Discussion Guide for the Olson Article

Stroke remains a leading cause of long-term disability, with more than half of survivors needing multidisciplinary rehabilitation. Early, intensive therapy can boost functional results, but many acutely or critically ill stroke patients get little to no rehabilitation during this vital recovery period. Virtual reality (VR) provides an immersive, feedback-oriented method that can complement traditional therapy and boost patient engagement. Although VR has shown potential in subacute and chronic stroke rehabilitation, its feasibility in the acute phase and across different age groups has not been thoroughly studied.To assess the feasibility and acceptance of using VR for patients hospitalized with acute stroke and examine how generational factors might affect the adoption of technology-based rehabilitation in critical care.This prospective, nonrandomized pilot study enrolled adults admitted to the neuroscience intensive care unit or the acute stroke unit during the early phase of stroke. Eligible participants had movement in at least 1 upper limb and were from the Baby Boomer, Generation X, or Millennial age groups. Patients with visual impairments or medical devices that prevented headset use were excluded. After giving verbal consent, participants were shown how to use the Meta Quest VR system and engaged in a 5-minute session of Beat Saber. Right after that, they completed the 4-item Feasibility of Intervention Measure (FIM) and Acceptability of Intervention Measure (AIM), both rated on 5-point Likert scales. Data were analyzed with SAS v9.4, using χ2 and Kruskal-Wallis tests to compare feasibility and acceptability across different generational groups.Thirty patients participated in the pilot study: 21 Baby Boomers (70%) and 9 Generation X adults (30%), with no eligible Millennials during the study. The mean time since stroke was 3.3 days. The groups were similar in race, ethnicity, and stroke details, although Generation X participants were mostly male (78% vs 43%, P < .001). Five patients (17%) removed the headset before completing the 5-minute VR session, citing fatigue or discomfort. Among those who completed the study, FIM and AIM scores were generally positive and did not differ significantly between groups. Mean (SD) FIM scores were 16.7 (5.9) for Generation X and 16.5 (3.4) for Baby Boomers (P = .29), whereas AIM scores were 17.3 (6.0) and 16.9 (4.2), respectively (P = .25). These results suggest that VR was well tolerated and viewed as feasible and acceptable in stroke patients of all ages.The study demonstrated that VR is both feasible and acceptable for patients recovering from acute stroke in a critical care setting. Baby Boomers and Generation X participants showed comparable favorability, suggesting that age cohort did not influence tolerance or engagement. Despite the presence of neuromonitoring and life-support equipment, most patients completed the 5-minute VR session without adverse effects, indicating that immersive technologies can be safely implemented early in stroke recovery. Findings support the potential integration of VR as an adjunct to conventional rehabilitation, highlighting the opportunity for nurses and physical or occupational therapists to incorporate brief, gamified exercises to enhance patient participation. Future studies should evaluate younger age groups and examine the effects of longer or repeated VR sessions on functional recovery.From using pagers to keep families informed to installing televisions in every room in the unit, DaiWai Olson, PhD, RN, has watched technology reshape critical care during his 40 years in neurocritical care. The emergence of VR and its promise in post–acute stroke care seemed like the next frontier: a new way to blend innovation with rehabilitation. “External stakeholders expressed concerns that only younger patients would use VR, so we set out to generate evidence,” he explains. His current team includes about 17 members spanning nursing students, research coordinators, new and seasoned nurses, medical students, residents, and physicians. “Each person brings unique strengths and perspectives, and that diversity is one of our greatest assets,” he says. Collaboration is not always smooth, though: “Nurses often undervalue their own professional insight. The nursing perspective is essential, and we need to recognize and advocate for its importance.” For Olson, the team’s success lies in balancing humility with confidence, honoring hierarchy without surrendering authority. “Nurses know the problems at the bedside,” he says. “We need to own our knowledge and our role in advancing care.”This study shows that VR can be safely and feasibly introduced in patients recovering from stroke in acute care settings. “Our findings showed that age is not a predictor of VR engagement—a critical insight because stroke affects people of all ages,” explains Dr Olson. Bedside nurses, physical therapists, and occupational therapists can incorporate short, guided VR sessions to supplement traditional rehabilitation early in recovery, using the same monitoring and safety practices already in place for other therapies. Dr Olson sees this study as the start of a larger movement: “We are not the first to explore VR in health care, and we won’t be the last—but that’s the point. Our goal is to understand how technology can enhance patient care.” He envisions nursing teams playing a central role in shaping how VR is adapted to the bedside, determining optimal session length, identifying content that promotes motor or cognitive recovery, and designing nurse-led VR modules tailored to patient needs. “Virtual reality has barely touched the medical community,” he adds. “We’re just beginning to scratch the surface of this exciting new tool to help our patients.”This feature briefly describes the personal journey and background story of the EBR article’s lead investigators, discussing the circumstances that led them to undertake the line of inquiry represented in the research article featured in this issue.DaiWai Olson, PhD, RN, has been a nurse since 1986, moving from a float assignment in Davenport, Iowa, to a lifelong career in neurocritical care. “I’ve always loved a good argument and a good challenge,” he says—a mindset that has guided his evolution from bedside clinician to nationally recognized nurse scientist and mentor. His curiosity first translated into research through a simple question about family visitation, which became an AACN-funded project using pagers to keep families informed. That early success, followed by his work on “Quiet Time” in a neuroscience intensive care unit, revealed what he now calls both nursing’s greatest limitation and opportunity: “We lack strong evidence for the vast majority of bedside interventions—but that gap means we can start fresh.” Olson believes the future of nursing science depends on persistence and mentorship. He encourages new investigators to seek guidance, learn methods, and contribute their own perspectives: “Senior researchers, myself included, see things through our own lens. You may notice something we’ve overlooked.”