The wide world of technological telerehabilitation for pediatric neurologic and neurodevelopmental disorders - a systematic review.

Introduction: The use of Information and Communication Technology (ICT) for assessing and treating cognitive and motor disorders is promoting home-based telerehabilitation. This approach involves ongoing monitoring within a motivating context to help patients generalize their skills. It can also reduce healthcare costs and geographic barriers by minimizing hospitalization. This systematic review focuses on investigating key aspects of telerehabilitation protocols for children with neurodevelopmental or neurological disorders, including technology used, outcomes, caregiver involvement, and dosage, to guide clinical practice and future research. Method: This systematic review adhered to PRISMA guidelines and was registered in PROSPERO. The PICO framework was followed to define the search strategy for technology-based telerehabilitation interventions targeting the pediatric population (aged 0-18) with neurological or neurodevelopmental disorders. The search encompassed Medline/PubMed, EMBASE, and Web of Science databases. Independent reviewers were responsible for selecting relevant papers and extracting data, while data harmonization and analysis were conducted centrally. Results: A heterogeneous and evolving situation emerged from our data. Our findings reported that most of the technologies adopted for telerehabilitation are commercial devices; however, research prototypes and clinical software were also employed with a high potential for personalization and treatment efficacy. The efficacy of these protocols on health or health-related domains was also explored by categorizing the outcome measures according to the International Classification of Functioning, Disability, and Health (ICF). Most studies targeted motor and neuropsychological functions, while only a minority of papers explored language or multi-domain protocols. Finally, although caregivers were rarely the direct target of intervention, their role was diffusely highlighted as a critical element of the home-based rehabilitation setting. Discussion: This systematic review offers insights into the integration of technological devices into telerehabilitation programs for pediatric neurologic and neurodevelopmental disorders. It highlights factors contributing to the effectiveness of these interventions and suggests the need for further development, particularly in creating dynamic and multi-domain rehabilitation protocols. Additionally, it emphasizes the importance of promoting home-based and family-centered care, which could involve caregivers more actively in the treatment, potentially leading to improved clinical outcomes for children with neurological or neurodevelopmental conditions. Systematic review registration: PROSPERO (CRD42020210663).

Far Transfer Effects of Trainings on Executive Functions in Neurodevelopmental Disorders: A Systematic Review and Metanalysis.

Executive Functions are a set of interrelated, top-down processes essential for adaptive goal-directed behaviour, frequently impaired across different neurodevelopmental disorders with variable degrees of severity. Many executive-function-training studies in children with neurodevelopmental disorders have focused on near effects, investigating post-treatment improvements on directly trained processes, while enhancements of skills not directly trained, defined as far effects, are less considered, albeit these could be extremely relevant for reducing the negative impact of a disorder's core symptomatology. This systematic review and metanalysis aims to investigate the far effect outcomes after EF training in children with different types of neurodevelopmental disorders. 17 studies met the inclusion criteria for the systematic review, while 15 studies were selected in the metanalysis. An overall statistically significant effect size was found in the majority of far effect outcome measures considered in the studies. In particular, trainings on executive functions determine significant far effects on daily life functioning (0.46, 95% CI: [0.05-0.87]) and clinical symptoms (0.33, 95% CI: [0.15-0.51]). Despite a high variability of the results, intensity, frequency and the laboratory/life contexts dimension seem to be the most influential variables in determining far effects. This systematic review and metanalysis highlights the need to measure far effects of executive function training in neurodevelopmental disorders, selecting treatments not only on directly targeted processes, but also according to far impacts on the functional weakness of the disorder.

Specific Learning Disabilities and Emotional-Behavioral Difficulties: Phenotypes and Role of the Cognitive Profile.

Specific Learning Disabilities (SLD) are often associated with emotional-behavioral problems. Many studies highlighted a greater psychopathological risk in SLD, describing both internalizing and externalizing problems. The aims of this study were to investigate the emotional-behavioral phenotype through the Child Behavior Checklist (CBCL), and evaluate the mediating role of background and cognitive characteristics on the relationship between CBCL profile and learning impairment in children and adolescents with SLD. One hundred and twenty-one SLD subjects (7-18 years) were recruited. Cognitive and academic skills were assessed, and parents completed the questionnaire CBCL 6-18. The results showed that about half of the subjects manifested emotional-behavioral problems with a prevalence of internalizing symptoms, such as anxiety and depression, over externalizing ones. Older children showed greater internalizing problems than younger ones. Males have greater externalizing problems compared to females. A mediation model analysis revealed that learning impairment is directly predicted by age and familiarity for neurodevelopmental disorders and indirectly via the mediation of the WISC-IV/WAIS-IV Working Memory Index (WMI) by the CBCL Rule-Breaking Behavior scale. This study stresses the need to combine the learning and neuropsychological assessment with a psychopathological evaluation of children and adolescents with SLD and provides new interpretative insights on the complex interaction between cognitive, learning, and emotional-behavioral phenotypes.

Executive Functions and Rapid Automatized Naming: A New Tele-Rehabilitation Approach in Children with Language and Learning Disorders.

Executive function deficits are documented in many neurodevelopmental disorders and may contribute to clinical complexity or rehabilitation resilience. The present research was primarily aimed at presenting and evaluating the feasibility and effectiveness of a telerehabilitation program used during the pandemic period. MemoRAN (Anastasis), a computerised cognitive training to improve executive control during visual-verbal integration tasks was used in a sample of 42 children (5-11 years old) with specific learning or language disorders. The MemoRAN training was based on exercises of inhibition, cognitive flexibility and updating in working memory for three months, with a frequency of approximately three sessions per week. Afterwards, a comparison between a subgroup of children using Memo-RAN and an active control group, using a tele-rehabilitation program directed on reading was conducted. Effect size analysis in pre-post measurements suggests an average effect of MemoRAN in measurements that require control processes, such as accuracy in dictation, reading, inhibition and working memory testing. Comparison with the active control group and the clinical utility implications of these types of treatment will be discussed.

Complex neurodevelopmental disorder in a preterm child with unilateral cerebellar hemorrhage.

BACKGROUND: Cerebellar hemorrhage (CBH) represents the main form of direct cerebellar injury in preterm infants. Most CBHs occur bilaterally, while isolated unilateral hemorrhages are less frequent and often associated with focal atrophy. Limited and heterogeneous data exist on preterm birth, unilateral CBH and consequent long-term neurodevelopmental and non-motor outcomes. CASE REPORT: This is the case of a six-year-old child, born preterm, diagnosed with a complete atrophy of the right cerebellar hemisphere through brain MRI and presenting mild social atypies, visuo-perceptive and pragmatic language impairment, but only minor neurological signs. DISCUSSION: Despite the large extension of the patient's CBH neurological sequelae were mild, likely due to cerebellar plasticity, and only specific deficits in non-motor, behavioral and social skills were shown. Evidence exists on cerebellar contribution to dynamic visual information processing and to perceptual signals detection and prediction, that might explain the presence of non-motor signs.

Dialogic Reading to Empower Executive Functions in Preschoolers.

Among the interventions recently developed to enhance Executive Functions (EFs) in preschoolers, Quincey Quokka's Quest (QQQ) is an illustrated book proposing EF activities embedded within a shared reading framework (Howard et al., 2017). In the present study, the Italian version of QQQ (QQQIT) was tested in 20 typical developing 4-5 year old children. Standardized tests were used to assess EFs pre- and post- intervention. QQQIT was conducted once a week for 8 weeks in small groups. A positive trend was registered in QQQIT performances from the first to the last sessions and a significant improvement, in comparison to the control condition, was obtained in the Color and Form Game test. These results, supporting the feasibility of the QQQIT intervention and its efficacy in increasing shifting abilities, confirm the usefulness of ecological interventions to empower specific EF components in preschool contexts.

Adaptive Working Memory Training Can Improve Executive Functioning and Visuo-Spatial Skills in Children With Pre-term Spastic Diplegia.

Pre-term spastic diplegia (pSD) due to periventricular leukomalacia is a form of cerebral palsy in which weaknesses in executive functions are reported beyond the core visuo-spatial deficits. The study aimed at improving executive functioning and visuo-spatial skills with an evidence-based training focused on working memory in children with pSD. The intervention study followed a stepped wedge design. 19 children with pSD (11 female and 8 male; age range: 4;1-13;1 years), mild to moderate upper limb impairment and Verbal Intelligence Quotient (VIQ) >80 participated to the study. The children were trained with a home-based adaptive working memory training (CogMed®) over a 5-week period. The primary outcome measure was the CogMed Improvement index; pre- and post-test explorative neuropsychological assessment was conducted with a subset of tests from the NEPSY-II battery. Working memory training in children with pSD significantly improved trained working memory abilities (CogMed indices) as well as non-trained skills, such as visuo-spatial skills, inhibition of automatic responses and phonological processing. The results suggest that standard rehabilitation schedules for children with pSD should be integrated with trainings on executive functions.

Training RAN or reading? A telerehabilitation study on developmental dyslexia.

Rehabilitation procedures recommended for developmental dyslexia (DD) are still not fully defined, and only few studies directly compare different types of training. This study compared a training (Reading Trainer) working on the reading impairment with one (Run the RAN) working on the rapid automatized naming (RAN) impairment, one of the main cognitive deficits associated with DD. Two groups of DD children (N = 45) equivalent for age, sex, full IQ, and reading speed were trained either by Reading Trainer (n = 21) or by Run the RAN (n = 24); both trainings required an intensive home exercise, lasting 3 months. Both trainings showed significant improvements in reading speed and accuracy of passages and words. Bypassing the use of alphanumeric stimuli, but empowering the cognitive processes underlying reading, training RAN may be a valid tool in children with reading difficulties opening new perspectives for children with severe impairments or, even, at risk of reading difficulties.

Improving Executive Functions at School in Children With Special Needs by Educational Robotics.

Children with Special Needs represent a highly heterogeneous group in terms of neurofunctional, behavioral, and socio-cognitive characteristics, but they have in common a frequent impairment of Executive Functions. Educational Robotics is generally dedicated to study the effects of constructing and programming robots based on children's learning and academic achievement. Recently, we found that being engaged in progressively more challenging robot planning and monitoring (ER-Lab) promotes visual-spatial working memory and response inhibition in early childhood during typical development, and that an ER-Lab can be a feasible rehabilitative tool for children with Special Needs. The present study aimed to verify the efficacy of the ER-Lab on Executive Functions in children with Special Needs for the first time by using an RCT within their school environment. To pursue these aims, this study reports the results obtained in 42 first-grade children with Special Needs engaged in school Educational Robotics Laboratories (ER-Lab) to promote Executive Functions by means of enjoyable, intensive, and incrementally more challenging activities requiring them to program a bee-shaped robot called Bee-bot® (Campus Store). Several adaptations were done to meet different motor, cognitive, and social needs. All children were evaluated by means of standardized tests performed by each child before and at the end of the ER-Lab activities. Children with Special Needs had significantly improved inhibition skills, and children with attentional impairment had more benefits in their inhibition of motor responses tasks with respect to children with a language deficit. Results of the study and future perspectives on how ER-Lab programs could become a powerful tool in classrooms with children with special needs are discussed.

Empowering Executive Functions in 5- and 6-Year-Old Typically Developing Children Through Educational Robotics: An RCT Study.

Educational Robotics (ER) is a new learning approach that is known mainly for its effects on scientific academic subjects such as science, technology, engineering, and mathematics. Recent studies indicate that ER can also affect cognitive development by improving critical reasoning and planning skills. This study aimed to quantify the ability of ER to empower Executive Functions (EF), including the ability to control, update, and program information, in 5- and 6-year-old children attending first grade, a crucial evolutionary window for the development of such abilities. A total of 187 typically developing children were enrolled and randomly allocated into two experimental conditions: A, for immediate ER training, and B, for waitlist. ER-Laboratories (ER-Lab) for small groups were organized at schools, using a child-friendly, bee-shaped robot called Bee-Bot® (Campus Store). Activities were intensive, enjoyable, and progressively more challenging over the 20 twice-weekly sessions. Outcome measures, based on standardized tests, were used to quantify the effects of ER on EF. Compared to the control group, the ER-Lab group showed significantly better ability to actively manipulate information in short-term memory and suppress automatic responses in favor of goal-appropriate actions. This RCT study provides the first quantitative evidence of the positive effects of ER activities for improving working memory and inhibition in the early school years.

Spastic diplegia in preterm-born children: Executive function impairment and neuroanatomical correlates.

BACKGROUND: The neuropsychological literature on preterm-born children with spastic diplegia due to periventricular leukomalacia is convergent in reporting deficits in non-verbal intelligence and in visuo-spatial abilities. Nevertheless, other cognitive functions have found to be impaired, but data are scant and not correlated with neuroimaging findings. AIMS: This study analyzes the neuropsychological strengths and weaknesses in preterm-born children with spastic diplegia (pSD) and their relationships with neuroanatomical findings, investigated by a novel scale for MRI classification. METHODS AND PROCEDURES: Nineteen children with pSD, mild to moderate upper limb impairment and Verbal IQ>80, and 38 normal controls were evaluated with a comprehensive neuropsychological battery (NEPSY-II), assessing Attention/Executive Functioning, Language, Memory, Sensorimotor, Social Perception and Visuospatial Processing domains. The MRIs were quantitatively scored for lesion severity. OUTCOMES AND RESULTS: The results showed that, beyond core visuo-spatial and sensory-motor deficits, impairments in attention and executive functions were present in more than half of the sample, particularly in children with damage to the anterior corpus callosum. CONCLUSIONS AND IMPLICATIONS: The findings are discussed in terms of clinical and rehabilitative implications tailored for pSD subgroups diversified for neuropsychological and neuroanatomical characteristics.

How many functional brains in developmental dyslexia? When the history of language delay makes the difference.

BACKGROUND: Clinical manifestations of developmental dyslexia (DD) are greatly variable, suggesting complex underlying mechanisms. It was recently advanced that the characteristics of DD in Italian, a language with shallow orthography, are influenced by a positive history for language delay. OBJECTIVE: We explored this hypothesis by studying in Italian individuals with DD (i) the brain representation of phonological processing with functional magnetic resonance imaging and (ii) the correlation between the patterns of activation and the presence/absence of previous language delay. METHOD: Thirteen individuals with DD and 13 controls participated in the functional magnetic resonance imaging experiment consisting of a rhyme-generation task. RESULTS: Individuals with DD showed a reduced activation of phonological processing areas of the left hemisphere, such as the middle frontal gyrus, the precuneus, and the inferior parietal lobule, and in particular the superior temporal gyrus. Furthermore, patients with a history of language delay had reduced activation in the left inferior and medial frontal gyrus, that was associated with worse reading and phonological accuracy than patients with normal language development. CONCLUSIONS: Neurofunctional profiles of Italian individuals with DD are correlated to the history of language delay, suggesting that the relatively better behavioral profiles observed in individuals without a history of language delay are associated with a major activation of frontal networks normally involved in phonological working memory.