Authors (including presenting author) :
Yeung M.Y. (1), Cheung P. (1), Lau C.M.J. (1), Chan Y.L. (1)
Affiliation :
Occupational Therapy Department, Kowloon Hospital (1)
Introduction :
Patients with stroke could feel hesitated and distressed in accessing the community especially in a crowded and road-packed city like Hong Kong. They might find difficulties in crossing road and taking escalator due to the impaired balance, slower reaction, functional status, self-efficacy and social support, etc. Patient might tend to avoid community living and their quality of life would be compromised. A community-accessibility-training (CAT) group was designed in Occupational Therapy (OT) department of Kowloon Hospital (KH). With use of virtual reality (VR), CAT group aimed at enhancing patient’s skills and self-efficacy in community living. The highly interactive and repetitive VR training could provide structural treatment in a safe and controlled simulating environment.
Objectives :
(1) The CAT group focused on train up patient’s community living skills including crossing road and taking escalator. (2) The CAT group aimed at enhancing patient’s self-efficacy in community living. (3) This study was to explore effectiveness of CAT group comparing with conventional OT community group with functional balance training.
Methodology :
It was a randomized-controlled-trial study. Purposeful sampling was adopted for patients with stroke who were receiving OT out patient training in KH. Recruited subjects were randomly allocated into CAT group as study group and conventional community group as control. CAT group involved two VR systems as training modality. One was VR play motion system for balance training and another VR system was for simulating road crossing and escalator taking. Meanwhile, conventional community group adopted functional balance training. Both of the groups would include an outing session for road crossing and escalator taking in real community environment. Both of the groups were in six-session structure. Two sessions were conducted per week. Each session lasted for 60 to 75 minutes. A blinded assessor conducted assessments in the first and last session. Outcome measures categorized as (1) physical parameters including reaction time of crossing road and stepping in escalator, Berg Balance Scale (BBS), six-minute walk test (6MWT) and timed up and go test (TUG). (2) Psychological parameters included Activities-specific Balance Confidence Scale (ABCS), Stroke-Adapted 30-Item Version of The Sickness Impact Profile (SA-SIP 30) and Community Integration Questionnaire (CIQ).
Result & Outcome :
From March 2019 to Dec 2019, 13 subjects were recruited and randomly allocated into study and control group. Both of groups showed significant improvement (p< 0.05) in reaction time of crossing road and CIQ (extent of community integration). Only CAT group showed significant improvement (p< 0.05) in reaction time of taking escalator, BBS (functional balance), ABCS (balance confidence), ABCS sub-item 14 and 15 (confidence in stepping on escalator with and without holding parcels) and SA-SIP 30 (quality of life). In conclusion, the preliminary result showed positive result on CAT group for enhancing community living skills. The study will be continued for further effectiveness analysis.
