Allison Ellington, Richard Adams, Marga White, Paul Diamond; Behavioral Intention to Use a Virtual Instrumental Activities of Daily Living System Among People With Stroke. Am J Occup Ther 2015;69(3):6903290030. https://doi.org/10.5014/ajot.2015.014373
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© 2020 American Occupational Therapy Association
OBJECTIVE. The purpose of this study was to investigate the behavioral intention to use (BIU) regarding a virtual system for practicing instrumental activities of daily living (IADLs) among people with stroke.
METHOD. Fourteen people who had sustained a stroke used a virtual world–based system over four sessions to participate in virtual occupations of preparing meals and putting away groceries. To investigate intention to use the technology, participants responded to a questionnaire based on the Technology Acceptance Model and were interviewed about the experience.
RESULTS. Analysis of questionnaire responses revealed favorable attitudes toward the technology and statistically significant correlations between these attitudes and positive BIU. Analysis of qualitative data revealed four themes to support system use: Use of the affected arm increased, the virtual practice was enjoyable, the technology was user-friendly, and the system reflected real-life activities.
CONCLUSION. This study shows that participants reported a positive BIU for the virtual system for practicing IADLs.
Use of affected arm increased. Despite participants’ considerable variations in length of time since their stroke (see Table 1), the most common theme related to an increase in the use of the affected arm during typical day-to-day activities. Participant 1 stated, “It especially got my arm moving.” Participant 8 compared movement during practice of virtual IADLs to movement during at-home exercise: “When you’re doing exercises at home [holding my arm still is] not something that I do. I move, but I don’t have to hold it still.” Other participants reported that VOTA highlighted residual deficits in upper-extremity function. For example, Participant 5 reported that “the positive side is I realize that the left side is not good. I’m saying that’s positive because normally I forget and don’t use my left side a lot—I use it but not a lot—so I thought it was stronger than it is.”
Using VOTA was enjoyable. Although participants had different experiences with technology before this study, many participants commented that their experience with the VOTA system was enjoyable or rewarding. Participants used the words good, interesting, useful, and worthwhile to describe their engagement with VOTA. Participant 13 stated that “anything we can use to help us get back our lives is alright in my book.”
Technology was user-friendly. Participants represented a wide spectrum of prior knowledge and experience with technology. Participant 3 commented, “I was wondering how I would do in a situation like this, and I think I did good. I was a little surprised.” Overall, participants were pleased with the usability of the VOTA system and the extent to which their abilities improved quickly over the four sessions. Participant 3 said, “The cooking seemed to get easier, each of the four sessions was easier. I think it helped doing the first three sessions, but the last session, I was more confident.” Participant 12 stated, “I think particularly when you’ve had a stroke, it’s hard to feel proficient at anything, and this lets you do that.” Additionally, field notes confirmed that participants rapidly improved their performance with the system. They required fewer verbal prompts from the occupational therapists, independently incorporated strategies suggested by the therapists, and frequently logged higher scores at each subsequent attempt.
VOTA reflected real-life occupations. Participants related to the realism of the virtual environment. They reported that “it was a real-life situation” and “it gives me normal things to do such as cooking and putting groceries away just like I do at home.” In particular, Participant 3 verbalized how she immersed herself in the virtual environment and began thinking ahead to the logical next steps. She stated, “They need to put knives and forks on the tray so you can really eat [the eggs] instead of just looking at [them].”
VOTA lacks fine motor integration. Two participants mentioned the lack of fine motor use in the virtual occupations selected for this study. Participant 8 explained, “I think it needs a different Kinect [to] pick up any movement from my hand.” Participant 14 stated, “It’s helpful, but it’s still hard for me to use the avatar [with] only the shoulder. I want to use my hand.”
Cueing should be improved. Although all participants were successful in learning and completing the virtual IADL occupations, some participants suggested improvements to the cueing integrated into the system. Participant 6 reported, “I still get confused with all the arrows,” whereas Participant 13 stated, “Gear down the enthusiasm level of my cheerleader.”
Virtual targets should be more sensitive. The software was custom built for the VOTA application, but participants suggested improving the sensitivity of virtual targets to allow easier and more consistent acquisition and placing of virtual objects. Participant 1 mentioned, “I couldn’t always tell when they wanted it to be dropped.”
Virtual world–based systems dedicated to the virtual practice of ADLs and IADLs should continue to be developed as an adjunct to current best practices in occupational therapy for patients after a stroke.
Virtual worlds may provide a safe environment for clients who are unable to practice ADLs and IADLs in a natural context because of physical, cognitive, or social support barriers.
Clients even many years after stroke are interested and motivated to practice virtual ADLs and IADLs.
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