Impact of AI-Powered Solutions in Rehabilitation Process: Recent Improvements and Future Trends.

Rehabilitation is an important and necessary part of local and global healthcare services along with treatment and palliative care, prevention of disease, and promotion of good health. The rehabilitation process helps older and young adults even children to become as independent as possible in activities of daily life and enables participation in useful living activities, recreation, work, and education. The technology of Artificial Intelligence (AI) has evolved significantly in recent years. Many activities related to rehabilitation have been getting benefits from using AI techniques. The objective of this review study is to explore the advantages of AI for rehabilitation and how AI is impacting the rehabilitation process. This study aims at the most critical aspects of the rehabilitation process that could potentially take advantage of AI techniques including personalized rehabilitation apps, rehabilitation through assistance, rehabilitation for neurological disorders, rehabilitation for developmental disorders, virtual reality rehabilitation, rehabilitation of neurodegenerative diseases and Telerehabilitation of Cardiovascular. We presented a survey on the newest empirical studies available in the literature including the AI-based technology helpful in the Rehabilitation process. The novelty feature included but was not limited to an overview of the technological solutions useful in rehabilitation. Seven different categories were identified. Illustrative examples of practical applications were detailed. Implications of the findings for both research and practice were critically discussed. Most of the AI applications in these rehabilitation types are in their infancy and continue to grow while exploring new opportunities. Therefore, we investigate the role of AI technology in rehabilitation processes. In addition, we do statistical analysis of the selected studies to highlight the significance of this review work. In the end, we also present a discussion on some challenges, and future research directions.

The Prevalence of Amnestic and Non-Amnestic Mild Cognitive Impairment and Its Association with Different Lifestyle Factors in a South Italian Elderly Population.

Mild Cognitive Impairment (MCI) is a transition stage between normal aging and dementia and can be useful to monitor the cognitive status of people at risk of dementias. Our aims were to investigate the prevalence of amnestic and non-amnestic MCI in a South Italian elderly population, and to identify socio-demographic, clinical and lifestyle factors associated with MCI. A cross-sectional retrospective population study on 839 community-dwelling participants over 60 years of age was carried out. Elderly people were administered a brief neuropsychological screening to identify their cognitive and functional status, and a questionnaire to investigate several socio-demographic, clinical, and lifestyle factors. Prevalence estimate for MCI was 12.0% (95% CI: 10.0-14.5%), for amnestic MCI was 7.4% (95% CI: 5.8-9.4%), and for non-amnestic MCI was 4.6% (95% CI: 3.4-6.4%), for people older than 60 years of age. Logistic regression models, corrected for age, sex, and education, revealed a significant association of MCI with the following factors: age, education, intellectual activities, and topographical disorientation. On the other hand, education, clinical factors (e.g., depression level and perceived physical pain), lifestyle factors (e.g., smoking, alcohol, and leisure/productive activities), dietary habits, quality of life, and self-reported topographical disorientation were non-significantly associated with MCI. Prevalence estimates and the association of MCI and its subtypes with risk and protective factors were discussed in comparison with the most recent systematic reviews and meta-analyses.

An assistive technology program for enabling five adolescents emerging from a minimally conscious state to engage in communication, occupation, and leisure opportunities.

BACKGROUND: Post-coma patients emerging from a minimally conscious state may have extensive motor disabilities and pose serious challenges to medical centers and home settings. OBJECTIVES: To promote academic performance and communication skills of post-coma individuals with traumatic brain injuries emerging from a minimally conscious state through an Assistive Technology setup. To evaluate its effects on the participants' positive participation. To generalize the learning process. To assess the intervention's clinical and social validity. METHOD: Study I included five adolescents exposed to an Assistive Technology setup enabling them with targeted adaptive behaviors. Study II involved fifty external raters in a social validation assessment. RESULTS: Data evidenced an improved performance of all the participants during the intervention, assessed through a concurrent multiple baseline design across participants. Social raters favorably scored the use of the technology. CONCLUSION: An Assistive Technology setup may be helpful to enhance the performance and positive participation of adolescents with traumatic brain injuries emerging from a minimally conscious state.

The Drives for Driving Simulation: A Scientometric Analysis and a Selective Review of Reviews on Simulated Driving Research.

Driving behaviors and fitness to drive have been assessed over time using different tools: standardized neuropsychological, on-road and driving simulation testing. Nowadays, the great variability of topics related to driving simulation has elicited a high number of reviews. The present work aims to perform a scientometric analysis on driving simulation reviews and to propose a selective review of reviews focusing on relevant aspects related to validity and fidelity. A scientometric analysis of driving simulation reviews published from 1988 to 2019 was conducted. Bibliographic data from 298 reviews were extracted from Scopus and WoS. Performance analysis was conducted to investigate most prolific Countries, Journals, Institutes and Authors. A cluster analysis on authors' keywords was performed to identify relevant associations between different research topics. Based on the reviews extracted from cluster analysis, a selective review of reviews was conducted to answer questions regarding validity, fidelity and critical issues. United States and Germany are the first two Countries for number of driving simulation reviews. United States is the leading Country with 5 Institutes in the top-ten. Top Authors wrote from 3 to 7 reviews each and belong to Institutes located in North America and Europe. Cluster analysis identified three clusters and eight keywords. The selective review of reviews showed a substantial agreement for supporting validity of driving simulation with respect to neuropsychological and on-road testing, while for fidelity with respect to real-world driving experience a blurred representation emerged. The most relevant critical issues were the a) lack of a common set of standards, b) phenomenon of simulation sickness, c) need for psychometric properties, lack of studies investigating d) predictive validity with respect to collision rates and e) ecological validity. Driving simulation represents a cross-cutting topic in scientific literature on driving, and there are several evidences for considering it as a valid alternative to neuropsychological and on-road testing. Further research efforts could be aimed at establishing a consensus statement for protocols assessing fitness to drive, in order to (a) use standardized systems, (b) compare systematically driving simulators with regard to their validity and fidelity, and (c) employ shared criteria for conducting studies in a given sub-topic.

The differential effect of normal and pathological aging on egocentric and allocentric spatial memory in navigational and reaching space.

BACKGROUND: Topographical disorientation (TD) refers to a particular condition which determines the loss of spatial orientation, both in new and familiar environments. TD and spatial memory impairments occur relatively early as effect of cognitive decline in aging, even in prodromal stages of dementia, namely mild cognitive impairment (MCI). AIMS: (a) To show that components linked to the recall of familiar spatial knowledge are relatively spared with respect to the learning of unfamiliar ones in normal aging, while they are not in MCI, and (b) to investigate gender differences for their impact on egocentric and allocentric frames of reference. METHOD: Forty young participants (YC), 40 healthy elderly participants (HE), 40 elderly participants with subjective memory complaints (SMC), and 40 elderly with probable MCI were administered with egocentric and allocentric familiar tasks, based on the map of their hometown, and with egocentric and allocentric unfamiliar tasks, based on new material to be learned. A series of general linear models were used to analyze data. RESULTS: No group differences were found on egocentric task based on familiar information. MCI performed worse than the other groups on allocentric tasks based on familiar information (YC = HE = SMC > MCI). Significant differences emerged between groups on egocentric and allocentric tasks based on unfamiliar spatial information (YC > HE = SMC > MCI). A gender difference was found, favoring men on allocentric unfamiliar task. CONCLUSION: Familiarity of spatial memory traces can represent a protective factor for retrospective components of TD in normal aging. Conversely, using newly learned information for assessment may lead to overestimating TD severity.

Virtual Reality as a Technological-Aided Solution to Support Communication in Persons With Neurodegenerative Diseases and Acquired Brain Injury During COVID-19 Pandemic.

The COVID-19 poses an ongoing threat to lives around the world and challenges the existing public health and medical service delivery. The lockdown or quarantine measures adopted to prevent the spread of COVID-19 has caused the interruption in ongoing care and access to medical care including to patients with existing neurological conditions. Besides the passivity, isolation, and withdrawal, patients with neurodegenerative diseases experience difficulties in communication due to a limited access to leisure opportunities and interaction with friends and relatives. The communication difficulties may exacerbate the burden on the caregivers. Therefore, assistive-technologies may be a useful strategy in mitigating challenges associated with remote communication. The current paper presents an overview of the use of assistive technologies using virtual reality and virtual body ownership in providing communication opportunities to isolated patients, during COVID-19, with neurological diseases and moderate-to-severe communication difficulties. We postulate that the assistive technologies-based intervention may improve social interactions in patients with neurodegenerative diseases and acquired brain injury-thereby reducing isolation and improving their quality of life and mental well-being.

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.

Experimental Examination and Social Validation of a Microswitch Intervention to Improve Choice-Making and Activity Engagement for Six Girls with Rett Syndrome.

Background: The use of assistive technology, specifically microswitches, with children with RTT has been shown to effectively moderate the impact of their disability on their quality of life- by facilitating access to meaningful leisure and other activities. Objectives: This study aimed to evaluate the effectiveness of a microswitch intervention on increased choice making, engagement in a targeted sorting activity, and indices of happiness, and decreased stereotypic behaviors for six girls with Rett syndrome. Targeted dependent variables were also assessed at six months post-intervention. Following the intervention study, 90 external raters completed a social validation procedure. Method: An ABABAB experimental sequence was implemented for each participant with a cross-over effect. A social validation assessment involving 90 external raters was carried out. Results: Data emphasized an improved performance for each participants involved (i.e., adaptive responses). Five participants showed a capacity of independent choice. One participant seemed to be closely linked to the position of the container. Social raters favorably endorsed the use of the program since they positively evaluated the use of the technology on all the dimensions investigated. Conclusion: A microswitch intervention may improve choice making and activity engagement for children with Rett syndrome. Further research is needed on the development of more sophisticated forms of individualized technological options to improve opportunities for enhanced engagement and choice-making for individuals with RTT.

Assistive technology for promoting adaptive skills of children with cerebral palsy: ten cases evaluation.

Objectives: To extend the use of assistive technology for promoting adaptive skills of children with cerebral palsy. To assess its effects on positive participation of ten participants involved. To carry out a social validation recruiting parents, physiotherapists and support teachers as external raters. Method: A multiple probe design was implemented for Studies I and II. Study I involved five participants exposed to a combined program aimed at enhancing choice process of preferred items and locomotion fluency. Study II involved five further children for a combined intervention finalized at ensuring them with literacy access and ambulation responses. Study III recruited 60 external raters for a social validation assessment. Results: All participants improved their performance, although differences among children occurred. Indices of positive participation increased as well. Social raters favorably scored the use of both technology and programs. Conclusion: Assistive technology-based programs were effective for promoting independence of children with cerebral palsy. Implications for Rehabilitation A basic form of assistive technology such as a microswitch-based program may be useful and helpful for supporting adaptive skills of children with cerebral palsy and different levels of functioning. The same program may improve the participants' indices of positive participation and constructive engagement with beneficial effects on their quality of life. The positive social rating provided by external experts sensitive to the matter may recommend a favorable acceptance and implementation of the program in daily settings.

Spatial reorientation decline in aging: the combination of geometry and landmarks.

OBJECTIVES: The study is focused on the assessment of reorientation skills in a sample of community-dwelling elderly people, manipulating landmarks and geometric (layout) information. METHOD: A neuropsychological assessment was administered to 286 elderly participants, divided into six groups (healthy controls, HC; four subgroups of participants with mild cognitive impairment, MCI; participants with probable dementia, Prob_D) and tested with the Virtual Reorientation Test (VReoT). VReoT manipulated different spatial cues: geometry and landmarks (proximal and distal). RESULT: Compared with HC, participants with MCI and Prob_D showed to be impaired in tasks involving geometry, landmarks and a combination of them. Both single and multiple domain impairment in MCI had an impact on reorientation performance. Moreover, VReoT was marginally able to discriminate between amnesic and non-amnesic MCI. The occurrence of getting lost events seemed to be associated to learning of geometric information. CONCLUSION: The associative strength between landmark and target plays an important role in affecting spatial orientation performance of cognitively impaired participants. Geometry significantly supports landmark information and becomes helpful with the increase of cognitive impairment which is linked to a decrement in landmark encoding. VReoT seems to represent a reliable evaluation supplement for spatial orientation deficits in prodromal stages of dementia.

A microswitch-based program for promoting initial ambulation responses: An evaluation with two girls with multiple disabilities.

We assessed the use of a microswitch-based program for promoting ambulation responses by two children with multiple disabilities. The goals of the study were to: (a) evaluate the importance of the contingency between the target behavior (forward step) and the programmed consequence (preferred stimuli), (b) measure effects of the intervention on indices of happiness, and (c) assess the social validation of the procedure using 20 physiotherapists as external raters. The intervention involved the automatic delivery of preferred stimuli contingent on forward steps. Results showed that both participants improved their performance (forward steps and indices of happiness) during contingent reinforcement phases compared to baseline and noncontingent reinforcement phases. Moreover, physiotherapists rated the intervention as socially valid.

Assistive technology to promote occupation and reduce mouthing by three boys with fragile X syndrome.

OBJECTIVES: To extend the use of assistive technology (AT) for promoting a new adaptive response and to reduce hand mouthing, by three boys with fragile X syndrome. To monitor the effects of the intervention program on the positive mood. To carry out a three month follow-up phases. To conduct a social validation assessment involving 30 parents of children who presented multiple disabilities as raters. METHODS: The study was implemented according to an ABAB experimental design, where A represented baseline phases (technology available but inactive) and B represented intervention phases (the technology ensured 7 s of positive stimulation). RESULTS: All participants improved and consolidated their performance. Parents involved in the social validation assessment rated positively the use of such technology. CONCLUSION: AT-based program was useful, affordable, and effective for enhancing constructive engagement, self-determination, and for improving quality of life by children with fragile X syndrome and severe to profound developmental disabilities.