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Introduction: Over the years, the conceptual approach to pediatric rehabilitation has reevaluated the parent's role in the therapeutic process, considering parental involvement as a necessary condition for the effectiveness of the intervention. In the field of pediatric intervention, the therapeutic use of robots represents a growing clinical interest, but the feasibility and applicability of these robotic interventions, including those involving parents, remain unclear. This systematic review aims to investigate parental involvement in robot-mediated interventions (RMI) for children and adolescents in the current literature. Our main goal is to analyze and summarize all existing studies to discuss and draw future research directions and implications for clinical practice. Method: After collecting results from 1,106 studies, the studies selected were analyzed using thematic analysis. The literature review was conducted in accordance with the PRISMA guidelines by searching databases such as PubMed and Web of Science until 07 February 2023. Studies that met the following inclusion criteria were included: (1) the use of a robot as a therapeutic-rehabilitation tool and (2) the presence/involvement of parents/caregivers in child-robot therapeutic sessions. Results: A total of 10 articles were included. The extracted data included study design, participant characteristics, type of robot used, outcome measures, aim, and type of intervention. The results reveal that parental involvement in RMI could be feasible and useful in improving intervention efficacy, particularly in improving the child's social-communicative abilities and the caregiver's educational skills. Discussion: RMI intervention with parental participation could be a useful therapeutic strategy in pediatrics. However, to date, few studies have investigated this specific topic, and the reported results may enhance future research to understand its effectiveness in specific areas of use. Systematic review registration: identifier: CRD42024553214.
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Background: Autism spectrum disorder (ASD) is a complex neurological development with social and communication deficits and sensory abnormalities. Sensory problems have a significant impact on daily life. Multisensory environments (MSEs), such as Snoezelen® rooms, offer controlled sensory stimulation. This study aims to evaluate the effect of MSE intervention with self-controlled sensory interactions on adaptive developmental skills and sensory responses in preschool ASD children. Methods: This pilot study was single-blind, randomized, controlled, and adhered to the CONSORT guidelines. Twenty participants were recruited and randomized into two groups: the control group (CG) underwent treatment as usual (TAU) with individual rehabilitation sessions of psychomotor therapy. The experimental group (EG) underwent TAU integrated with the use of an MSE. Developmental abilities and severity levels were assessed, pre-post, with the Psychoeducational Profile, Third Edition (PEP-3) and the Second Edition Childhood Autism Rating Scale (CARS-2). Results: A significant difference in taste, smell, and tactile behaviors according to the CARS-2, as well as in gross motor skills according to the PEP-3, was observed in the EG. Conclusions: This pilot study suggests that MSE-integrated intervention may be a valid strategy to improve self-management of the sensory profile in autistic individuals. Further studies are needed to better identify the intervention methodology and effectiveness.
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Introduction: Autism spectrum disorder is a lifelong neurodevelopmental disorder. The profile of functioning in autistic people is very heterogeneous, and it is necessary to take into account individual characteristics to better support integration in the workplace. However, unemployment rates are higher for autistic people than for other types of disabilities. We present a prospective case series to explore the feasibility and efficacy of an individual-supported program to enhance placement in a sheltered work environment delivered by an Italian community day care center. Methods: Autistic subjects, aged from 12 to 31 years, participated in an individual-supported program regarding employment in sheltered art workshops, integrated into the regular activity of a semi-residential center three times a week for 1 year. Their feasibility retention rate and time worked per session were registered; moreover, working methods efficacy and self-organization improvement were tracked by the Likert-based rating system. Secondary outcome measures span functional levels, challenge behaviors, and sensory problems. Results: All the individuals presented a good adaptation to the environment, with a significant increase in time worked per session. After 1 year, the intervention allowed an increase in tasks completed in an assigned complex job and an improvement in self-organization within the work schedule in a group of subjects consisting mainly of severe-to-moderate levels of autism severity (86.6%). Finally, we observed a significant increase in independent functioning areas of the TEACCH transitional assessment profile. Challenge behaviors and sensory problems were also recorded. Conclusion: This case series supports the idea that individual-supported programs for placement in sheltered job environments delivered by community day care centers could be feasible and effective for ASD with higher levels of severity and co-occurring intellectual disability. Further targeted studies based on community models and accessible methods need to be planned to define the effectiveness of the intervention and promote improved practice at the community level with a better social impact.
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Global developmental delay (GDD) is a complex disorder that requires multimodal treatment involving different developmental skills. The objective of this single-blind, randomized, controlled pilot study is to evaluate the feasibility and effectiveness of conventional rehabilitation programs integrated with the BTs-Nirvana virtual reality system. Patients with GDD aged 12 to 66 months were enrolled and treated for a 48-session cycle. Patients were randomized into two groups, (1) conventional treatment and (2) conventional treatment supplemented with the use of BTs-Nirvana, in a 1:1 ratio. Before and after treatments, areas of global development were tested with the Griffiths-III Mental Developmental Scale and the clinical indicator of global improvement were measured with the Clinical Global Impressions-Improvement (CGI-I). Feasibility was confirmed by the high retention rate. The experimental group presented a significantly improvement in General Quotient (GQ) after treatment (GQ, p = 0.02), and the effect of the two treatments was significantly different in both the GQ (t =2.44; p = 0.02) and the Foundations of Learning subscale (t =3.66; p < 0.01). The overall improvement was also confirmed by the CGI-I (p = 0.03). According to these preliminary data, virtual reality can be considered a useful complementary tool to boost the effectiveness of conventional therapy in children with GDD.
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Language disorders are characterized by impairments in verbal expression/understanding, including difficulties with one or more language components. The Virtual Reality Rehabilitation System (VRRS) is a bioelectromedical device equipped with exercise sections aimed at improving cognitive and language deficits. It also increases patient motivation and engagement. The aim of our study was to test the feasibility and efficacy of VRRS intervention to improve speech therapy treatment for children with speech disorders. Thirty-two patients were enrolled in this study and randomly assigned to the experimental (EG) or control group (CG). The CG underwent conventional speech therapy, while EG underwent VRRS-implemented speech therapy. Both groups were evaluated before (T0) and after (T1) the intervention using the Language Assessment Test. The results showed improvements in both groups. However, the EG group showed greater improvement in various areas, including comprehension of total words, repetition, naming of body parts, naming of everyday objects, total naming, morphosyntactic accuracy, sentence construction, average length of utterance, and spontaneous word production. This study demonstrated that VRRS can be a valuable tool for implementing effective speech rehabilitation. Further studies are needed, as the use of VRRS is still in its early stages, requiring larger samples sizes and long-term follow-up.
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Trisomy 8 mosaicism syndrome (T8MS) or "Warkany's syndrome 2" is a rare chromosomal disorder characterized by three copies of chromosome 8 in some cells of the body. T8MS incidence in the world population is about 1/25,000-50,000 live births with a 5:1 ratio between males and females. Since chromosomal mosaicism is often present in this syndrome, affected subjects present a phenotype varying from mild dysmorphism to severe structural anomalies. Malformations, including corpus callosum agenesis and renal abnormalities, have been described by many studies. We present a case in a girl 36 months in age, born to assisted fertilization (FIVET) and prenatal diagnosis by amniocentesis. In a fetus in the 22 week of gestation, she presented trisomy 8 mosaicism with ventriculomegaly, agenesis of the corpus callosum and a sequence of polymalformations. Through the early identification of symptoms that gradually occurred during development, the girl was submitted, early, to innovative complex instrumental using virtual reality (VR) rehabilitation. This study involves continuous monitoring and early management of symptoms, with the aim of improving the neurobehavioral outcomes of children with this rare disease by inducing structural neuroplastic responses and significantly reducing the impact that this disorder has on the development of children born without corpus callosum.