Danielle E Levac

Northeastern University | NEU · Department of Physical Therapy, Movement Sciences and Rehabilitation

Background: Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior change...

Purpose: The purported affective impact of virtual reality (VR) and active video gaming (AVG) systems is a key marketing strategy underlying their use in stroke rehabilitation, yet little is known as to how affective constructs are measured or linked to intervention outcomes. The purpose of this scoping review is to 1) explore how motivation, enjoy...

Purpose Despite increasing evidence for the effectiveness of off-the-shelf and rehabilitation-specific active video games (AVGs) and virtual reality (VR) systems for rehabilitation, clinical uptake remains poor. A better match between VR/AVG system capabilities and client/therapist needs, through improved end-user involvement (UI) in VR/AVG impleme...

Aim To evaluate the reliability of the Motor Learning Strategies Rating Instrument (MLSRI‐20) in gait‐based, video‐recorded physiotherapy interventions for children with cerebral palsy (CP). Method Thirty videos of 18 children with CP, aged 6 to 17 years, participating in either traditional or Lokomat‐based physiotherapy interventions were rated u...

Virtual reality and active video games (VR/AVGs) are promising rehabilitation tools because of their potential to facilitate abundant, motivating, and feedback‐rich practice. However, clinical adoption remains low despite a growing evidence base and the recent development of clinically accessible and rehabilitation‐specific VR/AVG systems. Given cl...

Aims: To determine the effects of a 5-day virtual reality (VR)-based intervention on anticipatory and reactive mechanisms of postural control in children and adolescents with cerebral palsy (CP). Methods: Eleven youth with CP (GMFCS levels I and II), ages 7-17, were allocated to intervention (N = 5) and control (N = 6) groups. Both groups attend...

Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Sys...

Objective: Commercially available active videogames (AVGs) are promising rehabilitation options, but lack of familiarity with game options may limit clinical integration. We evaluated content and format usability of the 'Kinect-ing' with Clinicians (KwiC) website, an online tool that characterizes commercially available games to support clinical d...

Background: Reactive and anticipatory postural activity has been described in single discrete perturbations in youth with cerebral palsy (CP) but not in continuous perturbation situations. Research question: We sought to determine how the ability to control postural responses (as reflected in the number of steps taken, postural muscle activity,...

Augmented feedback has motivational and informational functions in motor learning, and is a key feature of practice in a virtual environment (VE). This study evaluated the impact of narrative (story-based) feedback as compared to standard feedback during practice of a novel task in a VE on typically developing children's motor learning, motivation...

Background: Motivating interactive tools may increase adherence to repetitive practice for children with disabilities, but many virtual reality and active video gaming systems are too challenging for children with significant needs. Objective: The objective of this study was to develop and conduct a usability evaluation of the Fun, Interactive T...

BACKGROUND Motivating interactive tools may increase adherence to repetitive practice for children with disabilities, but many virtual reality and active video gaming systems are too challenging for children with significant needs. OBJECTIVE The objective of this study was to develop and conduct a usability evaluation of the Fun, Interactive Thera...

Introduction: Physical therapists should implement practice conditions that promote motor skill learning after neurological injury. Errorful and errorless practice conditions are effective for different populations and tasks. Errorful learning provides opportunities for learners to make task-relevant choices. Enhancing learner autonomy through cho...

Objective: Describe the clinical use of virtual reality (VR)/active videogaming (AVG) by physical therapists (PTs) and occupational therapists (OTs) in Canada, identify usage barriers and facilitators, evaluate factors that predict intention to use VR/AVGs, and determine therapists' learning needs. Design: Cross-sectional survey. Materials and...

To support the use of virtual environments (VEs) in pediatric rehabilitation, greater understanding of the extent and mechanisms by which practice in a VE might facilitate motor learning as compared to practice in a physical environment (PE) is required. One proposed mechanism is via enhanced user engagement and/or motivation, which may directly in...

Aims: To compare changes in gross motor skills and functional mobility between ambulatory children with cerebral palsy who underwent a 1-week clinic-based virtual reality intervention (VR) followed by a 6-week, therapist-monitored home active video gaming (AVG) program and children who completed only the 6-week home AVG program. Methods: Pilot n...

Purpose Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. Method A pre-post design evaluated a knowledge translation (K...

De-identified results for each participant on the Motor Learning Strategy Rating Instrument, the Chart-Stimulated Recall, and the e-learning modules. (XLSX)

Background Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenab...

Little is known about clinicians’ perspectives on the use of virtual reality (VR) and active video games (AVGs) in rehabilitation. We undertook an online survey of VR/AVG experience and learning needs in a sample of 1068 physical therapists and occupational therapists practicing in Canada. Nearly half (47%) had clinical experience with at least one...

Background Scoping studies (or reviews) are a method used to comprehensively map evidence across a range of study designs in an area, with the aim of informing future research practice, programs and policy. However, no universal agreement exists on terminology, definition or methodological steps. Our aim was to understand the experiences of, and co...

Background: Virtual reality active video games are increasingly popular physical therapy interventions for children with cerebral palsy. However, physical therapists require educational resources to support decision making about game selection to match individual patient goals. Quantifying the movements elicited during virtual reality active video...

Background: Sitting ability and function are commonly impaired after stroke. Balance training has been shown to be helpful, but abundant repetitions are required for optimal recovery and patients must be motivated to perform rehabilitation exercises repeatedly to maximize treatment intensity. Virtual reality training (VRT), which allows patients t...

Background: Scoping reviews are used to identify knowledge gaps, set research agendas, and identify implications for decision-making. The conduct and reporting of scoping reviews is inconsistent in the literature. We conducted a scoping review to identify: papers that utilized and/or described scoping review methods; guidelines for reporting scopi...

The knowledge-to-practice gap in rehabilitation has spurred knowledge translation (KT) initiatives aimed at promoting clinician behavior change and improving patient care. Online KT resources for physical therapists and other rehabilitation clinicians are appealing because of their potential to reach large numbers of individuals through self-paced,...

Background: Virtual reality (VR) systems are promising treatment options in stroke rehabilitation because they can incorporate motor learning strategies (MLS) supporting motivating task oriented practice. However, clinicians lack motor learning-based training for VR use. The objectives of this study were to design, implement and evaluate the effect...

Microsoft's Kinect for Xbox 360 virtual reality (VR) video games are promising rehabilitation options because they involve motivating, full-body movement practice. However, these games were designed for recreational use, which creates challenges for clinical implementation. Busy clinicians require decision-making support to inform game selection an...

Objectives The scoping review has become increasingly popular as a form of knowledge synthesis. However, a lack of consensus on scoping review terminology, definition, methodology, and reporting limits the potential of this form of synthesis. In this article, we propose recommendations to further advance the field of scoping review methodology. St...

The chapter summarizes the rationale and evidence for attributes of VR technology that target the motor learning variables of practice, augmented feedback, motivation, and observational learning. The potential for motor learning achieved with VR-based therapy to transfer and generalize to the tasks in the physical environment is discussed. Recommen...

ABSTRACT Adolescents with mild traumatic brain injuries (MTBI) are at substantial risk for repeat injury if they return to activity too soon. Post-concussion symptoms and impaired balance are two factors that limit return to activity. Post-injury assessments that challenge activity tolerance and balance skills are needed to ensure readiness to retu...

Virtual reality (VR) systems are promising treatment options for physical therapists (PTs) and occupational therapists (OTs) in stroke rehabilitation because they incorporate motor learning principles of task-oriented, challenging, and motivating practice. However, clinicians face challenges when integrating VR into clinical practice, including lim...

Virtual reality (VR) technology holds great promise for stroke rehabilitation. However, clinicians face challenges when integrating VR into clinical practice, including the limited availability of training to implement VR-based therapy using a motor learning approach. This poster describes a study in which a knowledge translation (KT) strategy desi...

Introduction: Developmental Coordination Disorder (DCD) is a common, chronic health condition that often goes unrecognized, yet research evidence indicates that children with DCD are at high risk for secondary physical health (obesity) and mental health issues (depression, anxiety). Early identification and intervention is required to enhance child...

The Nintendo Wii is a popular virtual reality (VR) video gaming system in rehabilitation practice and research. As evidence emerges related to its effectiveness as a physical therapy training method, clinicians require information about the pragmatics of its use in practice. The purpose of this descriptive qualitative study is to explore observatio...

PURPOSE:: To evaluate and compare the interrater reliability of the Motor Learning Strategy Rating Instrument (MLSRI) within usual and virtual reality (VR) interventions for children with acquired brain injury. METHODS:: Two intervention sessions for each of 11 children (total, 22) were videotaped; sessions were provided by 4 physical therapists. V...

The use of virtual reality (VR) systems within physical rehabilitation clinical practice and research is rapidly developing, highlighting the need for consensus as to the meaning and relevance of the label "VR therapy". The purpose of this communication is to argue that explicit examination of the inferences underlying this label and discussion reg...

The use of Interactive Computer Play (ICP) in rehabilitation is developing rapidly and is especially promising in interdisciplinary pediatric rehabilitation. This case report examines how the Nintendo Wii® can be used in the rehabilitation of an adolescent with Acquired Brain Injury (ABI). In particular it describes the use of the Nintendo Wii in a...

To evaluate reliability and feasibility of the Motor Learning Strategy Rating Instrument (MLSRI) in children with acquired brain injury (ABI). The MLSRI quantifies the extent to which motor learning strategies (MLS) are used within physiotherapy (PT) interventions. PT sessions conducted by ABI team physiotherapists with a convenience sample of chil...

Rehabilitation researchers who investigate complex interventions are challenged to describe the "active ingredients" of their interventions: the reason(s) why a treatment is expected to be effective. Interactive Computer Play (ICP) is an emerging complex intervention in rehabilitation practice and research. The purpose of this scoping review is to...

Developmental coordination disorder (DCD) is a common, chronic health condition that is poorly recognized and understood in school settings. Without appropriate support, children with DCD are at increased risk of depression, decreased fitness, and obesity. Evidence shows that occupational therapy intervention needs to shift from remediation of impa...

Little is known about how therapists promote learning of functional motor skills for children with acquired brain injuries. This study explores physiotherapists' description of these interventions in comparison to virtual reality (VR) video game-based therapy. Six physiotherapists employed at a children's rehabilitation center participated in semi-...

Multiple virtual reality (VR) systems are used to improve motor function in children and youth with neurological impairments. Galvin and Levac developed a classification framework to facilitate clinical decision-making about VR system use. This paper applies the classification framework to identify its strengths and limitations. The classification...

To explore the perceptions of people with spinal cord injury (SCI) regarding preferred messengers and methods for obtaining physical activity (PA) information. Using a phenomenological approach and interviewing techniques, five focus groups discussed PA information delivery methods and messengers. Sixteen community-dwelling adults with SCI (62.5% t...

The use of virtual reality (VR) as a therapeutic intervention to improve motor function is an emerging area of rehabilitation practice and research. This paper describes VR systems reported in research literature and proposes a classification framework that categorizes VR systems according to characteristics relevant to motor rehabilitation. A comp...

A goal of physical therapy interventions for children and youth with acquired brain injury (ABI) is the learning and relearning of motor skills. Therapists can apply theoretically derived and evidence-based motor learning strategies (MLSs) to structure the presentation of a task and organize the environment in ways that may promote effective, trans...

There is increasing interest in the use of commercially-available virtual reality video gaming systems within pediatric rehabilitation, yet little is known about the movement characteristics of game play. This study describes quantity and quality of movement during Nintendo Wii and Wii Fit game play, explores differences in these movement character...

Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides an excellent foundation for scoping study methodology, further clarifying and enhancing this framework will help support t...

To identify and describe the application of 3 motor learning strategies (verbal instructions, practice, and verbal feedback) within 4 intervention approaches (cognitive orientation to daily occupational performance, neuromotor task training, family-centered functional therapy, and activity-focused motor interventions). A scoping review of the liter...

A theoretical framework can help physiotherapists understand and promote recovery of function in children and youth with acquired brain injuries (ABI). Physiotherapy interventions for this population have traditionally been based in hierarchical-maturational theories of motor development emphasizing the role of the central nervous system (CNS) in c...

To determine the relationship between the amount of intra-individual variability in measures of abilities and participation throughout the first 8 months of recovery from ABI and outcome scores at 1 year. Greater amounts of intra-individual variability throughout recovery are hypothesized to predict better outcome scores at 1 year. This is a second...

Introduction: Children with acquired brain injury (ABI) receive physiotherapy interventions to promote motor skill relearning. Theoretically-driven motor learning strategies (MLS) may support therapists in this goal, but their use with this complex population is unexplored. Virtual reality (VR) games are popular interventions that may influence the...