Gaming Technology for Pediatric Neurorehabilitation: A Systematic Review

Abstract

IntroductionThe emergence of gaming technologies, such as videogames and virtual reality, provides a wide variety of possibilities in intensively and enjoyably performing rehabilitation for children with neurological disorders. Solid evidence-based results are however required to promote the use of different gaming technologies in pediatric neurorehabilitation, while simultaneously exploring new related directions concerning neuro-monitoring and rehabilitation in familiar settings.Aim of the Study and MethodsIn order to analyze the state of the art regarding the available gaming technologies for pediatric neurorehabilitation, Scopus and Pubmed Databases have been searched by following: PRISMA statements, PICOs classification, and PEDro scoring.Results43 studies have been collected and classified as follows: 11 feasibility studies; six studies proposing home-system solutions; nine studies presenting gamified robotic devices; nine longitudinal intervention trials; and eight reviews. Most of them rely on feasibility or pilot trials characterized by small sample sizes and short durations; different methodologies, outcome assessments and terminologies are involved; the explored spectrum of neurological conditions turns out to be scanty, mainly including the most common and wider debilitating groups of conditions in pediatric neurology: cerebral palsy, brain injuries and autism.ConclusionEven though it highlights reduced possibilities of drawing evidence-based conclusions due to the above outlined biases, this systematic review raises awareness among pediatricians and other health professionals about gaming technologies. Such a review also points out a definite need of rigorous studies that clearly refer to the underlying neuroscientific principles.

Virtual Art Therapy: Application of Michelangelo Effect to Neurorehabilitation of Patients with Stroke

“…However, differently from our present study, in that one, the subjects interacted with the video games through total body movements, and fine hand movements were not tracked by the computerized system. If, for children, gaming could be the keystone to improve their engagement and their active participation in the therapy sessions [ 30 ], for older people, art could play a similar role. Participation (defined as the active participation in the proposed exercises with maximal effort, as well as taking interest in them and future therapy sessions [ 21 , 22 ]) is fundamental for obtaining a good outcome in neurorehabilitation [ 31 ].…”

The Arrival of the Metaverse in Neurorehabilitation: Fact, Fake or Vision?

“…The disease represents the synthesis of the cognitive, sensory, motor and behavioral developmental deficits of a child and would find in the metaverse an opportunity to carry out a true multidimensional rehabilitation, thanks to a well-tested and customized rehabilitation protocol. Many studies have already reported positive results of clinical trials based on digital gaming technologies [ 47 ] and virtual reality [ 48 , 49 ] in children with cerebral palsy, as well as studies with the therapist not in person [ 50 ]. However, a recent systematic review found that the effect of VR in the rehabilitation of the upper limb of children with CP remains unclear [ 51 ].…”

Telerehabilitation in Low-Resource Settings to Improve Postural Balance in Older Adults: A Non-Inferiority Randomised Controlled Clinical Trial Protocol

“…Several exercise methods with virtual reality (VR) devices have been used in treatments for older adults and patients with neurodegenerative diseases [ 23 , 24 , 25 , 26 ]. Interfaces have been created to be used in computer or available electronic games that generate communication between the user and the virtual environment through body movements.…”

“…Interventions with these devices are based on exercise execution where the individual receives sensory stimuli (extrinsic feedback), mainly visual information, to increase the amount of input to allow motor self-adjustments. The use of these technologies seems to improve postural balance of older people, neurological and stroke patients, and patients with Parkinson’s disease [ 23 , 24 , 25 , 26 , 27 ]. Although the mechanisms still remains unclear, VR rehabilitation therapy shows a positive tendency to improve mental and physical health [ 27 , 28 , 29 , 30 ].…”

“…The benefits of VR-based therapies in older people and other populations have been demonstrated in in-person or face-to-face modalities, where a physiotherapist typically guides the therapy [ 23 , 24 , 25 , 26 ]. However, the COVID-19 pandemic has limited the access to those modalities, which spotlights telerehabilitation (TR) as a necessity to maintain rehabilitation therapies.…”