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PURPOSE. The purpose of this study is to evaluate the feasibility and users' perspectives of a novel virtual reality (VR) game-based rehabilitation intervention for people with stroke. METHOD. Six people with upper limb hemiplegia participated in a 6-week intervention that involved VR games. A series of eight progressively complex games was developed that required participants to navigate a submarine in a virtual ocean environment. Movement of the submarine was directed by forces applied to an arm interface by the affected limb. Outcome measures included assessments of arm function, questionnaires evaluating the intervention and a semi-structured interview concerning the participants' opinion of the intervention. RESULTS. All participants improved their performance on the games, although there were limited changes in clinical measures of arm function. All participants reported that they enjoyed the intervention with a wide range of overall perceptions of the experience of using VR. Three themes emerging from the interview data were: stretching myself, purpose and expectations of the intervention and future improvements. CONCLUSIONS. Participants found that taking part in this pilot study was enjoyable and challenging. Participants' feedback suggested that the games may be motivating and engaging for future users and have provided a basis for further development of the intervention.

In a highly variable population of older adults with mobility limitations, low-intensity functional home exercise of repeated sit-to-stands using the GrandStand System improved Berg Balance Scale score while low-intensity progressive resistance training did not. While statistically significant, the improvement in Berg Balance Scale score was modest raising the issue of what extent of change in score is clinically significant in this population.

ObjectiveTo enhance understanding of the experiences of ageing with cerebral palsy (CP) in adulthood with a particular focus on experiences with health services.DesignA qualitative descriptive methodology was applied to capture adults' views of ageing with CP and related interactions with health services. Semistructured interviews were undertaken with data systematically coded and interpreted by grouping information into categories. Themes that encompassed the categories were identified through thematic analysis.SettingAll healthcare settings.Participants28 adults (14 women) with CP, aged 37–70 years.Results5 themes covered the breadth of participants' experiences: (1) acceptance of change; (2) exploring identity: cerebral palsy as only one part of self; (3) taking charge of help; (4) rethinking the future and (5) interacting with health professionals. Being seen and being heard were the features described in positive healthcare interactions. Participants also valued health professionals who reflected on who holds the knowledge?; demonstrated a willingness to learn and respected participants' knowledge and experience.ConclusionsOur findings could, and arguably should, inform more responsive strategies for disabled people in health services and, indeed, all health consumers. Our study supports other findings that impairments related to CP change and, for many, severity of disabling impact increases with age. Increased interactions with health and rehabilitation professionals, as a consequence of these changes, have the potential to impact the person's healthcare experience either positively or negatively. A ‘listening health professional’ may bridge their knowledge gap and, in recognising the person's own expertise, may achieve three things: a more contextualised healthcare intervention; a better healthcare experience for the person with CP and positive impact on the person's sense of autonomy and identity by recognising their expertise. Future research should identify whether this approach improves the healthcare experience for adults living with CP.

Aims The high-level mobility assessment tool (HiMAT) was originally developed to quantify the physical ability of young people with TBI. The aims of this study were to determine the retest reliability and normative HiMAT values for young healthy adults. Known HiMAT normative scores may facilitate clinical decision making and goal setting in independently mobile people with traumatic brain injury as they provide a target for re-attaining pre-injury mobility levels Methods One hundred and three people, aged 18-25 years, were recruited. A sub-group of 59 participants completed repeat testing to investigate test-retest reliability. Findings Retest reliability measured using intraclass correlation coefficients was high (ICC (2,1)=0.88, 95% CI 0.82-0.92) with low typical error (0.95; 95% CI 0.85-1.09). The results of the Friedman test indicated that there was no significant difference between HiMAT test scores across the three time points for males, x2 (2, n=28)=4.04, P=0.13, or females, x2 (2, n=30)=4.52, P=0.11 indicating no practice effect had occurred. Males scored significantly higher than females. The median HiMAT score for males was 54/54 (inter-quartile range 53–54) and the 5th percentile was 50. For females, the median HiMAT score was 51/54 (inter-quartile range 48–53) and the 5th percentile was 44. A ceiling effect was evident for males as 52.1% achieved the maximum score. Conclusions The HiMAT has high retest reliability in the normal population and is susceptible to a ceiling effect for males, but not for females. Normative data provided in this study may aid clinicians to establish patient goals relative to the expected normal performance on this measure.