{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:30:15Z","timestamp":1793327415393,"version":"4.5.0"},"reference-count":31,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T00:00:00Z","timestamp":1736899200000},"content-version":"unspecified","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Topol Digital Fellowship","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,12,10]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"\n Objective<\/jats:title>\n 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\u2019s 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.<\/jats:p>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n An interpretative qualitative study used focus groups and 1:1 semi-structured interviews conducted in person and online to explore participants\u2019 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.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Two neurorehabilitation services located in two children\u2019s hospitals in England, UK.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Three physiotherapists, five occupational therapists, a play worker and four members from the Young Persons\u2019 Advisory Group took part. Four focus groups with 2\u20134 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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\u2019 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-083120","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T04:00:16Z","timestamp":1737000016000},"page":"e083120","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Factors influencing virtual reality use in paediatric acquired brain injury upper limb rehabilitation: a qualitative study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0049-8430","authenticated-orcid":false,"given":"Chandrasekar","family":"Rathinam","sequence":"first","affiliation":[{"name":"College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"},{"name":"Therapy Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Farr","sequence":"additional","affiliation":[{"name":"Faculty of Education, St. Edmund's College,University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ray","sequence":"additional","affiliation":[{"name":"Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajat","family":"Gupta","sequence":"additional","affiliation":[{"name":"College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"},{"name":"Birmingham Women's and Children's NHS Foundation Trust, Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,15]]},"reference":[{"key":"2025121600475646000_15.1.e083120.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/17518423.2018.1564394","article-title":"The Information Gap for Children and Young People with Acquired Brain Injury","volume":"23","author":"Dunford","year":"2020","journal-title":"Dev Neurorehabil"},{"key":"2025121600475646000_15.1.e083120.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2023-001885","article-title":"Impact of transcranial magnetic stimulation on motor function in children with acquired brain injury: a scoping review protocol","volume":"7","author":"Rathinam","year":"2023","journal-title":"BMJ Paediatr Open"},{"key":"2025121600475646000_15.1.e083120.3","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2015-308424"},{"key":"2025121600475646000_15.1.e083120.4","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1080\/21622965.2021.1919111","article-title":"Relationship between motor abilities and executive functions in patients after pediatric stroke","volume":"11","author":"Abgottspon","year":"2022","journal-title":"Appl Neuropsychol Child"},{"key":"2025121600475646000_15.1.e083120.5","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1225924","article-title":"Variation in the rate of recovery in motor function between the upper and lower limbs in patients with stroke: some proposed hypotheses and their implications for research and practice","volume":"14","author":"Abdullahi","year":"2023","journal-title":"Front Neurol"},{"key":"2025121600475646000_15.1.e083120.6","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2024.1388718","article-title":"Effect of non-invasive brain stimulation in children with acquired brain injury-a scoping review","volume":"15","author":"Rathinam","year":"2024","journal-title":"Front Neurol"},{"key":"2025121600475646000_15.1.e083120.7","doi-asserted-by":"publisher","DOI":"10.1044\/1092-4388(2008\/018)"},{"key":"2025121600475646000_15.1.e083120.8","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1111\/dmcn.14846","article-title":"Outcomes for children with acquired brain injury (ABI) admitted to acute neurorehabilitation","volume":"63","author":"Keetley","year":"2021","journal-title":"Dev Med Child Neurol"},{"key":"2025121600475646000_15.1.e083120.9","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/dmcn.14791","article-title":"Virtual reality for neurorehabilitation: hopes and challenges for therapists","volume":"63","author":"Rathinam","year":"2021","journal-title":"Dev Med Child Neurol"},{"key":"2025121600475646000_15.1.e083120.10","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.jht.2018.01.006","article-title":"Effectiveness of virtual reality in the treatment of hand function in children with cerebral palsy: A systematic review","volume":"32","author":"Rathinam","year":"2019","journal-title":"J Hand Ther"},{"key":"2025121600475646000_15.1.e083120.11","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1111\/dmcn.14762","article-title":"Virtual reality rehabilitation in children with brain injury: a randomized controlled trial","volume":"63","author":"Choi","year":"2021","journal-title":"Dev Med Child Neurol"},{"key":"2025121600475646000_15.1.e083120.12","unstructured":"Farr W , Green D . Lab to rehab: is virtual reality being adopted clinically for children? 13th icdvrat with itag. 2020."},{"key":"2025121600475646000_15.1.e083120.13","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/1559827618756588","article-title":"Virtual Reality for Pediatric Traumatic Brain Injury Rehabilitation: A Systematic Review","volume":"14","author":"Shen","year":"2020","journal-title":"Am J Lifestyle Med"},{"key":"2025121600475646000_15.1.e083120.14","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/02692155231187858","article-title":"Effectiveness of virtual reality interventions of the upper limb in children and young adults with cerebral palsy: A systematic review with meta-analysis","volume":"38","author":"Burin-Chu","year":"2024","journal-title":"Clin Rehabil"},{"key":"2025121600475646000_15.1.e083120.15","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1089\/g4h.2016.0089","article-title":"Virtual Reality and Active Videogame-Based Practice, Learning Needs, and Preferences: A Cross-Canada Survey of Physical Therapists and Occupational Therapists","volume":"6","author":"Levac","year":"2017","journal-title":"Games Health J"},{"key":"2025121600475646000_15.1.e083120.16","article-title":"Exercise interventions for cerebral palsy","volume":"6","author":"Ryan","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121600475646000_15.1.e083120.17","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"2025121600475646000_15.1.e083120.18","doi-asserted-by":"publisher","DOI":"10.1007\/s11135-021-01182-y"},{"key":"2025121600475646000_15.1.e083120.19","doi-asserted-by":"crossref","first-page":"322","DOI":"10.12968\/bjon.2022.31.6.322","article-title":"Evidence-informed practice: simplifying and applying the concept for nursing students and academics","volume":"31","author":"Kumah","year":"2022","journal-title":"Br J Nurs"},{"key":"2025121600475646000_15.1.e083120.20","first-page":"1","article-title":"Digital competency: a survey of UK allied health professionals","volume":"28","author":"Tack","year":"2022","journal-title":"Br J Healthc Manag"},{"key":"2025121600475646000_15.1.e083120.21","doi-asserted-by":"crossref","DOI":"10.1177\/2382120519901275","article-title":"Integrating Digital Health into the Curriculum-Considerations on the Current Landscape and Future Developments","volume":"7","author":"Aungst","year":"2020","journal-title":"J Med Educ Curric Dev"},{"key":"2025121600475646000_15.1.e083120.22","doi-asserted-by":"crossref","unstructured":"Parsons D , MacCallum K , Schofield L , et al . Next-generation digital curricula for future teaching and learning BT - emerging technologies and pedagogies in the curriculum. Singapore: Springer Singapore, 2020:3\u201319.","DOI":"10.1007\/978-981-15-0618-5_1"},{"key":"2025121600475646000_15.1.e083120.23","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1016\/j.pmrj.2018.07.004","article-title":"Barriers, Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review","volume":"10","author":"Glegg","year":"2018","journal-title":"PM R"},{"key":"2025121600475646000_15.1.e083120.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjinnov-2019-000384"},{"key":"2025121600475646000_15.1.e083120.25","doi-asserted-by":"crossref","first-page":"21501319241293311","DOI":"10.1177\/21501319241293311","article-title":"Immersive Technologies in Healthcare: An In-Depth Exploration of Virtual Reality and Augmented Reality in Enhancing Patient Care, Medical Education, and Training Paradigms","volume":"15","author":"Iqbal","year":"2024","journal-title":"J Prim Care Community Health"},{"key":"2025121600475646000_15.1.e083120.26","doi-asserted-by":"crossref","DOI":"10.3390\/brainsci13050819","article-title":"Virtual Reality Applications in Neurorehabilitation: Current Panorama and Challenges","volume":"13","author":"Nieto-Escamez","year":"2023","journal-title":"Brain Sci"},{"key":"2025121600475646000_15.1.e083120.27","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2021.700211","article-title":"The Challenges and Perspectives of the Integration Between Virtual and Augmented Reality and Manual Therapies","volume":"12","author":"Cerritelli","year":"2021","journal-title":"Front Neurol"},{"key":"2025121600475646000_15.1.e083120.28","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2018.00345","article-title":"Virtual Reality for Traumatic Brain Injury","volume":"9","author":"Zanier","year":"2018","journal-title":"Front Neurol"},{"key":"2025121600475646000_15.1.e083120.29","unstructured":"England NHS . A digital framework for allied health professionals. 2019."},{"key":"2025121600475646000_15.1.e083120.30","doi-asserted-by":"crossref","first-page":"204","DOI":"10.12968\/bjon.2019.28.3.204","article-title":"A long-term plan for embracing digital healthcare technology","volume":"28","author":"Glasper","year":"2019","journal-title":"Br J Nurs"},{"key":"2025121600475646000_15.1.e083120.31","doi-asserted-by":"crossref","DOI":"10.1186\/s43058-023-00442-2","article-title":"Implementation of virtual reality in healthcare: a scoping review on the implementation process of virtual reality in various healthcare settings","volume":"4","author":"Kouijzer","year":"2023","journal-title":"Implement Sci Commun"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-083120","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T08:48:12Z","timestamp":1765874892000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-083120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,15]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjopen-2023-083120"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-083120","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}