Cognitive Telerehabilitation Research Articles

The Impact of Different Telerehabilitation Methods on Peripheral Muscle Strength and Aerobic Capacity in COPD Patients: A Randomized Controlled Trial.

Lung diseases have profound effects on the aging population. We aimed to hypothesize and investigate the effect of remote pulmonary telerehabilitation and motor imagery (MI) and action observation (AO) methods on the clinical status of elderly chronic obstructive pulmonary disease (COPD) patients. Twenty-six patients were randomly assigned to pulmonary telerehabilitation (PtR) or cognitive telerehabilitation (CtR) groups. The programs were carried out 3 days a week for 8 weeks. The 6-min walk test (6MWT), modified Medical Research Council dyspnea score, blood lactate level (BLL), measurement of peripheral muscle strength (PMS), and electromyography activation levels of accessory respiratory muscles were the main outcomes. There was a statistically significant improvement (p < 0.05) in both groups in the 6MWT distance and in secondary results, except for BLL. Generally, in the mean muscle activity obtained from the electromyography measurement after the program, there were statistically significant increases in the PtR group and decreases in the CtR group (p < 0.05). There was a statistically significant increase in PMS in both groups. An active muscle-strengthening program has the same benefits as applying the muscle-strengthening program to the patient as MI and AO. CtR can be a powerful alternative rehabilitation method in respiratory patients who cannot tolerate active exercise programs.

Long-lasting improvements in episodic memory among subjects with mild cognitive impairment who received transcranial direct current stimulation combined with cognitive treatment and telerehabilitation: a multicentre, randomized, active-controlled study.

In recent years, an increasing number of studies have examined the potential efficacy of cognitive training procedures in individuals with normal ageing and mild cognitive impairment (MCI). The aims of this study were to (i) evaluate the efficacy of the cognitive Virtual Reality Rehabilitation System (VRRS) combined with anodal transcranial direct current stimulation (tDCS) applied to the left dorsolateral prefrontal cortex compared to placebo tDCS stimulation combined with VRRS and (ii) to determine how to prolong the beneficial effects of the treatment. A total of 109 subjects with MCI were assigned to 1 of 5 study groups in a randomized controlled trial design: (a) face-to-face (FTF) VRRS during anodal tDCS followed by cognitive telerehabilitation (TR) (clinic-atDCS-VRRS+Tele@H-VRRS); (b) FTF VRRS during placebo tDCS followed by TR (clinic-ptDCS-VRRS+Tele@H-VRRS); (c) FTF VRRS followed by cognitive TR (clinic-VRRS+Tele@H-VRRS); (d) FTF VRRS followed by at-home unstructured cognitive stimulation (clinic-VRRS+@H-UCS); and (e) FTF cognitive treatment as usual (clinic-TAU). An improvement in episodic memory was observed after the end of clinic-atDCS-VRRS (p < 0.001). We found no enhancement in episodic memory after clinic-ptDCS-VRRS or after clinic-TAU.Moreover, the combined treatment led to prolonged beneficial effects (clinic-atDCS-VRRS+Tele@H-VRRS vs. clinic-ptDCS-VRRS+Tele@H-VRRS: p = 0.047; clinic-atDCS-VRRS+Tele@H-VRRS vs. clinic-VRRS+Tele@H-VRRS: p = 0.06). The present study provides preliminary evidence supporting the use of individualized VRRS combined with anodal tDCS and cognitive telerehabilitation for cognitive rehabilitation. https://clinicaltrials.gov/study/NCT03486704?term=NCT03486704&rank=1, NCT03486704.

A Review on the Feasibility and Efficacy of Home-Based Cognitive Remediation in People with Multiple Sclerosis.

Cognitive impairment affects 34-65% of People with Multiple Sclerosis (PwMS), significantly impacting their quality of life. Clinicians routinely address cognitive deficits with in-clinic neuro-behavioural interventions, but accessibility issues exist. Given these challenges, coupled with the lifelong need for continuous assistance in PwMS, researchers have underscored the advantageous role of telerehabilitation in addressing these requirements. Nonetheless, the feasibility and efficacy of home-based cognitive remediation remain to be firmly established. In this narrative review, we aimed to investigate the feasibility and efficacy of digital telerehabilitation for cognition in PwMS. Thirteen relevant studies were identified and carefully assessed. Regarding the feasibility of cognitive telerehabilitation, evidence shows adherence rates are generally good, although, surprisingly, not all studies reported measures of compliance with the cognitive training explored. Considering the efficacy of rehabilitative techniques on cognitive performance in PwMS, findings are generally inconsistent, with only one study reporting uniformly positive results. A range of methodological limitations are reported as potential factors contributing to the variable results. Future research must address these challenges, as more rigorous studies are required to draw definitive conclusions regarding the efficacy of home-based cognitive remediation in PwMS. Researchers must prioritise identifying optimal intervention approaches and exploring the long-term effects of telerehabilitation.

The Effects of Exergame Telerehabilitation in Persons With Subjective Cognitive Decline.

The primary aim of this Stage IB randomized controlled trial (RCT) was to test the preliminary effects of a dual-task exergaming telerehabilitation intervention on cognition and aerobic fitness, compared to aerobic exercise (AEx) only and attention control (stretching) in older adults with subjective cognitive decline. This RCT randomized 39 participants on a 2:1:1 allocation ratio to supervised exergame (n = 20), AEx (n = 11), and stretching (n = 8) for 12 weeks. The dual-task exergaming was concurrent moderate-intensity cycling and BrainFitRx cognitive telerehabilitation. Cognition was assessed by NIH Toolbox Cognitive Battery and aerobic fitness by 6-minute walk test (6MWT) and shuttle walk test. The participants were 74.6 (7.4) years old and 69% were female. The effect of time was significant, F(1, 23.9) = 13.16, p = .001, for the Fluid Composite score, and significant within-group changes were seen for the exergame group, t(14.08) = 2.53, p = .024, d = 0.33. Between-group changes did not reach significant levels for any cognitive test. Between-group changes for the 6MWT were not significant. The exergame participants further improved their fluid cognition, whereas the AEx and stretching groups did not, indicating a potential synergistic effect from AEx and cognitive training. The aerobic fitness changes were similar between the exergame and AEx-only groups, indicating that the feasibility of adding cognitive training to AEx concurrently without sacrificing gains in aerobic fitness from AEx. This study shows the flexibility of exergame delivery and its potentially therapeutic effects in persons at risk for Alzheimer's dementia. NCT04311736.

Cognitive telerehabilitation: an expert consensus paper on current evidence and future perspective.

The progressive improvement of the living conditions and medical care of the population in industrialized countries has led to improvement in healthcare interventions, including rehabilitation. From this perspective, Telerehabilitation (TR) plays an important role. TR consists of the application of telemedicine to rehabilitation to offer remote rehabilitation services to the population unable to reach healthcare. TR integrates therapy-recovery-assistance, with continuity of treatments, aimed at neurological and psychological recovery, involving the patient in a family environment, with an active role also of the caregivers. This leads to reduced healthcare costs and improves the continuity of specialist care, as well as showing efficacy for the treatment of cognitive disorders, and leading to advantages for patients and their families, such as avoiding travel, reducing associated costs, improving the frequency, continuity, and comfort of performing the rehabilitation in its own spaces, times and arrangements. The aim of this consensus paper is to investigate the current evidence on the use and effectiveness of TR in the cognitive field, trying to also suggest some recommendations and future perspectives. To the best of our knowledge, this is the first consensus paper among multiple expert researchers that comprehensively examines TR in different neurological diseases. Our results supported the efficacy and feasibility of TR with good adherence and no adverse events among patients. Our consensus summarizes the current evidence for the application of cognitive TR in neurological populations, highlighting the potential of this tool, but also the limitations that need to be explored further.

Smartphone-Based Cognitive Telerehabilitation: A Usability and Feasibility Study Focusing on Mild Cognitive Impairment.

The implementation of cognitive health apps in patients with mild cognitive impairment (MCI) is challenging because of their cognitive, age, and other clinical characteristics. In this project, we aimed to evaluate the usability and feasibility of the Rehastart app tested in MCI patients. Eighteen subjects affected by MCI due to neurodegenerative disorders (including Parkinson's disease, multiple sclerosis, and amnestic/multidomain MCI) and eighteen healthcare professionals were recruited to this study. Patients were registered on the app by clinicians and they were assigned a protocol of specific cognitive exercises. The recruitment was conducted in the period between March and June 2023. The trial testing of the app consisted of three sessions per week for three weeks, with each session lasting about 30 min. After three weeks, the participants as well as medical personnel were invited to rate the usability and feasibility of the Rehastart mobile application. The instruments employed to evaluate the usability and feasibility of the app were the System Usability Scale (SUS), The Intrinsic Motivation Inventory (IMI) and the Client Satisfaction Questionnaire (CSQ). We did not find statistically significant differences on the SUS (p = 0.07) between healthcare professionals and patients. In addition, we found promising results on subscales of the Intrinsic Motivation Inventory, suggesting high levels of interest and enjoyment when using the Rehastart app. Our study demonstrated that smartphone-based telerehabilitation could be a suitable tool for people with MCI due to neurodegenerative disorders, since the Rehastart app was easy to use and motivating for both patients and healthy people.

Exploring the neural and behavioral correlates of cognitive telerehabilitation in mild cognitive impairment with three distinct approaches.

Currently, the impact of drug therapies on neurodegenerative conditions is limited. Therefore, there is a strong clinical interest in non-pharmacological interventions aimed at preserving functionality, delaying disease progression, reducing disability, and improving quality of life for both patients and their caregivers. This longitudinal multicenter Randomized Controlled Trial (RCT) applies three innovative cognitive telerehabilitation (TR) methods to evaluate their impact on brain functional connectivity reconfigurations and on the overall level of cognitive and everyday functions. We will include 110 participants with mild cognitive impairment (MCI). Fifty-five participants will be randomly assigned to the intervention group who will receive cognitive TR via three approaches, namely: (a) Network-based Cognitive Training (NBCT), (b) Home-based Cognitive Rehabilitation (HomeCoRe), or (c) Semantic Memory Rehabilitation Training (SMRT). The control group (n = 55) will receive an unstructured home-based cognitive stimulation. The rehabilitative program will last either 4 (NBTC) or 6 weeks (HomeCoRe and SMRT), and the control condition will be adapted to each TR intervention. The effects of TR will be tested in terms of Δ connectivity change, obtained from high-density electroencephalogram (HD-EEG) or functional magnetic resonance imaging at rest (rs-fMRI), acquired before (T0) and after (T1) the intervention. All participants will undergo a comprehensive neuropsychological assessment at four time-points: baseline (T0), within 2 weeks (T1), and after 6 (T2) and 12 months (T3) from the end of TR. The results of this RCT will identify a potential association between improvement in performance induced by individual cognitive TR approaches and modulation of resting-state brain connectivity. The knowledge gained with this study might foster the development of novel TR approaches underpinned by established neural mechanisms to be validated and implemented in clinical practice.Clinical trial registration: [https://classic.clinicaltrials.gov/ct2/show/NCT06278818], identifier [NCT06278818].

Enhancing the Quality of Life of Patients with Multiple Sclerosis: Promising Results on the Role of Cognitive Tele-Rehabilitation Plus Virtual Reality.

(1) Background: Patients with multiple sclerosis often face obstacles accessing traditional rehabilitation programs, primarily due to mobility limitations. Tele-rehabilitation (TR) is seen as a promising solution to overcome these barriers, though its precise influence on patients' quality of life (QoL) has not been thoroughly investigated. Thus, the aim of the present study was to assess the feasibility of a cognitive TR in a sample of Italian patients with MS. (2) Methods: Thirty-six patients diagnosed with MS, attending the Robotic and Behavioral Neurorehabilitation Unit of the IRCCS "Bonino-Pulejo" Neurolesi Center in Messina, Italy, between October 2019 and March 2020 were enrolled in the study. All patients were randomly assigned, using block randomization with a block size of 2 × 2, to two groups: the control group (CG), composed of 16 patients who received traditional cognitive training, and the experimental group (EG), composed of 20 patients who underwent TR training with a VRRS (virtual reality rehabilitation system). Each patient underwent an assessment before (T0) and immediately after (T1) the rehabilitation treatment, using the Quality of Life-54 Multiple Sclerosis (MSQoL-54). (3) Results: Only in the EG, we observed a statistically significant improvement in the QoL related to mental well-being following the paired T-test (MSQoL p-value < 0.001). Notably, no significant differences were found in the CG (MSQoL p-value of 0.67). (4) Conclusions: Our data suggest that TR training combined with VR has the potential to improve the well-being of individuals with MS.

Virtual coach and telerehabilitation for Parkinson´s disease patients: vCare system

Abstract Aim The vCare system is a virtual coach that involves physical and cognitive telerehabilitation and a daily life monitoring system. This pilot study aims to evaluate the vCare pilot test for Parkinson’s disease (PD) patients and to analyze the usability and the satisfaction level of patients and their quality of life (QoL). Subject and methods Twenty PD patients were randomized, 10 patients into the vCare group focused on personalized home telerehabilitation [motor and cognitive rehabilitation (4 days/week for 4 months)], while the control group (10 patients) continued the clinical standard at the clinic. A pre-post clinical evaluation and a cost-utility study were performed. Results Repeated measures ANOVA showed significant improvement in the PD vCare group compared to the control group (p&lt;.05). Specifically, the PD vCare group showed significant improvement in cognition (p=.016), and QoL dimensions of mobility (p=.008), self-care (p=.008), daily activities (p=.010) and pain/discomfort (p=.004) at post-treatment. vCare PD patients showed high adherence to the vCare system (90.5-100%). Costs per patient in the control group were higher (€5,108.26) than in the vCare group (€2,243.07). Conclusion The PD vCare group significantly increase their QoL, cognition, motor symptoms, and daily life activities compared to the control group. Patients showed high adherence to the vCare coach, the care plan, rehabilitation, and devices. The vCare system seems to be an optimal and cost-effective tool for telerehabilitation in PD.

In person versus remote cognitive rehabilitation in patients with subjective cognitive decline or neurocognitive disorders: what factors drive patient's preference?

To date, there is still a lack of consensus for identifying the ideal candidate for cognitive telerehabilitation (TR). The main goal of the present study is to identify the factors associated to the preference for either TR or in-person cognitive training (CT) programs in older adults at risk of dementia or with early cognitive impairment. A sample of 56 participants with subjective cognitive decline or neurocognitive disorders eligible for CT were enrolled at the Dementia Research Center and Neurorehabilitation Unit of IRCCS Mondino Foundation. All individuals underwent a baseline assessment to capture their complete profile, including cognitive reserve and lifestyle habits, sociodemographic characteristics, cognitive functioning, and mental health. Patients were then asked their preference for TR or in-person CT, before being randomized to either treatment as per protocol procedures. Statistical analyses included explorative descriptive approach, logistic regression, and non-parametric models to explore the overall contribution of each variable. The two (TR and in-person) preference groups were similar for cognitive functioning and mental health status. Socio-demographic and lifestyle profiles seem to be the most important factors to influence the preference in terms of the area under the curve (AUC) of the models. The two preference groups differed in terms of socio-demographic characteristics (e.g., level of technological skills, age, and distance from the clinic). Furthermore, participants who selected the TR modality of CT had significantly higher levels of cognitive reserve and adopted more protective lifestyle habits (e.g., regular physical activity, Mediterranean diet) when compared to those who preferred in-person CT. These findings highlight that the preference to receive CT delivered by TR or in person is a complex issue and is influenced by a variety of factors, mostly related to lifestyle habits and sociodemographic characteristics. Availability of profiles of patients that may be more attracted to one or the other modality of TR may help promote shared decision-making to enhance patient experience and outcomes.

Effectiveness of cognitive rehabilitation on mild cognitive impairment using teleneuropsychology.

To measure the effects of cognitive telerehabilitation on cognition, neuropsychiatric symptoms, and memory strategies in a cohort of patients with mild cognitive impairment. A sample of 60 patients with mild cognitive impairment according to Petersen's criteria was randomly divided into two groups: 30 treatment cases and 30 controls (waiting list group). Subjects were matched by age, sex, and Montreal Cognitive Assessment. The treatment group received ten cognitive telerehabilitation sessions of 45 minutes duration once a week. Pre-treatment (week 0) and post-treatment (week 10) measures were assessed for both groups. Different linear mixed models were estimated to test treatment effect (cognitive telerehabilitation vs. controls) on each outcome of interest over time (pre/post-intervention). A significant group (control/treatment) x time (pre/post) interaction revealed that the treatment group at week 10 had better scores in cognitive variables: memory (RAVLT learning trials p=0.030; RAVLT delayed recall p=0.029), phonological fluency (p=0.001), activities of daily living (FAQ p=0.001), satisfaction with memory performance (MMQ satisfaction p=0.004) and use of memory strategies (MMQ strategy p=0.000), as well as, and a significant reduction of affective symptomatology: depression (GDS p=0.000), neuropsychiatric symptoms (NPI-Q p=0.045), forgetfulness (EDO-10 p=0.000), and stress (DAS stress p=0.000). Our study suggests that CTR is an effective intervention.

Implementation of Cognitive Telerehabilitation during COVID-19 Pandemic

Objective(s)The purpose of this systematic review was to examine the effectiveness of implementing cognitive telerehabilitation during the Coronavirus pandemic.Data SourcesThis review was conducted using the following databases: Taylor & Francis, Science Direct, Google Scholar, and ProQuest Central. Inclusion criteria consisted of peer-reviewed articles published in English between the years of 2017-2021. Keywords for the search included cognitive telerehabilitation, pandemic, COVID-19, and Coronavirus. A total number of 17 articles were reviewed, and 6 articles were retained.Study SelectionLiterature Review.Data ExtractionIndependent extraction by multiple observers.Data SynthesisResearch indicated that cognitive telerehabilitation was an effective modality for individuals with neurological conditions, including stroke, traumatic brain injury, Alzheimer's disease, Parkinson's disease and parkinsonian syndromes, and multiple sclerosis. Furthermore, reviewed literature reported that remote communication technologies can be effective options to support health care interventions, including cognitive rehabilitation.ConclusionsSocial distancing measures implemented during the COVID-19 pandemic interrupted access to routine medical care for many individuals with neurological diseases. Overall, studies indicated that cognitive telerehabilitation was an effective modality in neurorehabilitation as it overcame both geographical and social-distancing limitations. Moreover, methodological and technological improvements may improve the delivery of cognitive telerehabilitation for individuals with reduced mobility. New alternatives such as cognitive telerehabilitation may be implemented as an urgent and effective response to provide continuity of care and social connectedness during the COVID-19 pandemic.Author(s) DisclosuresN/A.

HomeCoRe for Telerehabilitation in Mild or Major Neurocognitive Disorders: A Study Protocol for a Randomized Controlled Trial.

Background: Given the limited effectiveness of pharmacological treatments for cognitive decline, non-pharmacological interventions have gained increasing attention. Evidence exists on the effectiveness of cognitive rehabilitation in preventing elderly subjects at risk of cognitive decline and in reducing the progression of functional disability in cognitively impaired individuals. In recent years, telerehabilitation has enabled a broader application of cognitive rehabilitation programs. The purpose of this study is to test a computer-based intervention administered according to two different modalities (at the hospital and at home) using the tools CoRe and HomeCoRe, respectively, in participants with Mild or Major Neurocognitive Disorders.Methods: Non-inferiority, single-blind randomized controlled trial where 40 participants with Mild or Major Neurocognitive Disorders will be assigned to the intervention group who will receive cognitive telerehabilitation through HomeCoRe or to the control group who will receive in-person cognitive intervention through CoRe, with the therapist administering the same computer-based exercises. The rehabilitative program will last 6 weeks, with 3 sessions/week, each lasting ~45 min. All the participants will be evaluated on an exhaustive neuropsychological battery before (T0) and after (T1) the intervention; follow-up visits will be scheduled after 6 (T2) and 12 months (T3).Discussion: The results of this study will inform about the comparability (non-inferiority trial) of HomeCoRe with CoRe. Their equivalence would support the use of HomeCoRe for at distance treatment, favoring the continuity of care.Ethics and Dissemination: This study has been approved by the Local Ethics Committee and registered in https://clinicaltrials.gov (NCT04889560). The dissemination plan includes the scientific community through publication in open-access peer-reviewed scientific journals and presentations at national and international conferences.Trial Registration: Clinicaltrials.gov https://clinicaltrials.gov/ct2/show/NCT04889560 (registration date: May 17, 2021).

Improving cognitive functions in adolescents with learning difficulties: A feasibility study on the potential use of telerehabilitation during Covid-19 pandemic in Italy

Introduction. Learning disabilities are due to genetic and/or neurobiological factors that alter brain functioning by affecting one or more cognitive processes related to learning. This study aimed to assess the efficacy of cognitive telerehabilitation in adolescents with learning disabilities to overcome the treatment problems related to the COVID-19 pandemic lockdown. Methods. Twenty-four patients diagnosed with Unspecified Learning Disability (mean ± SD age: 18.2 ± 2.9 years; 50% male) were enrolled in this study. The patients were assessed by a neuropsychological evaluation at the beginning and at the end of the program. All patients received cognitive treatment via a specific telehealth app to stimulate the cognitive skills related to learning. The treatment lasted four weeks, with a daily training (lasting up to 60 min), for five days a week. Results. Our young patients reported a statistically significant improvement in the main cognitive domains that are usually compromised in learning disabilities, including sustained and selective attention, shifting of attention, control of interference, memory and speed of information processing. Moreover, the patients showed a good usability and motivation during the training. Conclusions. Our study has shown that telerehabilitation could be a valid tool for the rehabilitation of specific cognitive skills in adolescents with learning difficulties.

Cancer-related cognitive impairment in cancer: Examining portuguese cancer survivors’ acceptability and expectations regarding cognitive telerehabilitation interventions

IntroductionCancer-related cognitive impairment (CRCI) is one of the most frequent and worrying side effects experienced by non-central nervous system (CNS) cancer survivors, generally related to cancer treatments. Considering its detrimental impact on quality of life, including work-related outcomes, it is necessary to identify effective intervention options. Cognitive rehabilitation is considered the first-line intervention to address CRCI, being effective at improving cognitive functioning. Internet-based interventions are emerging as important means of intervention in the field of cognitive rehabilitation (known as cognitive telerehabilitation), considering the potential to overcome accessibility issues and being cost-effective.ObjectivesTo assess the acceptability and expectations regarding such interventions, considering the scarce literature.MethodsA nationwide online survey was disseminated to Portuguese non-CNS cancer survivors, aged 18-65 years, who had finished active treatments, with no metastases/history of neurological or psychiatric disease/alcohol or drug abuse. Preexisting knowledge about CRCI, expectations for support to cognitive difficulties, Internet use for health and support purposes, and intervention needs and preferences in the context of cognitive telerehabilitation were examined; sociodemographic and clinical variables (e.g., age, education, employment status, cancer treatments), as well as cognitive complaints (Portuguese version of the Functional Assessment of Cancer Therapy-Cognitive, FACT-Cog), were also assessed.ResultsFindings from this study are important to help health professionals and researchers understand and identify cancer survivors’ needs regarding cognitive telerehabilitation interventions.ConclusionsThis information could be used as a support and guide for the development and delivery of these interventions for non-CNS cancer survivors.

Cognitive Telerehabilitation for Older Adults With Neurodegenerative Diseases in the COVID-19 Era: A Perspective Study.

The COVID-19 pandemic is a global health problem that is radically transforming public and private healthcare organizations around the world, negatively affecting the rehabilitative treatments of non-COVID pathologies as well. In this situation, it becomes crucial to be able to guarantee the continuity of care also to all those patients with neurodegenerative diseases unable to reach healthcare services. Remote communication technologies are gaining momentum as potentially effective options to support health care interventions—including cognitive rehabilitation—while patients can stay safely at home. In this context, we are implementing HomeCoRe (i.e., Home Cognitive Rehabilitation software) in order to offer an innovative approach and a valid support for home-based cognitive rehabilitation in neurodegenerative diseases, such as mild cognitive impairment and early dementia. HomeCoRe has been developed within a research project between engineers and clinicians in order to obtain a usable and safe cognitive rehabilitation tool. This software has multiple advantages for patients and therapists over traditional approaches, as shown in its use in hospital settings. HomeCoRe could then represent an opportunity for accessing cognitive rehabilitation in all those situations where patients and therapists are not in the same location due to particular restrictions, such as COVID-19 pandemic.

Can patients with severe traumatic brain injury be trained with cognitive telerehabilitation? An inpatient feasibility and usability study

Traumatic Brain Injury (TBI) is the most common cause of long-term disability and death among young adults. Innovation technology, with regard to telerehabilitation, may be of help in managing these frail patients. The aim of the study is to evaluate whether TBI patients and caregivers are able to properly use a Tele-rehabilitation device during hospitalization. Ten TBI subjects (5 males and 5 females; mean age of 45.7 ± 14.4 years), and their caregivers (6 males and 4 females; mean age of 43.7 ± 13.5 years) were consecutively recruited in this preliminary study. After 3 meetings with the telemedicine operators aimed to provide both patients and caregivers with the basic information for the proper use of the device, patients were submitted to 6 training sessions, provided 3 times per week for two weeks, each session lasting about one hour. The telerehabilitation simulation was carried out using the tele-cockpit station and the VRRS-Tablet, used either in the patient's room or in the institute's Family Room. The motivation during training was positive, as per the Intrinsic Motivation Inventory score: 202.6 for patients and 216 for caregivers. Participants also presented positive usability scores, as per the System Usability Scale score: 68 for patients and 69 for caregivers. Our feasibility and usability study supports the idea that in-patients with severe TBI could benefit from cognitive telerehabilitation performed in the pre-discharge phase, in order to get a higher level of adherence to the home tele-treatment and potentially better outcomes.

Remote Eye-Tracking for Cognitive Telerehabilitation and Interactive School Tasks in Times of COVID-19

In the attempt to mitigate the effects of COVID-19 lockdown, most countries have recently authorized and promoted the adoption of e-learning and remote teaching technologies, often with the support of teleconferencing platforms. Unfortunately, not all students can benefit from the adoption of such a surrogate of their usual school. We were asked to devise a way to allow a community of children affected by the Rett genetic syndrome, and thus unable to communicate verbally, in writing or by gestures, to actively participate in remote rehabilitation and special education sessions by exploiting eye-gaze tracking. As not all subjects can access commercial eye-tracking devices, we investigated new ways to facilitate the access to eye gaze-based interaction for this specific case. The adopted communication platform is a videoconferencing software, so all we had at our disposal was a live video stream of the child. As a solution to the problem, we developed a software (named SWYG) that only runs at the “operator” side of the communication, at the side of the videoconferencing software, and does not require to install other software in the child’s computer. The preliminary results obtained are very promising and the software is ready to be deployed on a larger base. While this paper is being written, several children are finally able to communicate with their caregivers from home, without relying on expensive and cumbersome devices.

Cognitive training in adults with intellectual disability: pilot study applying a cognitive tele-rehabilitation program

Introduction This pilot study analyzes the effect of a cognitive training program in adults with intellectual disability (ID). Method Twenty subjects (mean age 52.7 ± 9.77 years) with mild and moderate ID were divided in control and experimental group. Only the experimental group received the training program. This program was applied through the GNPT® (Guttmann, NeuroPersonalTrainer®) platform for people with ID. Results The results revealed a significant improvement in the Kaufman Brief Intelligence Test-2 scores (Matrices subtest) in the experimental group [Z = 2.12; p = .03] after the intervention, indicating an enhancement in fluid ability due to effect of cognitive training program. Conclusion Findings provide evidence of the importance of applying these programs in a systematized way in adults with ID.

The TCTRS Project: A Holistic Approach for Telerehabilitation in Rett Syndrome

Telerehabilitation (TR) has been proven to be an effective tool in improving the adaptive skills of children and young adults with Multiple Disabilities (MDs). The application of a comprehensive set of new technologies reveals new opportunities for both physical and cognitive telerehabilitation, but there is no holistic approach in the case of genetic syndromes. In this paper we present reflections and early results of the TCTRS project that aims at implementing a telerehabilitation system capable of offering complete coverage of rehabilitation needs for people with Rett Syndrome, from both the physical and cognitive points of view. Moreover, the data acquired through the system can also represent a basis for machine learning applications to remotely support therapists and physicians. Our first tests on the system application show the great potential of our approach, in terms of feasibility and applicability, for both rehabilitation centers and families.