Search Results (72)

Background: Serious games (SGs) are primarily aimed at promoting learning, skills training, and rehabilitation. Artificial intelligence, immersive technologies, the metaverse, and neurotechnologies promise the next revolution in gaming. Meta-skills are considered the “must-have” skills for thriving in the era of rapid change, complexity, and innovation. Μeta-skills can be defined as a set of higher-order skills that incorporate metacognitive, meta-emotional, and meta-motivational attributes, enabling one to be mindful, self-motivated, self-regulated, and flexible in different circumstances. Skillfulness, and more specifically meta-skills development, is recognized as a predictor of optimal performance along with mental and emotional wellness. Nevertheless, there is still limited knowledge about the effectiveness of integrating cutting-edge technologies in serious games, especially in the field of meta-skills training. Objectives: The current systematic review aims to collect and synthesize evidence concerning the effectiveness of advanced technologies in serious gaming for promoting meta-skills development. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was employed to identify experimental studies conducted in the last 10 years. Four different databases were employed: Web of Science, PubMed, Scopus, and Google Scholar. Results: Forty-nine studies were selected. Promising outcomes were identified in AI-based SGs (i.e., gamified chatbots) as they provided realistic, adaptive, personalized, and interactive environments using natural language processing, player modeling, reinforcement learning, GPT-based models, data analytics, and assessment. Immersive technologies, including the metaverse, virtual reality, augmented reality, and mixed reality, provided realistic simulations, interactive environments, and sensory engagement, making training experiences more impactful. Non-invasive neurotechnologies were found to encourage players’ training by monitoring brain activity and adapting gameplay to players’ mental states. Healthy participants (n = 29 studies) as well as participants diagnosed with anxiety, neurodevelopmental disorders, and cognitive impairments exhibited improvements in a wide range of meta-skills, including self-regulation, cognitive control, attention regulation, meta-memory skills, flexibility, self-reflection, and self-evaluation. Players were more self-motivated with an increased feeling of self-confidence and self-efficacy. They had a more accurate self-perception. At the emotional level, improvements were observed in emotional regulation, empathy, and stress management skills. At the social level, social awareness was enhanced since they could more easily solve conflicts, communicate, and work in teams. Systematic training led to improvements in higher-order thinking skills, including critical thinking, problem-solving skills, reasoning, decision-making ability, and abstract thinking. Discussion: Special focus is given to the potential benefits, possible risks, and ethical concerns; future directions and implications are also discussed. The results of the current review may have implications for the design and implementation of innovative serious games for promoting skillfulness among populations with different training needs. Full article

Purpose: Over the past decade, tele-neurorehabilitation (TNR) has emerged as a vital and effective tool for delivering continuous care to stroke patients, playing a key role in enhancing functional recovery and ensuring consistent access to rehabilitation services. In the field of TNR, various protocols are utilized to ensure effective cognitive stimulation at home. Recent preliminary studies highlight the employment of multidomain cognitive interventions, which would seem to induce more stable and relevant cognitive recovery in stroke patients. A randomized controlled trial (RCT) study was conducted to compare the effectiveness of a TNR multidomain cognitive approach to conventional face-to-face cognitive treatment. Methods: A total of 30 patients with stroke were equally enrolled and randomly assigned to the experimental and control groups. In the experimental group, patients received sessions of home-based cognitive virtual reality rehabilitation system (VRRS) training. The control group underwent traditional face-to-face cognitive multidomain treatment at the hospital. The therapy was given for one hour every day for four weeks in both groups. Specific cognitive domains, including memory, praxis skills, executive functions, and speech therapy, were stimulated in the procedure. Neuropsychological evaluations were performed at three timepoints: at baseline (T0), at the end of TNR (T1), and six months later (T2). Results: The TNR group demonstrated significant improvements in working memory and language abilities, as well as in depressive symptoms and caregiver burden, with an average decrease of 2.07. Most of this improvement persisted 6 months after treatment. The group that received face-to-face cognitive treatment showed improvements (not persisting at T2) after treatment in a task measuring constructive apraxia and alternating attention with the cognitive skill of set-shifting. Conclusions: According to our findings, multidomain cognitive TNR may be useful in enhancing cognitive outcomes in stroke populations (even six months after treatment concludes). TNR may also be a viable way to deliver these interventions since it boosts people’s motivation to train and, consequently, their adherence to treatment while also having a positive effect on caregivers’ distress management. Full article

International literature in the field of rehabilitation and psychological support is increasingly characterized by the inclusion and use of video games and virtual media, even if the results are controversial. The theoretical basis on which the study presented is based is Video Game Therapy^®. This approach uses commercial video games, which are generally free or available at a relatively low cost. These games possess many essential functions that make them practical as preventive tools or support for integration into traditional therapies. Video Game Therapy^® allows the patient to reflect on emotional containment and cognitive self-regulation to establish a state of mental balance and well-being. It encourages insight and leads the player to reflect on some salient aspects of their character and lifestyle and their emotions and thoughts linked to specific life episodes relived in the game setting. Starting from these premises, the study shows promising results, presenting a single case of a boy with social isolation problems and relational difficulties, in which significant changes were highlighted in the perception, expression, and management of emotions, as well as in metacognition and self-efficacy. Full article

Extended reality (XR) technologies—encompassing virtual reality (VR), augmented reality (AR), and mixed reality (MR)—are transforming cognitive assessment and training by offering immersive, interactive environments that simulate real-world tasks. XR enhances ecological validity while enabling real-time, multimodal data collection through tools such as galvanic skin response (GSR), electroencephalography (EEG), eye tracking (ET), hand tracking, and body tracking. This allows for a more comprehensive understanding of cognitive and emotional processes, as well as adaptive, personalized interventions for users. Despite these advancements, current XR applications often underutilize the full potential of multimodal integration, relying primarily on visual and auditory inputs. Challenges such as cybersickness, usability concerns, and accessibility barriers further limit the widespread adoption of XR tools in cognitive science and clinical practice. This review examines XR-based cognitive assessment and training, focusing on its advantages over traditional methods, including ecological validity, engagement, and adaptability. It also explores unresolved challenges such as system usability, cost, and the need for multimodal feedback integration. The review concludes by identifying opportunities for optimizing XR tools to improve cognitive evaluation and rehabilitation outcomes, particularly for diverse populations, including older adults and individuals with cognitive impairments. Full article

Background/Objectives: Parkinson’s disease (PD) is a neurodegenerative disorder, characterised by cardinal motor features and a multitude of non-motor manifestations. Among them, cognitive impairment in PD has been recognised as a defined clinical entity, and it might lead to an increased risk of developing dementia. Consequently, the present review aimed to ascertain the available interventions for the training of cognitive abilities in persons with PD (PwPD). Methods: PRISMA guidelines were followed to select studies in the following databases: PubMed, PsycINFO, and Web of Science. Two independent reviewers conducted the different phases of the review, and a third expert was called in to address any doubts/conflicts. Randomised controlled trials and randomised clinical trials concerning cognitive training with cognitive outcomes in PwPD were selected. Results: A total of 28 articles were included. The considered studies applied various experimental interventions for the training of cognitive functions in PwPD: computer-based platforms, exergames, paper-and-pencil programmes, dual-task or treadmill training with action observation therapy, motor imagery, and virtual reality components, interventions targeting precise cognitive domain, tele-rehabilitation, transcranial direct current stimulation, structured cognitive training, and multimodal treatments. Cognitive functions were assessed employing neuropsychological tests, self-report questionnaires, and computerised batteries. Conclusions: Overall, the review reported better performances in the experimental groups compared to the control groups, in several cognitive domains. Structured cognitive training emerged as the most effective strategy to enhance cognitive functioning in PwPD. However, further studies are necessary to determine the most appropriate and useful training and to develop interventions that also consider patients’ quality of life. Full article

Background: Parkinson’s disease is a neurodegenerative disorder affecting the central and peripheral nervous systems. Its treatment combines pharmacological and rehabilitative approaches, aimed at improving motor symptoms and preventing cognitive decline. Virtual reality emerges as a complementary rehabilitative option, showing efficacy in enhancing motor and cognitive aspects. This study systematically reviews the effectiveness of virtual reality in the rehabilitation of individuals with Parkinson’s disease. Methods: A systematic review was carried out. The Jadad scale was used to assess the methodological quality of the included studies, and the Oxford Center for Evidence-Based Medicine criteria were applied to determine the level of evidence and recommendation. The review followed PRISMA guidelines, with a literature search conducted in databases such as Cochrane and PubMed. Results: The studies indicate improvements in gait, balance, and overall motor function in Parkinson’s patients using virtual reality, though limitations such as small sample sizes and the lack of control groups in some studies are noted. Conclusions: Virtual reality proves to be an effective tool in Parkinson’s rehabilitation, enhancing balance and motor function. However, more studies with adequate methodological quality and larger sample sizes are needed to validate these findings. Full article

Background/Objectives: This research investigates brain connectivity patterns in reaction to social and non-social stimuli within a virtual reality environment, emphasizing their impact on cognitive functions, specifically working memory. Methods: Employing the LEiDA framework with EEG data from 47 participants, I examined dynamic brain network states elicited by social avatars compared to non-social stick cues during a VR memory task. Through the integration of LEiDA with deep learning and graph theory analyses, unique connectivity patterns associated with cue type were discerned, underscoring the substantial influence of social cues on cognitive processes. LEiDA, conventionally utilized with fMRI, was creatively employed in EEG to detect swift alterations in brain network states, offering insights into cognitive processing dynamics. Results: The findings indicate distinct neural states for social and non-social cues; notably, social cues correlated with a unique brain state characterized by increased connectivity within self-referential and memory-processing networks, implying greater cognitive engagement. Moreover, deep learning attained approximately 99% accuracy in differentiating cue contexts, highlighting the efficacy of prominent eigenvectors from LEiDA in EEG analysis. Analysis of graph theory also uncovered structural network disparities, signifying enhanced integration in contexts involving social cues. Conclusions: This multi-method approach elucidates the dynamic influence of social cues on brain connectivity and cognition, establishing a basis for VR-based cognitive rehabilitation and immersive learning, wherein social signals may significantly enhance cognitive function. Full article

Background/Objectives: Cognition plays a major role in prosthetic rehabilitation success. The ability to identify patients who may have difficulty understanding and adapting to the rehabilitation process is beneficial for clinicians and patients to allow for targeted and appropriate therapy. The research aim was to codesign a process that facilitates routine cognitive screening into the amputee inpatient journey. Methods: A convenience sample of sixteen medical and allied health practitioners from one local health district undertook a codesign process over 10 months from March to November 2023. A combination of virtual and face-to-face data collection occurred. Each of the codesign meetings was audio recorded, following which transcription occurred. Transcripts were reviewed using thematic analysis-based techniques to capture themes and consensus within the group. Results: Two pathways were established for use within one local health district, allowing clinicians to measure the cognition of patients in both inpatient and outpatient settings either before or after they underwent amputation. The newly established pathways provide step-by-step guidance for clinicians, such as how to address contraindicators for testing and providing guidance for subsequent neuropsychological testing. The Montreal Cognitive Assessment (MoCA), both paper based and electronic based, was selected as the cognitive screening tool for implementation. Conclusions: Utilizing codesign as a method for generating a cognitive screening pathway for amputees was successful. The pathways generated should be reviewed for suitability for application in other health settings. Full article

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder that requires comprehensive and personalized rehabilitation. This retrospective study focused primarily on the usability and patient acceptability of the innovative pathway. In addition, the secondary objective was to evaluate the effectiveness of a personalized and multidisciplinary rehabilitation pathway on cognitive function, especially executive functions. Methods: We conducted a retrospective study on 80 patients with PD (Hoehn and Yahr scores 1–3). Patients were divided into an experimental group (EG), which received the innovative pathway, and a control group (CG), which received traditional therapy. The rehabilitation program included three phases: initial outpatient assessment, a two-month inpatient program, and a telerehabilitation phase in a day hospital (DH) or home environment. Interventions combined traditional therapies with treatments based on robotic and virtual reality. Cognitive assessments (Mini Mental State Examination—MMSE—and frontal assessment battery—FAB), mood (Hamilton Rating Scale—Depression—HRS-D), anxiety (HRS-Anxiety—HRS-A), and goals achievement (GAS) were the primary outcome measures. Results: At baseline, there were no significant differences between the groups in terms of age, gender, education, or test scores. After rehabilitation, EG showed significant improvements in all measures (p < 0.001), particularly in cognitive tests and goal achievement. CG improved in GAS (p < 0.001) and mood (HRS-D, p = 0.0012), but less than EG. No significant changes were observed in the MMSE of CG (p = 0.23) or FAB (p = 0.003). Conclusions: This study highlights the high usability and acceptability of VR and robotics in PD rehabilitation, contributing to improved adherence and patient engagement. The experimental group showed greater cognitive benefits, particularly in executive functions. These results are in line with the existing literature on personalized technology-based rehabilitation strategies for PD. Full article

This study explores neuroplasticity through the use of virtual reality (VR) and brain–computer interfaces (BCIs). Neuroplasticity is the brain’s ability to reorganize itself by forming new neural connections in response to learning, experience, and injury. VR offers a controlled environment to manipulate sensory inputs, while BCIs facilitate real-time monitoring and modulation of neural activity. By combining VR and BCI, researchers can stimulate specific brain regions, trigger neurochemical changes, and influence cognitive functions such as memory, perception, and motor skills. Key findings indicate that VR and BCI interventions are promising for rehabilitation therapies, treatment of phobias and anxiety disorders, and cognitive enhancement. Personalized VR experiences, adapted based on BCI feedback, enhance the efficacy of these interventions. This study underscores the potential for integrating VR and BCI technologies to understand and harness neuroplasticity for cognitive and therapeutic applications. The researchers utilized the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to conduct a comprehensive and systematic review of the existing literature on neuroplasticity, VR, and BCI. This involved identifying relevant studies through database searches, screening for eligibility, and assessing the quality of the included studies. Data extraction focused on the effects of VR and BCI on neuroplasticity and cognitive functions. The PRISMA method ensured a rigorous and transparent approach to synthesizing evidence, allowing the researchers to draw robust conclusions about the potential of VR and BCI technologies in promoting neuroplasticity and cognitive enhancement. Full article

Introduction: Apraxia is a neurological disorder that is common after a stroke and impairs the planning and execution of movements. In the rehabilitation field, virtual reality (VR) presents new opportunities and offers advantages to both rehabilitation teams and individuals with neurological conditions. Indeed, VR can stimulate and improve cognitive reserve and abilities, including executive function, and enhance the patient’s emotional status. Aim: The objective of this research is to determine the effectiveness of VR in improving praxis skills and behavioural functioning in individuals with severe stroke. Methods: A total of 20 stroke patients were enrolled from February 2022 to March 2023 and divided by the order of their recruitment into two groups: the experimental group (EG: n = 10) received training to improve their praxis skills using VR whereas the control one (CG: n = 10) received the same amount of standard training. All patients underwent an evaluation using a psychometric battery that consisted of the Hamilton Rating Scale for Depression (HRS-D), Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Spinnler and Tognoni test, and De Renzi and Faglioni test. Valuations were performed before rehabilitation (T0) and after its completion (T1). Results: Both groups demonstrated significant improvements post-intervention. The EG showed a greater enhancement in their MMSE scores (p = 0.002), and reductions in both ideomotor and constructive apraxia (p = 0.002 for both), compared to the CG. The VR-based training also resulted in significant improvements in their depression symptoms (HRSD scores improved, p = 0.012 in EG vs. p = 0.021 in CG). Conclusions: This pilot study suggests that VR could help reduce cognitive, constructive apraxia and ideomotor apraxia symptoms caused by stroke injury. Full article

Background: Young people with intellectual developmental disabilities have a persistent delay in the development of executive functions. Virtual reality (VR) is increasingly being used as a cognitive intervention tool, with significant effectiveness demonstrated in different types of populations. Methods: This pilot study aims to investigate the impact of a cognitive training program utilizing VR on young adults diagnosed with intellectual developmental disabilities (IDDs). The participants (N = 15) served as their own control group and were assessed three times: weeks 0, 8, and 16, with a rest period (0–8 weeks) and an intervention period (8–16 weeks). The assessments included measures of cognitive function provided by E-Prime^® (Version 3). Results: Overall, an improvement in working memory and inhibitory control was found after the intervention, but not in sustained attention. Conclusions: These findings suggest that VR-based cognitive training holds promise as an effective intervention for enhancing cognitive abilities in young adults with intellectual developmental disabilities. This study provides a foundation for future investigations into VR’s role in cognitive rehabilitation and its potential to support daily living skills and overall quality of life for individuals with IDDs. Further research is needed to explore the long-term effects and broader applicability of VR interventions. Full article

Background: In recent years, there has been a growing use of technological advancements to enhance the rehabilitation of individuals who have suffered from cerebrovascular accidents. Virtual reality rehabilitation programs enable patients to engage in a customized therapy program while interacting with a computer-generated environment. Therefore, our goal was to investigate the effectiveness of virtual reality in occupational therapy for people’s rehabilitation after a cerebrovascular accident. Methods: We systematically searched databases (Pubmed/Medline, Scopus, Web of Science, and Science Direct) for randomized controlled trials published within the last 10 years. Studies involving adult stroke survivors undergoing virtual reality-based interventions aimed at improving upper-extremity motor function were included. The quality assessment followed PRISMA guidelines, with the risk of bias assessed using the Cochrane tool (version 6.4) and methodological quality evaluated using GRADEpro. Results: We selected sixteen studies that met the main criteria for the implementation of virtual reality technology. The interventions described in the articles focused mainly on the upper extremities and their fine motor skills. Conclusions: When used in conventional treatments to improve people’s motor and cognitive functions after a cerebrovascular accident, virtual reality emerges as a beneficial tool. Additionally, virtual reality encourages adherence to the interventional process of rehabilitation through occupational therapy. Full article

Cognitive impairment associated with schizophrenia (CIAS) represents one of the core features of the disorder and has a significant impact on functional and rehabilitation outcomes of people living with schizophrenia spectrum disorders (SSD). The aim of this critical review is to highlight the most recent evidence on effective treatments available for CIAS, to discuss the current challenges in this field, and to present future perspectives that may help to overcome them. Concerning psychopharmacological approaches, among the most indicated strategies for the management and prevention of CIAS is to favor second-generation antipsychotic medications and avoid long-term and high-dose treatments with anticholinergic medications and benzodiazepines. Moreover, non-pharmacological approaches such as cognitive remediation and physical exercise-based programs represent evidence-based interventions in the treatment of CIAS that have shown reliable evidence of effectiveness on both cognitive and functional outcomes. These treatments, however, are still delivered to people accessing mental health services with a diagnosis of CIAS in an uneven manner, even in high-income countries. Academic and clinical partnership and collaboration, as well as advocacy from service users, families, carers, and stakeholders’ organizations could help to reduce the bench to bedside gap in the treatment of CIAS. Future perspectives include the development of novel pharmacological agents that could be effective in the treatment of CIAS, the implementation of novel technologies such as telemedicine and virtual reality in the delivery of evidence-based interventions to improve accessibility and engagement, and further research in the field of non-invasive brain stimulation. Full article

(1) Background and objectives: Paediatric brain injuries can lead to motor and cognitive deficits. Effective rehabilitation is critical for enhancing independence. While virtual reality (VR) and transcranial direct current stimulation (tDCS) have independently demonstrated beneficial effects on motor and cognitive functions, their combined efficacy and its cognitive effects remain to be explored in this population. We aim to investigate the effects of integrating tDCS with VR training on upper limb (UL) functionality and cognitive outcomes through a triple-blind randomised trial. (2) Methods: Twenty-eight children with hemiparesis secondary to non-progressive brain damage will be randomly allocated into two groups: active anodal tDCS (2 mA) plus UL VR training, and sham tDCS with identical VR training. The tDCS will target M1 of the affected or most affected hemisphere for 20 min, simultaneous to VR training. The following four assessments will be carried out: pre-intervention, post-intervention, and three- and six-months follow-up. (3) Results: This study will explore motor and cognitive outcomes of a motor-based intervention in paediatric brain damage. We hypothesise that the experimental group will show significant improvements in UL function and cognition, enhancing their functional recovery. (4) Conclusions: We propose a multidisciplinary therapeutic approach combining neuromodulation and VR to potentiate functional recovery through enhancing motor and cognitive performance in paediatric brain damage. Full article