• celebral palsy
• children
• infant
• movement disorder
• neurodevelopmental disorder
• technological assessment
• telerehabilitation

New developments in health information technologies and increased access to healthcare services have facilitated the growth of telemedicine, allowing remote interactions between clinicians and patients. The widespread use of digital devices and Information and Communication Technologies (ICT) has expanded the possibilities to implement technology-based healthcare solutions, both during patients' recovery and after discharge. Telemedicine, particularly, enhances continuity of care from hospital to home, supporting remote monitoring and consultation.
This PhD thesis focuses on the integration of technology into the assessment and rehabilitation of children with neurodevelopmental disorders. During my PhD research, I have focused on two primary objectives: improving the assessment of children with neurodevelopmental disorders through the use of technology, and developing innovative telerehabilitation methods, evaluating their feasibility and effectiveness.
Neurodevelopmental disorders include a wide range of conditions that manifest during the early development of children, when an early and accurate diagnosis is essential for better outcomes. Ongoing research into technological innovations aims to standardise and quantify clinical assessment procedures and treatments, leading to the development of new tools through multidisciplinary collaboration among clinicians, engineers, computer scientists, and family associations. Although the design and validation of these new tools is complex, their potential to improve outcomes is substantial.
The research introduced in this thesis stems from clinical practice, from which insights and needs that have emerged, have guided the development of various innovative research projects applicable to both assessment and treatment.
The implementation of digital databases and clinical registries at IRCCS Fondazione Stella Maris, have proven to be a springboard for conducting retrospective studies, supporting data-driven clinical practices and the recruitment of patients for new research studies (such as "DataNetCP" for cerebral palsy and "RedCap MD" for movement disorders).
In clinical practice, various outcome measures are employed, often relying on clinician-dependent scales; however, this thesis underscores the future necessity of integrating traditional clinical outcome measures with newer technological tools to achieve more accurate and detailed assessments.
A central aspect of this research is the feasibility of integrating advanced technologies such as virtual reality (VR), robotic systems, and wearable sensors into clinical contexts for both assessment and rehabilitation. Technological systems like the Virtual Reality Rehabilitation System (VRRS) and MOTORE have pointed out promising results in assessing motor functions and postural control, specifically for patients with cerebral palsy and movement disorders. These technologies have shown the usability and adaptability for paediatric needs. The VRRS, for instance, provides the capability to obtain quantitative measures that align with the clinical descriptions of various motor patterns. MOTORE, on the other hand, can yield quantitative data on upper limbs functions in children with unilateral cerebral palsy, while wearable sensors, such as accelerometers, have proven useful for monitoring motor behaviour in spontaneous environments and daily living activities.
During my PhD project we also explores the possibilities of telerehabilitation by considering the use of various platforms tailored to the rehabilitative needs of children, providing examples of studies ranging from newborns to adolescents. Systems such as the VRRS, Tele-UPCAT, and CareToy-Revised have simplified personalised and home-based rehabilitation, making treatment more accessible and customized the individual needs of our patients. These systems promote a family-centred approach to care, encouraging caregiver involvement in the rehabilitation process.
In conclusion, this research highlights the significant potential of integrating advanced technologies into the assessment and treatment of neurodevelopmental disorders. While further studies are necessary to optimise these tools for paediatric use, the merge of traditional clinical assessments with technology can lead to a more global understanding of motor development and improved rehabilitation. The future of care for children with neurodevelopmental disorders will likely involve a blend of clinical expertise and innovative technologies, ensuring that assessment and rehabilitation are effective, accessible, and centred on the needs of children and their families.