Telerehabilitation Protocols With Digital and Robotic Tools for People With Chronic Neurological Disorders

Change in global cognitive functioning as measured by the Montreal Cognitive Assessment (MoCA test, Conti et al., 2015) in PD, MS, and post-stroke groups

The MoCA test is a screening battery which also includes subtests to assess frontal functions such as set-shifting, abstraction and cognitive flexibility (MoCA total score range: 0-30). High scores are indicative of better general cognitive performance.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in visuoperceptual and attentional abilities as measured by the Trail Making Test (TMT part A and B, Giovagnoli et al., 1996) in PD, MS, and post-stroke groups

The TMT is a neuropsychological test that involves visual scanning (TMT-A) and dual-task (TMT-B). The TMT is scored by how long it takes to complete each part of the test. High execution times indicate poor performance.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in visuoperceptual and attentional abilities as measured by the and the Symbol Digit Modalities Test (SDMT; Smith A., 1973; Nocentini U., 2006) in PD, MS, and post-stroke groups

The SDMT is a commonly used test to assess psychomotor speed. This paper-pencil measure involves a substitution task using a coding key with nine different abstract symbols, each paired with a numeral. Below the key, a series of these symbols is presented, and the participant is asked to write down the corresponding number for each symbol. The score consists of the number of correct substitutions within 90 seconds. Higher scores indicate better performance.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in depressive symptoms as measured by the Beck Depression Inventory for Primary Care (BDI-PC, Steer et al., 1999) in PD, MS, and post-stroke groups

The BDI-PC is a 7-item questionnaire with each item rated on a 4-point scale (0-3). It is scored by summing ratings for each item (range 0-21). Higher scores indicate greater deflection of mood tone.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in anxiety level as measured by the State-Trait Anxiety Inventory - Form Y (STAI - Y2; Spielberger, 1983; Pedrabissi & Santinello, 1989) in PD, MS, and post-stroke groups

The STAI-Y is a commonly used measure of trait and state anxiety (20 items for each). All items are rated on a 4-point scale (from "Almost Never" to "Almost Always"). STAI - Y2 is scored by summing ratings for each item (State-Anxiety: range 0-80; Trait Anxiety: range 0-80). Higher scores indicate greater anxiety.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in gross manual dexterity as measured by the Box and Block Test (BBT; Desrosiers et al., 1994) in PD, MS, and post-stroke groups

The BBT is composed of a wooden box divided into two compartments, one of which contains 150 blocks. The BBT administration consists of asking the patient to move, one by one, the maximum number of blocks from one compartment to another within 60 seconds. The score is based on the number of blocks transferred from one compartment to the other in 60 seconds. Higher scores are indicative of better manual dexterity.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in finger dexterity as measured by the Nine Hole Peg Test (Feys et al., 2017) in PD and MS groups

Participants are asked to take 9 pegs from a container, one by one, and place them into the 9 holes on the board of the test, as quickly as possible, using only the hand evaluated. The scoring considers the number of seconds taken by patients to complete the test or the number of pegs placed in 50 or 100 seconds. High execution times indicate poor finger dexterity.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in dynamic balance as measured by the modified Dynamic Gait Index (mDGI; Anastasi et al., 2019) in PD and MS groups

the mDGI measures the capacity to adapt gait to complex tasks utilizing 8 tasks and 3 facets of performance (gait pattern score \[0 -3\], level of assistance \[0 -2\], and time level score \[0 -3\]). The total task score (range 0 - 8) is calculated by summing the 3 performance facet scores for each task. Higher scores are indicative of better performance.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in static and dynamic balance as measured by the Mini-Best Test (Franchignoni et al., 2010) in PD and MS groups

The Mini-BESTest aims to identify the disordered systems underlying the postural control responsible for poor functional balance. This tool is composed by 27 tasks (36 items in total) assessing bio-mechanical constraints, stability limits/verticality, anticipatory responses, postural responses, sensory orientation, and stability in gait. Each item is scored based on ordinal scale scoring from 0- 3 where 3 = best performances and 0 = worst performances. The total score is provided as a percentage. Higher scores are indicative of better performance.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in perceived stability during activities of daily living as measured by the Activities Balance Confidence scale (ABC; Cattaneo et al., 2006; Franchignoni et al., 2014) in PD and MS groups

ABC is a 16-item questionnaire that measures an individual's confidence during activities without falling or experiencing a sense of unsteadiness. Each item is scored ranging from 0 to 100. Higher scores are indicative of higher perceived stability.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in motor functionality as measured by the Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS; Goetz et al., 2008) part III only in the PD group

MDS-UPDRS assess changes in motor functionality. Part III (''motor examination") is composed of 18 items scored using a 5-point ordinal scale where 0 = "normal", 1 = "slight", 2 = "mild", 3 = "moderate", 4 = "severe". Higher scores indicate increased severity

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in the level of disability as measured by the EDSS (Kurtzke, 1983) only in the MS group

EDSS evaluates changes in their level of disability. It provides a total score on a scale that ranges from 0 to 10 in 0.5-unit increments. Higher scores indicate higher levels of disability.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in sensory-motor function of the upper limb as measured by the Fugl-Meyer Assessment - Upper Extremity (Fugl Meyer et al. 1975) only in post-stroke group

The FMA-UL will be used to assess the motor functioning of the upper limb. Scoring is based on direct observation of performance. Items are scored using a 3-point ordinal scale where 0 = cannot perform, 1 = performs partially, and 2 = performs fully. The total possible motor score for the upper extremity is 66.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)

Change in motor function of the upper limb as measured by the Action Research Arm Test (ARAT; Lyle, 1981) only in post-stroke group

The ARAT is a 19-item measure assessing the upper extremity performance (coordination, dexterity and functioning). Items are scored using a 4-point ordinal scale where 0 = "no movement", 1= "movement task is partially performed", 2 = "movement task is completed but takes abnormally long", and 3 = "movement is performed normally". Scores range from 0-57 points with higher scores indicating better performance.

Time frame: Baseline, post-treatment, and follow-up (2 months after the end of treatment)