to use implement VR for upper limb rehabilitation. VR, virtual reality.
See this image and copyright information in PMC

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