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

Abstract

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).

Keywords: children; home-based; neurodevelopmental disorders; neurological disorders; pediatric; technologies; telerehabilitation.

Figure 1

PRISMA Flow Diagram: the flow diagram represents the stages of the search strategy and the selection process of the articles included in the review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Figure 2

The landscape of neurological and neurodevelopmental disorders: the figure represents the distribution of the reviewed papers according to the nosographic classification of their populations. The diameter of the bubbles is proportional to the numerosity of the groups. ADHD, Attention Deficit and Hyperactivity Disorder; ASD, Autistic Spectrum Disorder; ABI, Acquired Brain Injury; DCD, Developmental Coordination Disorder; SLD, Specific Learning Disabilities; DS, Down Syndrome; ID/DD, Intellectual Disability/Developmental Delay; NF1, Type 1 Neurofibromatosis; FASD, Fetal Alcohol Spectrum Disorder; FXS, Fragile-X Syndrome; SDCP, speech disorder associated to cleft palate.

Figure 3

The role of the caregivers and the impact of technologies. The classification of the caregivers’ role is summarized in the bar graphs above. The upper one represents the distribution of the labels applied to the involvement of the caregivers described in the reviewed papers (more than one label could be applied to each article). The labels are reported on the axis according to the spectrum from “passive” to “active,” which is represented alongside the bar graph. The lower graphs represent the results of the cross-application of the classification of the caregivers’ role and the technologies taxonomy. The results are expressed in percentage of paper describing each role out of total number of papers included in the review (upper graph) or out of the number of papers included in each technology subgroup (lower graphs). BRI, Bringer; SUP, Supported; INF, Informer; OBS, Observer; LEA, Learner; IMPL, Implementer; ADA, Adapter; CDM, Collaborative Decision Maker.

Figure 4

Rehabilitative workload of technological telerehabilitative interventions: the workload of the rehabilitative interventions is represented in the bar graph based on the “treatment intensity index” we applied by dividing the minimum total rehabilitative workload described in the papers (in minutes) by the total time span of the intervention (in weeks). Each bar represents a 30-min step. Bars are segmented in different colors according to the classification of effectiveness. NA, articles not containing sufficiently detailed information to calculate the index.

Figure 5

Evidence grade and effectiveness of technological telerehabilitative interventions: the bar graph summarizes the qualitative description of the evidence grade and the effectiveness of the reviewed papers. The study design was classified according to the NHMRC Hierarchy and effectiveness was labeled according to the outcomes. Bars are segmented in different colors according to the classification of effectiveness. NHMRC, National Health and Medical Research Council.

Figure 6

The landscape of technologic telerehabilitation for pediatric neurologic and neurodevelopmental disorders: the infographic summarizes the main analyzed variables of the reviewed papers. The bubbles’ diameter and the orange columns’ width are proportional to the number of identified papers per diagnostic group. The icons represent the classification of the adopted technological devices (see below); every icon corresponds to a single paper. The colors correspond to the classification of the efficacy of the interventions described in each paper (i.e., red, not effective; dark green, effective based on primary outcome; light green, effective based on secondary outcomes; gold, feasibility as primary outcome). , Virtual reality and active video gaming devices; , Telemedicine and Telemonitoring devices; Computer-based program; , Web-based platform; , other devices.