Background: Cerebral palsy (CP) is the most common cause of disability in developmental age, affecting motor and postural skills. With growth, lower-limb orthopedic surgery often becomes necessary. Post-surgical walking rehabilitation programs generally involve conventional therapy with only limited evidence on the use of robot-assisted gait training (RAGT). The aim of the present pilot study is to assess the feasibility and the preliminary functional outcomes of an intensive 3-week rehabilitation of 15 sessions with Lokomat combined with 15 sessions of conventional physiotherapy. Methods: In total, 27 patients with diplegic cerebral palsy who underwent orthopedic surgery were recruited. Outcomes collected: the 6 min walking test (primary outcome), the Gross Motor Function Measure-88, the Gillette Functional Assessment Questionnaire, 3D gait analysis, and spasticity and force metrics of the lower limbs. Paired statistical tests were used to assess pre–post changes. Results: A pre–post statistically significant improvement was observed in gait endurance in the 6MWT (Δ = 28.56 ± 34.28 m; p < 0.001) and in gross motor functional skills. Gait parameters showed some functional and structural improvements, and joint stiffness was reduced in some measures. Conclusions: This combined rehabilitative approach seems to be promising in postoperative patients with CP. Future studies, involving a control group and larger sample size, are needed to generalize our results.

IntroductionCerebral palsy (CP) is a common childhood-onset neurological condition often associated with crouch gait, a pathological walking pattern impairing mobility. Wearable robotic devices are emerging as promising tools for paediatric gait rehabilitation, but evidence on their rehabilitative and assistive effects remains limited. This exploratory study evaluated the rehabilitative and assistive effects of a 10-session training programme using Agilik, a paediatric knee exoskeleton, in children with CP and crouch gait, during level-ground, uphill, and downhill walking.MethodsEight children with CP completed the intervention. Assessments were performed at baseline (T0) and post-intervention (T1), including walking endurance, speed, balance, spasticity, and clinical joint and muscle length assessments. Three-dimensional gait analysis (GRAIL system) quantified sagittal-plane hip, knee, and ankle range of motion during level-ground, uphill, and downhill walking. At T1, joint range of motion was analysed with and without Agilik to assess its assistive effect. User satisfaction was evaluated using the child-adapted QUEST 2.1 questionnaire.ResultsGiven the exploratory nature of this study, results were interpreted primarily at the individual level using predefined minimal clinically important difference (MCID) thresholds. When clinically relevant changes occurred, improvements were more frequently observed than deteriorations in walking endurance (MCID > 15 m), speed (MCID > 0.1 m/s), muscle lengths (>5°), and joint range of motion (>5°). No significant group-level rehabilitative changes were observed (all p > 0.05). In contrast, the assistive evaluation showed statistically significant increases in knee and hip range of motion across all walking conditions (p < 0.05), with all participants improving at the knee in every condition. Satisfaction scores (7-point scale) were high for size, appearance, usability, and set-up time (median ≥ 4/7), while weight, reliability, and timely performance received lower ratings (median 3.5/7).ConclusionsThis exploratory study demonstrates a clear assistive biomechanical benefit of Agilik, particularly at the knee and hip. Individual-level analyses suggest that some participants may experience clinically meaningful improvements following training; however, these observations are hypothesis-generating and cannot be interpreted as evidence of a rehabilitative effect. Larger randomised controlled studies are needed to determine whether repeated exposure to assisted gait translates into sustained functional gains.

Objectives To examine the emotional, cognitive and dispositional experience of children and adolescents undergoing Lokomat rehabilitation by integrating self-evaluation, therapist observations and physiological metrics across repeated sessions, with the aim of characterising how patient experience evolves throughout paediatric robot-assisted gait training.Design Prospective observational study using a multidimensional assessment approach combining self-report, therapist ratings and physiological measures.Setting Inpatients undergoing robot-assisted gait training (RAGT) with the Lokomat at the Scientific Institute Eugenio Medea in Bosisio Parini (Italy).Participants 42 children and adolescents (N=42; mean age 11.66±5.59 years) undergoing RAGT.Interventions Robot-assisted gait therapy with the Lokomat. Participants underwent 30-minute therapy sessions as per routine rehabilitation protocols, with treatment durations ranging from 15 to 20 sessions, as prescribed by their referring clinician.Primary and secondary outcome measures Participants completed ad-hoc questionnaires about emotional, cognitive and dispositional factors before and after therapy; therapists provided structured assessments of patient engagement and psychological states. Physiological data, such as heart rate variability (HRV) and electrodermal activity (EDA), were recorded using wearable sensors to capture physiological correlates of emotional and cognitive engagement.Results The results showed that by the end of Lokomat therapy, patients displayed increased cognitive engagement and better emotional regulation, along with higher vagal activity (normalised high-frequency) and increased phasic EDA responses. According to the therapists, patients appeared more confident, calm and cooperative. Sympathetic activation observed during satisfaction ratings reflected the involvement of the autonomic nervous system in positive emotional experiences.Conclusions This study, therefore, emphasises a multidimensional approach to rehabilitation, which involves subjective patient self-assessments, therapist observations and physiological signals in an effort to capture a more comprehensive patient experience. The findings highlight the importance of personalised, patient-centred approaches and contribute new evidence on the psychological and physiological effects of RAGT in paediatric populations. Further research is warranted to confirm these results and explore their clinical implications.Trial registration number NCT05767268.

Patient engagement is essential for improving clinical outcomes in pediatric neuromotor rehabilitation. Physiological computing offers a quantitative aid for its assessment, but clinical implementation is limited by intrinsic noise in therapist-reported labels and high inter-subject physiological variability. The study aims to predict absolute Engagement State and relative Engagement Dynamics in 31 underage participants (21 with neuromotor disorders, 10 neurotypical). Multimodal data (heart rate variability, electrodermal activity, and acceleration) and PRIME-SP engagement labels were collected during technology-assisted rehabilitation. Following feature extraction, confident learning reduced noise in therapist annotations, and hierarchical Bayesian models were trained and tested under cold start and adaptive learning evaluation paradigms. Results proved the non-destructive effectiveness of adaptive learning, achieving F1-Scores of 0.75 and 0.79 for Engagement State and Dynamics, respectively. The study marks a first step towards the development of a decision support system for real-time engagement assessment.

The new generation is growing up in a context where sustainability and climate change (CC) are considered the “issues of our time”. In line with this, education plays a crucial role in raising awareness of CC among young people. However, one of the main challenges is showing CC’s effects, as they are often perceived as temporally and spatially distant, and many individuals struggle to visualise the real impact that CC’s consequences will have on the future world. The present study describes the co-design of a 360° video showing the effects of CC in familiar environments, conducted with a class of pre-teens. Co-design is a method that enables end-users, who are not trained in design, to work alongside professionals in creative processes. Moreover, participating in collaborative workshops reduces the distance between users and the topic addressed, enhancing their engagement and awareness of it. The results show that participants were satisfied with the developed content and enjoyed taking part in the co-design process. These findings suggest the potential of participatory workshops for developing 360° videos with students and provide a foundation for future investigations about their educational impact.

BackgroundCerebral palsy (CP) is the most common neuromotor disability in children and often results in spastic diplegia, which can lead to crouch gait. This gait pattern, resulting from weakness predominantly in the extensor muscles and spasticity mainly affecting the flexors, is characterized by excessive knee flexion, insufficient hip extension, and excessive ankle dorsiflexion, which together can progressively impair walking. The Agilik powered knee-ankle-foot orthosis is designed to enhance knee extension and potentially improve gait in children with CP. Here we present the protocol of a study that aims to evaluate the clinical effectiveness of Agilik in a domiciliary setting.MethodsAccording to this protocol, the multicentre randomized controlled trial will enrol 40 children with CP (aged 5-17 years) exhibiting crouch gait. Participants will be randomly assigned to either the Intervention Group, which will receive training with the Agilik device, or the Control Group, which will maintain their standard routines and therapies. All participants will undergo physical examination and baseline assessments. Then, while the Control Group continues the usual care, the Intervention Group will begin the Agilik program, including three device fitting visits, 4/5 weeks of hospital training, and two months of home-based sessions. Both groups will be evaluated at three time points: baseline, after the intervention, and at a one-month follow-up. Primary endpoints include the 6-Minute Walking Test and Knee Extension in Mid-Stance computed during gait analysis. Secondary endpoints assess gross-motor abilities, gait speed, 3D gait analysis with electromyography, joint range of motion, muscle length, self-perceived performance, spasticity, and balance. Additionally, the Intervention Group will provide feedback on the usability and acceptability of the device, and on cognitive, behavioural and affective engagement.DiscussionThis trial will provide valuable insights into the effectiveness of the Agilik device in children with CP and crouch gait. It will help emphasizing the potential benefits of the device on daily living activities and gait performance. The findings could influence clinical practice and guide future interventions for managing crouch gait in CP, potentially leading to enhanced quality of life for these children.Trial registrationThe trial has been registered the 30th September 2024 on ClinicalTrials.gov with the identifier NCT06622655.

Physical activity (PA), defined by the World Health Organization (WHO) as any body movement involving the musculoskeletal system, provides health benefits from an early age. In addition, regular PA supports the treatment of chronic diseases and improves the well-being of children with clinical conditions such as neuromotor disorders (ND). However, both medical and psychosocial barriers can hinder children with compromised health conditions from maintaining active lifestyles. The recent diffusion of digital tools has proven to be a valuable tool in overcoming these barriers and promoting PA even among children with chronic diseases. Starting from these assumptions, this study presents preliminary results from the reframing of existing co-design methods through the active involvement of children with ND as co-designers in the process itself. Within this framework, children play a role in shaping knowledge around inclusive co-design practices aimed at improving PA. Intuitiveness and accessibility of these methods, together with the transferability of the outcomes into clear and specific design requirements are the main challenges tackled by the research. The resulting adapted methods will serve as a foundation for future work aimed at designing digital solutions that can enhance motivation toward active lifestyles, as well as for further investigating children’s perspectives on PA.

This paper describes the development, fabrication and testing of Playcuff, a wearable device designed to act as a videogame controller for children with motor disabilities, which also provides an orthotic action to improve the control of the upper limb. The aim of this device is to empower children with motor impairment and enable them to access and enjoy gaming despite their disabilities. The videogame controller function was achieved through on-board gesture classification using a two-tiered Fine Tree machine learning algorithm integrated into the device’s firmware. Based on features extracted from two inertial sensors present on the device, the classifier was trained to identify in real time 22 classes representing different postures and movements of forearm and wrist, showing an accuracy higher than 94

The acceptance and effective use of assistive robotic arms by people with neurological conditions strongly depend on the usability of the control interface. This study evaluated the usability of a voice control system for an assistive robotic arm in both healthy participants and individuals with neurological disorders, and compared its applicability and effectiveness with conventional joystick control. A voice control module based on automatic speech recognition and text-to-speech feedback was developed for a commercially available 6-degree-of-freedom assistive robotic arm. The system was implemented using the Robot Operating System (ROS) and an Italian speech-recognition knowledge base. Voice control was tested in 20 healthy subjects and 20 individuals with varying levels of upper-limb impairment due to neurological diseases. Participants performed representative activities of daily living, including (i) pressing an elevator button, (ii) picking up a TV remote control, and (iii) pouring water into a glass. Task completion time, usability, and speech recognition accuracy were assessed and compared between voice and joystick control. All participants except one with neurological impairment were able to successfully use the voice interface, whereas only 11 could operate the joystick. Voice control achieved a recognition accuracy of 87% and a System Usability Scale (SUS) score corresponding to a "Good" adjective rating. Overall, these results indicate that voice control represents a promising and inclusive access modality, with the potential to improve the usability of assistive robotic arms, particularly for individuals with severe motor impairments.

BACKGROUND:Myotonic Dystrophy Type 1 is a rare multisystem disorder, with symptoms including progressive muscle weakness, myotonia and fatigue. Although mobility measures are now common in several tests performed in clinics, their quantification using wearable sensors have not been significantly explored in the literature. This study investigated variation of gait characteristics during prolonged walking in individuals with Myotonic Dystrophy Type 1 using a single wearable sensor, and their association with gait fatigability proxies. METHODS:Forty-two subjects with Myotonic Dystrophy Type 1 and 15 healthy controls performed a 6-min walk test while wearing a single lumbar-mounted inertial measurement unit. Minute-by-minute gait parameters were extracted and compared between groups using repeated-measures ANOVA. Correlation analysis was performed to examine whether changes in gait parameters were related to motor functional ability levels. RESULTS:Patients demonstrated significantly impaired gait compared to controls, with reduced speed, cadence, step length, and increased stride time variability. While controls and mildly affected subjects showed similar temporal patterns, including a speed decrease in mid-test followed by recovery in the final minute, moderately affected subjects maintained a stable but slower pace throughout. Changes in cadence across the test were weakly but significantly correlated with clinical disability measures. CONCLUSION:Wearable sensors worn during prolonged walking assessments can detect subtle gait alterations in Myotonic Dystrophy Type 1 that vary by disability level, potentially serving as objective outcome measures for monitoring disease progression and evaluating therapeutic interventions. TRIAL REGISTRATION:The trial was retrospectively registered in Clinicaltrials.gov (NCT06666816, date of registration 31/10/2024). URL: https://clinicaltrials.gov/study/NCT06666816.

IntroductionPediatric medical device development remains limited, particularly for rare and complex conditions such as cyanotic congenital heart disease (CCHD). Although advances in surgery and diagnostics have improved survival, continuous and non-invasive monitoring of metabolic and physiological deterioration is not available outside hospital settings. Wearable devices could address this gap, but their clinical adoption requires alignment with real-world needs, usability, and healthcare workflows. This study aimed to capture clinician perspectives to inform the early development of a wearable multiparametric biosensor for pediatric CCHD within the European OrphaDev4Kids project (EU4H-2023-PJ).MethodsA structured, web-based anonymous survey was distributed through EPTRI channels to reach pediatric cardiology experts across Europe, including members of the OrphaDev4Kids Clinical Expert Committee. The questionnaire addressed current monitoring practices in CCHD, unmet clinical needs, usability and compliance, data integration, training requirements, and data governance. Quantitative responses were analyzed using descriptive statistics, and qualitative feedback was descriptively reviewed.ResultsClinicians reported that current CCHD monitoring relies mainly on imaging and basic physiological parameters, with minimal assessment of metabolic markers and no availability of non-invasive metabolic monitoring. Infancy, both before and after heart surgery, was identified as the most critical phase for remote monitoring. Respondents strongly supported non-invasive, multiparametric wearable devices providing threshold-based alerts and longitudinal summaries rather than continuous data streams. Comfort, intuitive design, and minimal disruption to daily activities were key determinants of patient compliance, while integration with clinical workflows, training, and technical support were essential for adoption. Clinicians also emphasized the importance of secure, regulation-compliant data handling. Despite limited familiarity with advanced wearable devices, clear and consistent expectations regarding functionality and usability emerged.ConclusionThis expert consultation identifies a clear unmet need and strong clinical support for the development of wearable, multiparametric biosensors tailored to pediatric patients with CCHD. The findings provide actionable guidance for device design and highlight the importance of combining technological innovation with human-centered design, workflow integration, and robust data governance to enable future clinical adoption.

Cerebral palsy (CP) is the most common motor disability in childhood, affecting movement, muscle tone, and posture as a result of a non-progressive lesion in the developing brain. Children with CP frequently present with alterations in gait and postural control that significantly impact their daily functioning and quality of life. Although conventional physical therapy remains the cornerstone of rehabilitation, adherence and motivation are persistent challenges, particularly in pediatric populations. Non-immersive virtual reality (VR) systems, such as Rehametrics, which use standard screens and motion-capture sensors rather than head-mounted displays, offer an interactive, game-based rehabilitation environment that may enhance motivation, promote repetitive motor practice, and provide objective performance metrics to clinicians. The primary aim of this study is to evaluate the feasibility and user satisfaction of a non-immersive VR rehabilitation system, i.e. Rehametrics, for gait and balance training in children with CP. Secondary objectives include assessing the system's impact on functional mobility, gross motor function, balance, active participation, and user experience. This is a pre-post single group pilot exploratory study. Ten children aged 4 to 10 years with a diagnosis of CP, confirmed by a pediatric neurologist, will be recruited from Centro Médico Universitario “Pedro P. Díaz”, Arequipa, Peru. Each participant will serve as their own control. The intervention consists of 9 sessions with Rehametrics, a non-immersive VR rehabilitation system designed to train gait and balance through interactive virtual scenarios. Outcome measures include: number of sessions completed, the User Satisfaction Evaluation Questionnaire (USEQ), the Timed Up and Go test (TUG), the Gross Motor Function Measure (GMFM-88), the Pediatric Balance Scale (PBS), the Pittsburgh Rehabilitation Participation Scale (PRPS), and the User Experience Questionnaire (UEQ). Pre- and post-intervention assessments will be conducted by a trained physical therapist blinded to session performance data. Statistical analysis will use paired Student's t-test for normally distributed continuous variables and non-parametric tests (Wilcoxon signed-rank) for ordinal data. Recruitment has not yet commenced. Results from this pilot study are expected to provide preliminary estimates of effect size and feasibility parameters to inform the design of a larger controlled trial. This protocol describes a novel application of Rehametrics, as a rehabilitation tool for children with CP. Findings will contribute evidence on the feasibility, satisfaction and preliminary clinical outcomes of game-based VR training targeting gait and balance in a pediatric rehabilitation setting in a middle-income country context. ClinicalTrials.gov — NCT07612332 — https://clinicaltrials.gov/study/NCT07612332

Children with neuromotor disorders often experience hand impairments that limit independence in daily tasks as well as the acquisition of new skills. Robotic aids like hand exoskeletons can improve function, but many designs fail to meet user needs, reducing adoption. This study collected parental feedback to guide the development of user-centered hand exoskeletons. An anonymous online survey was distributed to the parents of children with neurological disorders and previously treated at IRCCS E. Medea - Associazione "La Nostra Famiglia" in Bosisio Parini, Italy. Only parents of children with upper limb impairments were invited to answer. The survey explored their perceptions of hand exoskeletons, focusing on functional needs, user-friendliness, and training expectations. A total of forty-six surveys were completed, of which three were incomplete and therefore excluded. Of the forty-three considered, 76.3% expressed interest in a hand exoskeleton for their child, identifying dressing, hygiene, and eating as key activities to address. Key issues in the development of an exoskeleton for the parents were weight, comfort, associated aesthetics and trust. User feedback emphasizes the need for comfortable, lightweight designs with aesthetic appeal to reduce stigma. Parents prioritized functional benefits for daily activities over recreational use.

Social Bike is a system that combines a cycle-ergometer with three non-immersive Serious Games. It is de-signed to combine physical and cognitive exercise, individually or socially, and to promote a more active lifestyle. In this work, we present a multi-center evaluation focused on the system’s usability and user experience, conducted in three clinical centers, a school, and a research institute, involving both patients with rehabilitation needs and healthy users (N=87). The study combines quantitative and qualitative measures. Each participant completed two 10-minute cycling sessions with the system: one in individual mode and one in social mode. Furthermore, a subsample of patients (N=6) used the system for 2 weeks and reported feedback on motivation, sense of inclusion, and game experience after this period. Social Bike was perceived as usable by both healthy participants and patients (tot SUS mean = 77.86 ± 12.5), but patients reported significantly higher usability (U = 397.5, p = 0.002). Qualitative data confirmed the value of the social mode in supporting motivation and engagement and suggested targeted improvements to the interface and game balance. Longitudinal exploratory analysis indicated good stability in patient motivation to use the system (Median = 6 in t0 and t1 single mode; Median = 5.88 in t0 and t1 social mode) and a stable sense of inclusion (Median = 4 in t0 and t1, both game modes). These results provide preliminary evidence on the system’s applicability in clinical and non-clinical settings.

Evidence-based guidelines for motor rehabilitation in Hereditary Spastic Paraplegia (HSP) are still lacking but robotic gait training may offer benefits for motor function and walking. The aim of this study is to evaluate the effects of a robot-assisted gait training (RAGT) combined with traditional treatment (TT) on gait pattern, motor skills and quality of life in subjects affected by HSP. 40 patients (33 pure; 20 pediatric) underwent an intensive program with RAGT and TT daily (five-times a week for three consecutive weeks). Patients were evaluated pre and post intervention with gait analysis, gross-motor and timed walking tests and quality of life questionnaires. A three-month follow-up was conducted. A statistically significant improvement was observed in the Six-Minute Walk Test (6MWT). Enhancements have been obtained also in the Ten-Meter Walk Test (10mWT), the Berg Balance Scale (BBS) and the GMFM-88. The Spastic Paraplegia Rating Scale (SPRS) suggested reduction in disease severity. Quality of life's questionnaires showed improved perceived physical health. Gait analysis data did not show significant changes. Intensive treatment with a combination of RAGT and TT improves functional skills and quality of life in HSP. These new findings could guide clinical management and development of future rehabilitation studies.

Background/Objectives: Beyond the core characteristics of the condition, autistic individuals often significantly struggle with postural balance. This pilot study aimed to investigate the effects of an immersive virtual reality-based training administered with Gait Real-time Analysis Interactive Lab (GRAIL) on postural balance of autistic children. Methods: A total of 20 autistic participants aged 6 to 13 were enrolled in a 5-week randomized, parallel-group, open-label, controlled trial, and received either balance training with the GRAIL system or no training. The trial was registered at ClinicalTrials.gov (identifier: NCT04276571). The primary outcome measures were the change in center of pressure (CoP) metrics during GRAIL balance assessments and the change in motor skills as assessed with Movement Assessment Battery for Children-2. Secondary outcome measures included parent-report Developmental Coordination Disorder Questionnaire, center of mass metrics, and gait parameters evaluated with GRAIL. ANCOVA tests were performed for all outcomes, with time (T0 and T1) as within-subjects factor, the group (training and control groups) as between-subjects factor, and considering age as covariate. Results: Slight but significant time by group interactions were found in some CoP metrics (i.e., sway path length, velocity in the antero-posterior direction, and the jerk). Conclusions: These findings preliminarily suggest that a virtual reality-based training may induce slight modifications in postural balance strategies, which can be enhanced with longer or more intensive training.

BACKGROUND:Functional Electrical Stimulation Assisted Cycling (FES-cycling) is a rehabilitation intervention for individuals with Spinal Cord Injury (SCI), offering benefits like increased muscle trophism, improved cardiopulmonary function, and reduced bone demineralization. Despite numerous studies on its physical advantages, few have focused on user experience. This study evaluates the user experience, usability, acceptability, and human-device interaction of two FES-cycling systems: a recumbent FES-bike prototype from Politecnico di Milano and the commercial BerkelBike Pro. METHODS:We recruited 15 participants with SCI, aged 18-65, with varying injury levels. The user experience (primary outcome), acceptability, usability, human-device interaction, and ergonomics of both systems were investigated by means of 4 questionnaires: the User Experience Questionnaire (UEQ), the Technological Acceptance Measure 3 (TAM-3), the System Usability Scale (SUS), and a customized questionnaire to evaluate human-device interaction both in terms of ergonomic aspects and psychological factors. RESULTS:The user experience received positive evaluations across all dimensions (scores ≥ 1.5 on a scale from -3 to 3), with slightly higher, though not statistically significant, scores for the FB. Secondary outcomes indicated strong acceptability (global TAM-3 scores > 5.5/7 for both devices), high usability ratings (SUS scores ≥ 75/100 for both devices), and favorable interaction and ergonomics, emphasizing ease of use, comfort, and alignment with user expectations. CONCLUSIONS:The study underscores the positive user experience as the primary outcome, along with strong acceptance and usability of both devices, emphasizing their potential to enhance Sport-Therapy and the value of integrating user perspectives in future development.

Background: Telerehabilitation is a promising solution to provide continuity of care. Most existing telerehabilitation platforms focus on rehabilitating upper limbs, balance, and cognitive training, but exercises improving cardiovascular fitness are often neglected. Objective: The objective of this study is to evaluate the acceptability and feasibility of a telerehabilitation intervention combining cognitive and aerobic exercises. Methods: A virtual reality-based dual-task exercise exploiting a cycle ergometer was designed, developed, and integrated with a commercially available telerehabilitation platform. Patients with different conditions were enrolled and administered subjective questionnaires investigating attitudes toward technology, usability, technology acceptance, and subjective workload. Their therapists were interviewed, and adherence and performance data were analyzed. Results: In total, 26 patients with neurological or post-COVID symptoms were included. Their attitude toward technology (range: 0-5) did not change after the training period (pre: 3.44 [IQR 0.63]; post: 3.50 [IQR 0.48]); the platform was rated usable and acceptable. Frustration and physical and mental workload were present, especially among younger participants. The adherence was moderate, but individual differences were present (0.59 [IQR 0.54]). The therapists highlighted the potential of remote rehabilitation programs but also identified some limitations. Conclusions: This study proved the feasibility and acceptability of a customized virtual reality-based telerehabilitation program allowing for the safe implementation of aerobic cycling-based dual-task training. The solution was judged meaningful for dehospitalized patients, although some environmental and technical barriers should be overcome to implement telerehabilitation more effectively.

OBJECTIVE:Spinal orthoses are the most viable conservative treatment for scoliosis, and additive manufacturing techniques have shown huge perspective in producing patient-specific braces, reducing material waste, and production times. This pilot study aimed at determining whether 3D-printed braces could induce advantages or disadvantages compared to conventional braces in terms of mobility and gait, and at quantitatively evaluating the effects of braces on mobility and gait. METHODS:Ten participants were included in the study, eight with adolescent idiopathic scoliosis and two with osteogenesis imperfecta. Participants were asked to perform Timed-Up and Go (TUG) tests wearing a triaxial accelerometer under three conditions: unbraced, wearing a conventional (i.e., thermoformed) brace, and wearing a 3D-printed brace. After segmenting each TUG test in sub-phases, metrics quantifying gait and mobility were computed, and Friedman tests among all conditions were performed. RESULTS:No significant differences in scoliotic patients mobility and gait between conventional and 3D-printed brace conditions were found, potentially suggesting that 3D-printed braces are as effective as conventional ones. Conversely, Stand flexion amplitude and Sit extension amplitude were lower in both conventional and 3D-printed brace conditions compared to the unbraced, meaning that braces limited the trunk range of motion. As for gait parameters, no significant differences in Walk Cadence and Walk Velocity among the three conditions were found, indicating that braces did not affect gait, at least during TUG tests. TRIAL REGISTRATION:The study was registered at Clinicaltrials.gov (Study ID NCT04282408, Date of Registration February 11th, 2020).

BACKGROUND:The number of people who require a wheelchair is rising due to an increased number of injuries and the growing number of elderly. Training of new wheelchair users is mandatory to let them feel independent and safe. Virtual reality (VR)-based wheelchair simulators allow training wheelchair skills in a controlled, safe, and repeatable environment. Our group recently developed a wheelchair simulator for a motion platform in semi-immersive VR. OBJECTIVE:To assess the usability and user experience of two VR-based training environments in 20 participants considering the sense of presence, the cybersickness, the suitability of VR system, and the performance and to assess if these evaluations are influenced by the expertise in the use of a wheelchair. MATERIALS AND METHODS:The simulator was composed of a moving platform, an adaptable wheelchair, and two VR environments (one outdoor - OE, one indoor - IE) projected on a 180° screen. 10 able-bodied volunteers (wheelchair naïve-users, WNUs) and 10 expert wheelchair users (WUs) due to spinal cord injury were recruited. They performed one session during which they tested the indoor (IE) and the outdoor (OE) VR environment. Measures to assess user experience, such as the System Usability Scale, the Technological Acceptance Measure, and the Suitability Evaluation Questionnaire were administered. RESULTS:The usability of WUs was high in both environments, while WNUs had some difficulties in IE navigation. Acceptance (TAM mean score) was significantly higher for the OE (p-value = 0.017) in both groups (WNU-OE: 5.11 ± 0.44; WU-OE: 5.18 ± 0.67; WNU-IE: 4.75 ± 0.47; WU-IE: 4.85 ± 0.62). Suitability was higher for OE and generally higher for WUs. CONCLUSION:Our study focused on user experience during VR-powered wheelchair navigation in both WUs and naïve ones. The system proved to be engaging and caused low cybersickness effects. Future works will focus on longer training and will assess performance improvements longitudinally.