Abstract Details

OnabotulinumtoxinA is safe and effective for treating lower limb spasticity (LLS). Treatment outcomes and adverse events may be affected by injector training and experience. Treatment of LLS with onabotulinumtoxinA requires an understanding of muscle anatomy, dosing, and injection techniques.

To assess the benefits of a virtual reality (VR)–based training platform.

A VR-based platform employing an immersive experience with haptic technology was designed to provide training on the use of onabotulinumtoxinA for LLS to increase treatment consistency and enhance knowledge and injection competency. In a pilot program conducted from December 2020 through August 2021, US-based medical trainees underwent one-on-one training on lower limb anatomy and injection guidance, then assessed the platform by completing pre- and post-training surveys. 

Six medical students, 124 residents, and 10 fellows from 21 academic centers completed pre−VR-training surveys; 111 completed post−VR-training surveys. Average learning time per VR session was ~43 minutes. The percentage of participants who were very comfortable with localization of lower limb muscles increased from 8% pre−VR-training to 14% post−VR-training. Percentages of participants identifying all correct responses almost doubled from pre−VR-training to post−VR-training when asked about possible functions of the flexor digitorum longus (12% vs 22%) and what muscles to consider injecting in a hypothetical poststroke patient (21% vs 40%). Pre−VR-training, 46% and 34% of respondents indicated that a VR-based training tool would be very or extremely useful, respectively; post−VR-training responses were 33% and 52%, respectively. Top features participants found beneficial were the realistic feel of needle insertion/removal (82%) and the ability to use injection guidance (79%).

Preliminary results suggest medical trainees have incomplete baseline knowledge and the potential need for additional training experience, for which VR may be useful. VR training duration and additional interventions to optimize training need to be defined.