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PURPOSE To understand the impact of an intensive rehabilitation program based on exergames in balance and lower limb function in a teenager with cerebral palsy. METHODS The rehabilitation program comprised different customised exergames and was delivered in 5 weekly sessions of 30 min for 4 weeks. Pre-, post-, and 1-month Follow-up assessments included the following metrics: Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Gross Motor Function Measure (GMFM), Posturography, and Gait analysis. RESULTS We observed increased scores after the intervention of 9/72 points in GMF - Module E (Walk, Run and Jump) and of 9/56 points in BBS, sustained at Follow-up. Changes in function, specifically in the quality and independence of the performance of specific movements such as turning 360°, increased distance reaching forward, walk behind, step over obstacles, and step stairs up and down were also observed. Gait kinematics and Spatio-temporal parameters tended to get closer to the 50th percentile. CONCLUSIONS We observed positive changes in motor function of a teenager with cerebral palsy, with sustained increased scores at a 1-month Follow-up. Findings are suggestive that intensive rehabilitation programs using exergames with high customisation features are a potentially valuable rehabilitation tool for training balance in teenagers with Cerebral Palsy.Implications for rehabilitationExergames may be a useful for providing balance training for teenagers who have a mixed form of cerebral palsy.Exergames that require body displacement may be suitable for modulating gait kinematics and spatio-temporal parameters.The customisation of virtual rehabilitation tools seems to impact the motivation and effort of the user positively.

Cognitive deficits are a core feature of mental and behavioral disorders, leading to poor treatment adherence and functionality. Virtual reality (VR) methodologies are promising solutions for cognitive interventions in psychiatry once they provide greater ecological validity. This study assessed and compared two content-equivalent cognitive training (CT) interventions, delivered in desktop VR (Reh@City v2.0) and paper-and-pencil (Task Generator (TG)) formats, in patients with mental and behavioral disorders. 30 patients were randomly assigned to the Reh@City v2.0 group and the TG group. Both groups of patients underwent a time-matched 24-sessions intervention. Neuropsychological assessments were performed at baseline, post-intervention, and follow-up. A within-groups analysis revealed significant improvements in visual memory and depressive symptomatology after the Reh@City intervention. The TG group improved in processing speed, verbal memory, and quality of life (social relationships and environmental domains). Between groups, Reh@City led to a greater reduction in depressive symptomatology, whereas the TG group showed higher improvements in social relationships aspects of quality of life. At follow-up, previous gains were maintained and new improvements found in the Reh@City (global cognitive function, language, visuospatial and executive functions) and the TG groups (attention). The Reh@City significantly reduced depressive symptomatology, and the TG led to greater improvements in processing speed, abstraction, and social relationships domain of quality of life at follow-up. Both interventions were associated with important cognitive, emotional, and quality of life benefits, which were maintained after two months. Reh@City and TG should be considered as complementary CT methods for patients with mental and behavioral disorders. Trial registration The trial is registered at ClinicalTrials.gov, number NCT04291586.

Background: Restorative Brain-Computer Interfaces (BCI's) can provide an alternative non-muscular channel for patients who lack volitional movement by reinforcing the modulation of sensorimotor rhythms through motor-imagery (MI). MI practice can be augmented through embodied feedback delivered by virtual reality (VR). Nonetheless, detailed information concerning the impact of VR-BCI training in clinical outcome is still largely missing. This paper investigates the long-term effect of VR-BCI training in brain activity patterns measured by the electroencephalogram (EEG) and clinical scales of stroke patients. Methods: Four chronic stroke patients underwent a 3-week VR-BCI intervention. Fugl-Meyer Assessment (FMA) was conducted pre-, post- intervention, and a follow-up, one-month later. The VR-BCI training consisted of a bimanual rowing task (NeuRow) involving MI and motor observation. From the EEG, the Event-related Desynchronization (ERD) was extracted from the Mu band (8-12 Hz). Finally, the BCI performance was computed from the BCI training session. Results: All patients showed significantly increased Mu ERD compared to baseline, however, the affected side showed reduced ERD during the contralateral MI. Significant ERD differences originating from both the lesioned and the healthy hemisphere were found when comparing post- with pre- intervention in all patients, and decreasing ERD was found for patients with no clinical improvement. Patients with decreased lateralization of ERD had no improvement of the FMA score. Conclusion: Stroke patients in the chronic phase can modulate their brain activity patterns using MI in a VR-BCI task, with observable patient-specific differences between brain activity and clinical outcome. Nonetheless, only patients with increased ERD lateralization showed clinical improvement.