A Perspective on Implementation of Technology-Driven Exergames for Adults as Telerehabilitation Services

Abstract

A major concern of public health authorities is to also encourage adults to be exposed to enriched environments (sensory and cognitive-motor activity) during the pandemic lockdown, as was recently the case worldwide during the COVID-19 outbreak. Games for adults that require physical activity, known as exergames, offer opportunities here. In particular, the output of the gaming industry nowadays offers computer games with extended reality (XR) which combines real and virtual environments and refers to human-machine interactions generated by computers and wearable technologies. For example, playing the game in front of a computer screen while standing or walking on a force plate or treadmill allows the user to react to certain infrastructural changes and obstacles within the virtual environment. Recent developments, optimization, and minimizations in wearable technology have produced wireless headsets and sensors that allow for unrestricted whole-body movement. This makes the virtual experience more immersive and provides the opportunity for greater engagement than traditional exercise. Currently, XR serves as an umbrella term for current immersive technologies as well as future realities that enhance the experience with features that produce new controllable environments. Overall, these technology-enhanced exergames challenge the adult user and modify the experience by increasing sensory stimulation and creating an environment where virtual and real elements interact. As a therapy, exergames can potentially create new environments and visualizations that may be more ecologically valid and thus simulate real activities of daily living that can be trained. Furthermore, by adding telemedicine features to the exergame, progress over time can be closely monitored and feedback provided, offering future opportunities for cognitive-motor assessment. To more optimally serve and challenge adults both physically and cognitively over time in future lockdowns, there is a need to provide long-term remote training and feedback. Particularly related to activities of daily living that create opportunities for effective and lasting rehabilitation for elderly and sufferers from chronic non-communicable diseases (CNDs). The aim of the current review is to envision the remote training and monitoring of physical and cognitive aspects for adults with limited mobility (due to disability, disease, or age), through the implementation of concurrent telehealth and exergame features using XR and wireless sensor technologies.

Telerehabilitation proposal of mind-body technique for physical and psychological outcomes in patients with fibromyalgia

“…However, our rehabilitation protocol was mainly based on the awareness of movement, using "color" as a positive emotional anchor, having not had the possibility of monitoring the cardiorespiratory parameters, typical of aerobic training protocols albeit at low intensity and having chosen, an approach oriented to mind-body techniques, proposed with benefit in fibromyalgia patients and spine chronic pain (Tubach et al, 2005;Adler-Neal and Zeidan, 2017;Paolucci et al, 2017). Mind-body technique as mindfulness interventions can help patients cope with their stress-related experiences may reduce symptoms and improve wellbeing (Kozasa et al, 2012;Schmidt et al, 2012;Onieva-Zafra et al, 2015;Theadom et al, 2015;Meulenberg et al, 2022): these interventions are oriented to train the participants to intentionally observe thoughts, emotions, and bodily sensations as they are perceived on a moment-to-moment basis with an open, non-judgmental attitude (Day et al, 2014;Flynn, 2020). However, resilience and coping ability, measured by RSA and CSQR subscales, are less or none affected by telerehabilitation on our sample.…”

“…The FM patient during telerehabilitation could be evaluated along the coordinates of these three dimensions (stress, resilience, and coping) in order not only to verify the effectiveness of the therapy, but to understand which are the patient's weak points on which to intervene (Meulenberg et al, 2022).…”

“…From these premises, our aim was to evaluate the effects of a telerehabilitation on pain severity, physical and psychological aspects in a sample of patients with fibromyalgia. Our hypothesis was that a telerehabilitation program based on body awareness exercises in movement and muscle stretching, linked to mindfulness "here and now" strategies, could reduce pain and improve the main symptoms of FM which are variable during a period of the disease of mobility and social restrictions imposed by the COVID-19 pandemic (Casale et al, 2019;de Sire et al, 2021;Salaffi et al, 2021;Meulenberg et al, 2022).…”

Impact of Motor-Cognitive Interventions on Selected Gait and Balance Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Finally, the current scarcity of literature on motor-cognitive interventions in specific disease populations may open new avenues of discussion for the implementation of such training. For example, technology-driven exergames with forms of extended reality (XR) that combine real and virtual environments and relate to human-machine interactions generated by computers and wearable technologies will provide services for remote monitoring, training, and telerehabilitation (Meulenberg et al, 2022 ). The nature of engagement in XR allows training and/or rehabilitation exercises to feel similar to physically performed actions, while seemingly being more engaging, motivating, and stimulating than conventional practice.…”

A Literature Review of High-Tech Physiotherapy Interventions in the Elderly with Neurological Disorders

“…Generally, a successful application of telemedicine technologies and smart environments should meet criteria of robustness, safety, and usability for patients; to be scalable and fitting regarding social, technical, and economic aspects and infrastructures; and finally, to be able to motivate and be transparent for patients, caregivers, health professionals, and regulatory organizations in order to increase confidence in rehabilitation technology for a home model so that all stakeholders will embrace them [ 165 , 171 ]. Such a shift from a traditional to modern telemedicine-assisted physiotherapy methods is expected to occur and the pandemic can act as an accelerator for the adoption by patients, caregivers, and rehabilitation professionals and for market penetration of the proposed technological rehabilitation [ 172 , 173 , 174 , 175 ].…”