Virtual Reality Training May Improve Quality of Care in Lower Limb Spasticity With OnabotulinumtoxinA


Results from pilot program using a VR-based platform suggest medical trainees may benefit from further VR training to gain a complete baseline knowledge of treating lower limb spasticity with onabotulinumtoxinA.

Erin McGonigle Ketchum, MD, assistant professor, Medical College of Wisconsin, Froedtert Hospital

Erin McGonigle Ketchum, MD

Based on results from a recent pilot program, medical trainees could provide higher quality care by improving their knowledge on treating lower limb spasticity (LLS) with onabotulinumtoxinA through trainings done on a VR-based platform. Findings show that the percentage of participants who identified all the correct responses for treating LLS with onabotulinumtoxinA from pre- to post-VR-training almost doubled.1

The participants in the pilot program were asked about possible functions of the flexor digitorum longus, for which the change in improvement from pre- to post-VR training was 12% vs 22%. Also, when the participants were asked about what muscles to consider injecting in a hypothetical poststroke patient, the result came to an improvement percentage of 21% versus 40% in comparison from pre- to post-VR training. The authors concluded that having medical trainees with more experience and knowledge on injector training when using onabotulinumtoxinA for LLS may help with treatment outcomes and adverse events.

Presented at the 2022 American Association of Neuromuscular & Electrodiagnostic Medicine Annual Meeting, held September 21-24, in Nashville, Tennessee, study author Erin McGonigle Ketchum, MD, assistant professor, Medical College of Wisconsin, Froedtert Hospital, and colleagues’ data showed the participants who were very comfortable with localization of LL muscles increased from 8% pre-VR-training to 14% post-VR training. McGonigle et al noted that the VR-based platform employs “an immersive experience with haptic technology was designed to train on onabotulinumtoxinA use for LLS to increase treatment consistency and enhance injection competency.”

During the pre-VR training experience, the percent of participants who indicated that a VR-based training tool would be very useful was 46%, and for those who thought it was extremely useful came to 34%. Additionally, the percentages of the post-VR-training responses were 33% and 52%, respectively.1 The percent of participants that felt that the top beneficial features were the realistic feel of needle insertion/removal was 82%, and while 79% of participants felt this way about the ability to use injection guidance.

The pilot program began in December 2020 and ended in August 2021 and was made up of US-based medical trainees who underwent 1-on-1 training on LL anatomy and injection guidance. They were then assessed on the platform through the use of pre- and post-training surveys. The participants consisted of medical students (n = 6), residents (n = 124), and fellows (n = 10) 21 academic centers completed pre-VR-training surveys and 111 completed post-VR-training surveys. As for the duration per VR session, the average learning time was about 43 minutes.

McGonigle and colleagues noted that for future treatment with onabotulinumtoxina for LLS, medical trainees could benefit from strengthening their skills in duration, optimizing their training experience, to provide the best quality of care for patients. Other additional interventions or trainings for medical trainees over the cause of improving the quality of treatment for LLS need to be defined through more research.

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1. McGonigle E, Downie S, Esquenazi A, et al. A Virtual Reality Platform to Facilitate Training on Treatment of Lower Limb Spasticity with Onabotulinumtoxina. Presented at: AANEM 2022; September 21-24; Nashville, TN. Abstract 90.
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