Neurodevelopmental disorders, such as Cerebral Palsy (CP), Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), are complex conditions that affect various aspects of children's development. Despite advancements in treatments, conventional rehabilitative interventions tend to focus on specific aspects, often overlooking the holistic needs of the patient. Many of these interventions fail to engage children, who may feel uninvolved or demotivated. Innovative technologies, such as immersive virtual reality (IVR), offer a promising alternative to make rehabilitation more engaging and comprehensive. This study aims to evaluate the effects of IVR-based rehabilitation on children and adolescents with neurodevelopmental disorders, focusing on improvements in cognitive, motor, and social functions. We hypothesize that IVR will enhance social interaction, attention, motor skills, and overall quality of life. The study will include children and adolescents aged 8 to 18 years, diagnosed with ADHD, ASD, and cerebral palsy. The CAR-EN platform, which provides a highly customizable therapeutic environment, will be used. Assessments will measure cognitive, motor, and social skills before and after the intervention. We expect immersive virtual reality to lead to significant improvements in the participants' cognitive, motor, and social abilities. These findings could potentially contribute to a shift in therapeutic guidelines, offering more effective treatments for children with neurodevelopmental disorders.
This protocol was created to evaluate the effects of rehabilitation with IVR in subjects with neurodevelopmental disorders that profoundly impact their quality of life and that of their families: Cerebral Palsy (CP), Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD). In the literature we find many studies and guidelines concerning the neuropsychological interventions envisaged for the pathologies that affect our protocol. However, rehabilitation interventions in the developmental age often focus on a single clinical aspect, aiming to implement some deficient skills and losing sight of the global vision of the patient and his needs. Furthermore, conventional rehabilitation methods do not always appear motivating for the minor, who is often forced to perform the tasks required in a non-participatory and active way. In recent decades, scientific research has instead highlighted the effectiveness of therapeutic interventions with innovative technologies, demonstrating how these tools can make the rehabilitation process more engaging and stimulating, both for adults and minors. In particular, the use of Immersive Virtual Reality (IVR) is configured as a promising frontier in neuropsychological rehabilitation, with the potential to significantly improve patients' quality of life and optimize clinical outcomes compared to traditional methods.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
108
The experimental intervention uses the CAREN immersive virtual reality system, which integrates visual, auditory and tactile sensory stimuli, to stimulate cognitive, motor and social skills through interactive exercises. The system monitors progress in real time and reduces the stress associated with traditional therapies, offering an innovative and engaging therapy experience.
\- Neuropsychomotricity for children with cerebral palsy, with the objectives of motor improvement, balance and coordination. - Cognitive-behavioral training for ADHD, focusing on attentional skills, planning and emotional self-regulation. - Cognitive-behavioral training for ASD, focusing on cognitive flexibility, impulse control and motor coordination.
IRCCS Neurolesi Bonino Pulejo
Messina, Messina, Italy
RECRUITINGVisual Attention and Memory Assessed by the Leiter International Performance Scale - Third Edition (Leiter-3)
The primary outcome will be assessed using the Attention and Memory subtests of the Leiter International Performance Scale - Third Edition (Leiter-3), a standardized nonverbal cognitive assessment tool commonly used in children and adolescents. These subtests evaluate sustained attention, selective attention, visual working memory, immediate memory recall, and delayed memory recall. Higher raw and standardized scores indicate better cognitive performance in the assessed domains.
Time frame: Baseline (T0), 1 month (T1), 3 months (T2), 3-month follow-up (T3)
Gross Motor Function Assessed by the Gross Motor Function Measure-66 (GMFM-66)
Gross motor function will be assessed using the Gross Motor Function Measure-66 (GMFM-66), a standardized observational assessment tool designed to evaluate changes in gross motor abilities in children with motor disabilities. The GMFM-66 provides an interval-level total score derived from 66 items covering key domains of gross motor function, including lying and rolling, sitting, crawling and kneeling, standing, walking, running, and jumping. Higher scores indicate better gross motor function.
Time frame: Baseline (T0), 1 month (T1), 3 months (T2), 3-month follow-up (T3)
Muscle Spasticity Assessed by the Modified Ashworth Scale (MAS)
Muscle spasticity will be assessed using the Modified Ashworth Scale (MAS), a standardized clinical rating scale used to measure resistance to passive soft-tissue stretching as an indicator of muscle spasticity. The MAS is scored on a 5-point ordinal scale ranging from 0 to 4, where 0 indicates no increase in muscle tone and 4 indicates affected parts rigid in flexion or extension. Higher scores indicate greater muscle spasticity, reflecting a worse outcome.
Time frame: Baseline (T0), 1 month (T1), 3 months (T2), 3-month follow-up (T3)
Balance Assessed by the Tinetti Assessment Tool - Balance Subscale
Balance will be assessed using the Balance Subscale of the Tinetti Assessment Tool, a standardized clinical scale designed to evaluate postural stability as part of functional mobility and fall risk assessment. The Balance Subscale is scored on a range from 0 to 16, with higher scores indicating better balance and a lower risk of falls. Lower scores indicate reduced mobility and higher fall risk.
Time frame: Baseline (T0), 1 month (T1), 3 months (T2), 3-month follow-up (T3)
Attention and Memory Assessed by the NEPSY-Second Edition (NEPSY-II)
The outcome will be assessed using the Attention and Memory domain of the NEPSY-Second Edition (NEPSY-II), a standardized developmental neuropsychological assessment battery designed to evaluate cognitive functioning in children. The Attention and Memory domain includes subtests assessing sustained attention, selective attention, auditory and visual attention, immediate and delayed memory, and working memory. Scores are reported as age-normed scaled scores derived from standardized test performance. Higher scores indicate better attention and memory functioning.
Time frame: Baseline (T0), 1 month (T1), 3 months (T2), 3-month follow-up (T3)
Executive Function Assessed by the Tower of London Test
Executive functioning will be assessed using the Tower of London Test, a standardized neuropsychological assessment designed to evaluate executive functions, particularly planning ability, problem-solving, and working memory. Outcome parameters include the total number of correct solutions, number of moves, and task completion time. Higher performance scores indicate better executive functioning, whereas a greater number of errors or longer completion times indicate poorer performance.
Time frame: Baseline (T0), 1 month (T1), 3 months (T2), 3-month follow-up (T3)
Executive Function Assessed by the Behavior Rating Inventory of Executive Function - Second Edition (BRIEF-2)
Executive functioning will be assessed using the Behavior Rating Inventory of Executive Function - Second Edition (BRIEF-2), a standardized caregiver-report questionnaire designed to evaluate everyday executive function behaviors in children and adolescents aged 5 to 18 years. The BRIEF-2 yields three index scores-Behavior Regulation Index, Emotion Regulation Index, and Cognitive Regulation Index-as well as a Global Executive Composite (GEC) score, derived from nine clinical scales. All outcomes are reported as age-normed T-scores. Higher T-scores indicate greater executive function difficulties, reflecting worse outcomes.
Time frame: Baseline (T0), 1 month (T1), 3 months (T2), 3-month follow-up (T3)
Behavioral and Attention Symptoms Assessed by the Conners' Rating Scales - Third Edition (Conners 3)
Behavioral, emotional, and attention-related symptoms will be assessed using the Conners' Rating Scales - Third Edition (Conners 3), a standardized caregiver- and teacher-report questionnaire designed to evaluate behavioral and attentional difficulties in children and adolescents. The Conners 3 provides T-scores across multiple clinical scales, including Inattention, Hyperactivity/Impulsivity, Executive Functioning, Learning Problems, Aggression, and Peer Relations, based on age- and sex-normed data. Higher T-scores indicate greater severity of behavioral and attention-related symptoms, reflecting worse outcomes.
Time frame: Baseline (T0), 1 month (T1), 3 months (T2), 3-month follow-up (T3)
Behavioral and Emotional Problems Assessed by the Child Behavior Checklist (CBCL) - Parent Version
This outcome will be assessed using the Child Behavior Checklist (CBCL), a standardized caregiver-report questionnaire designed to evaluate emotional and behavioral problems in children and adolescents. The CBCL provides syndrome scale scores (e.g., Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, Aggressive Behavior) and broad-band composite scores (Internalizing, Externalizing, and Total Problems). Scores are reported as T-scores, derived from age- and gender-normed data. Higher T-scores indicate greater behavioral or emotional difficulties, representing a worse outcome.
Time frame: Baseline (T0), 1 month (T1), 3 months (T2), 3-month follow-up (T3)
Motor Competence Assessed by the Movement Assessment Battery for Children - Second Edition (Movement ABC-2)
Motor competence in children and adolescents will be assessed using the Movement Assessment Battery for Children - Second Edition (Movement ABC-2), a standardized test. The Movement ABC-2 evaluates three motor domains: Manual Dexterity, Aiming and Catching, and Balance (static and dynamic). The assessment provides age-standardized scores, a Total Motor Score, and percentile rankings. Higher scores indicate better motor performance, whereas lower scores reflect greater motor coordination difficulties, representing a worse outcome.
Time frame: T0 (Baseline), T1 (1 month), T2 (3 months), T3 (Follow-up at 3 months)
System Usability Assessed by the System Usability Scale (SUS)
System usability will be assessed using the System Usability Scale (SUS), a standardized 10-item questionnaire designed to measure users' perceived usability of a system or device. The SUS provides a total score ranging from 0 to 100, calculated according to the standard scoring method. Higher scores indicate better perceived usability, with scores above 68 generally considered above average usability.
Time frame: Up to 7 months
Behavioral Safety Assessed by the Behavioral Safety Event Rating Scale (B-SERS)
Behavioral safety will be assessed using the Behavioral Safety Event Rating Scale (B-SERS), based on a behavioral risk assessment framework. The B-SERS evaluates the frequency and severity of safety-related behavioral events, such as behaviors that may pose a risk to oneself, others, or the environment. The scale includes 5 items, each scored from 0 to 4 (0 = no event; 1 = mild; 2 = moderate; 3 = marked; 4 = severe). The total score ranges from 0 to 20, with higher scores indicating worse safety outcomes.
Time frame: Up to 7 months
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