Date of Award

Fall 2012

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Rehabilitation Science


Cheryl Missiuna



Committee Member

Carol DeMatteo, Laurie Wishart, Virginia Wright


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 therapist use of MLS. A valid, reliable method to examine MLS during usual and VR-based interventions is required.

Purpose: To: 1) identify the active ingredients of VR interventions; 2) develop and examine the psychometric properties of an instrument to measure MLS use; and 3) explore physiotherapists’ perspectives on promoting motor learning within usual and VR-based interventions for children with ABI.

Methods: A scoping review methodology was used to identify the active ingredients of VR interventions. Nineteen experts and clinicians participated in a content validation process to develop an instrument to measure MLS. Inter-rater reliability of the instrument was evaluated within 22 videotaped usual and VR-based physiotherapy sessions with children with ABI. Six therapists participated in qualitative interviews about these interventions.

Results: The scoping review identified 11 active ingredients of VR; 6 related to motor learning theory. The Motor Learning Strategy Rating Instrument (MLSRI) was developed. Inter-rater reliability was high (0.81) for usual interventions but low (0.28) for VR-based interventions. Therapists described the importance of considering intervention goals and child characteristics when promoting motor learning; VR was viewed as a complex, motivating intervention that influenced their use of verbal strategies.

Conclusions: A motor learning theoretical framework may be relevant to clinicians and researchers using VR in pediatric rehabilitation. Qualitative findings enhance understanding of how therapists promote motor learning in usual and VR-based physiotherapy interventions for children withABI. The use of MLS can be measured reliably within usual interventions, but further instrument refinements are required to rate MLS use within VR-based physiotherapy for children with ABI.

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