Table 1.

Studies integrating AT-based and VR solutions to improve communication in individuals with neurodegenerative diseases and acquired brain injuries.

References	Aim of the study	Patients (Type)	Intervention	Technology (Type)	Main outcomes
AT-based solutions
Lancioni et al. (17)	To study an extended smartphone-aided program that supported daily activities in addition to communication and leisure in individuals with intellectual and visual or visuo-motor disabilities	N = 6 participants with visual or hearing impairment. Age = between 35 and 58 years old	The participants alternated periods in which they could engage in communication and leisure with periods in which they were provided with instructions for daily activities	The extended program relied on the use of a Samsung Galaxy J4 Plus smartphone, which was fitted with Android 9.0 operating system and MacroDroid	After using the smartphone application, participants maintained successful communication and leisure engagement and started and carried out daily activities successfully
Lancioni et al. (37)	To assess an upgraded smartphone-based program to foster independent leisure and communication activity of participants with mild to moderate intellectual disability, sensory or sensory-motor impairments, and limited speech skills	N = 8 participants with visual or hearing impairment. Age = between 35 and 58 years old	Participants conducted leisure and communication activities by placing mini objects or pictures representing those activities and containing frequency-code labels on the smartphone. The smartphone, via the Macrodroid application, discriminated the participants' requests and provided them with the requested activities	The program was based on the use of (a) a Samsung Galaxy A3 smartphone with Android 6.0 Operating System, near-field communication, music and video player functions, and Macrodroid application, and (b) special radio frequency-code labels	After using the smartphone application, participants succeeded in requesting/accessing those activities independently and spent about 70–90% of their session time busy with those activities
Comer et al. (38)	To present an Internet-delivered Parent-Child Interaction therapy (PCIT) directly to families in their own home	Not applicable (methods article)	Not applicable (methods article)	Two computers (one in the therapist office and one in the family's home). A webcam. High-speed Internet connection	Internet-based delivery of PCIT (I-PCIT) may offer a transformative medium for overcoming traditional barriers to care. I-PCIT therapists provide remote, real-time coaching to parents during home-based parent-child interactions
Lancioni et al. (39)	To assess (a) the usability and effectiveness of the technology that allows the person to access a variety of stimulus events (e.g., songs and videos), to request caregiver's functional procedures, and to communicate with relevant partners via text messaging, and (b) the potential impact of the simultaneous availability of these technologies, in 2 post-coma persons who had emerged from a minimally conscious state and were affected by multiple disabilities	N = 2 participants emerged from a minimally conscious state and affected by multiple disabilities. A woman and a man of 44 and 24 years of age, respectively	The participants had to select different options within a computer program in order to access to a variety of pleasant stimuli, to request caregiver's functional procedures, and to communicate with relevant partners via text messaging. Such options were selected throughout a microswitch, which was triggered by a behavioral response and that in turn activated the choice process within the computer program	Leisure stimulus engagement and procedure requests: portable computer with commercial software, a microswitch for the participants' response, and an interface connecting the microswitch to the computer.Text messaging communication: portable computer, a GSM modem, a microswitch for the participants' response, an interface connecting the microswitch to the computer, and specifically developed software	The participants were successful at each of the three stages of the study, thus providing relevant evidence concerning performance achievements
Lancioni et al. (40)	To allow persons with multiple disabilities to (a) write and send messages to distant partners and (b) have messages from those partners read out to them	N = 2 women with multiple disabilities due to complications during the gestational period and to a mild form of Joubert syndrome, aged 31 and 22 years old, respectively	The participants had to select different options within a computer program in order to write and send text messages to distant partners and to have them read from such partners	A net-book computer connected to the special keyboards arranged for the two participants, a global system for mobile communication modem (GSM), a pressure microswitch to activate the computer, interfaces linking the microswitch and the GSM modem to the computer, and a specifically developed software program	The special text messaging communication system enabled the two participants to successfully communicate with distant partners, and both participants were able to write their text messages through the technology options (i.e., the special keyboards) adopted for them
VR-based solutions
Isernia et al. (41)	To report results on efficiency measures and perceived functioning in real world of the Human Empowerment Aging and Disability program (HEAD), a DH-telerehabilitation system for people with chronic neurological diseases	N = 107 patients with Parkinson's Disease, Multiple Sclerosis, and chronic stroke. Age = between 18 and 80 years old	Patients received a 3-month rehabilitation training at home	A computer. Internet connection and motor capture devices, such as Kinect (Microsoft, WA, USA) and Leap Motion (Leap Motion Inc., CA, USA). Virtual reality scenario	The telehealth-based approach is both feasible and efficient in providing rehabilitation care to the patients from clinic to home. Increasing and maintaining participation as well as autonomy in daily routine
Baker et al. (42)	To investigate how 3D virtual environments can support social experiences in older adults	N = 25 older adults. Age = between 70 and 81 years old	The older adults participated in three workshops that allowed them to experience core aspects of social VR, in which they could design their own virtual avatars	Virtual avatars projected on a 180-degree semi-circular screen (workshop 2). Two Microsoft Kinect 3D cameras in each room were used to track participants' movement. Head-mounted display provided virtual embodiment (workshop 3)	The results from the workshops provide insight into older adults' design motivations when creating embodied avatars for social VR; their acceptance of social VR as a communication tool; and their views on how social VR might play a beneficial role in their lives. Participants placed critical importance on behavioral anthropomorphism—the embodied avatars' ability to speak, move, and act in a human-like manner
Slater et al. (43)	To investigate whether a body swapping to a Freud virtual body, where participants attempted to resolve their problem using their own words from two different embodied perspectives, or whether a conversation in which they talk about their problem with a pre-programmed animated virtual Freud would be equally efficacious in producing positive psychological outcomes	N = 69 healthy subjects. Age = between 18 and 32 years old	Participants alternating between being embodied in their own and the Freud virtual body while maintaining a self-dialogue, as if between two different people	Digital scanning set-up: iPad equipped with a structured light range sensor + inverse kinematics techniques the upper body movements of the participants could be inferred and mapped to their virtual representation. Vive head-mounted-display (HMD) made by HTC that displays a 3D scene	The results showed that the Self-Conversation method results in a greater perception of change and help compared to having a conversation with a virtual Sigmund Freud
Osimo et al. (44)	To observe how participants alternately switched between a virtual body closely resembling themselves where they described a personal problem and a VB representing Dr Sigmund Freud, from which they offered themselves counseling	N = 22 healthy subjects (males). Age = between 23 and 24 years old	Participants alternately switched between a virtual body closely resembling themselves where they described a personal problem and a VB representing Dr Sigmund Freud	The head-mounted display used was the Oculus DK2. Participants wore an XSens MVN motion capture suite consisting of the MVN Link 17 tracker tracking suit and MVN Studio software to stream motion data. Software Skanect (http://skanect.occipital.com/) version 1.6 to acquire the whole body scan	Counselor resembles Freud participants improve their mood, compared to the counselor being a self-representation. The improvement was greater when the Freud virtual body moved synchronously with the participant, compared to asynchronously visuo-motor coordination
Perez-Marcos et al. (45)	To propose an integrated approach that includes three key and novel factors: (a) fully immersive virtual environments, including virtual body representation and ownership; (b) multimodal interaction with remote people and virtual objects including haptic interaction; and (c) a physical representation of the patient at the hospital through embodiment agents (e.g., as a physical robot)	Not applicable (methods article)	Not applicable (methods article)	A Head-mounted display with head-tracking for immersion in the virtual environment from a first-person perspective of the avatar representing him. A wireless body tracking system for controlling over the avatar's movements. A haptic device with force-feedback is used for tactile interaction with the environment and/or remote persons. Physiological sensors and electrodes for monitoring the patients' physiological and emotional state	This unique system for telerehabilitation is the result of the integration of state of the art technologies developed at different institutions in the fields of VR, haptics, computer science, biomedical research, and neuroscience. This approach systematically differs from non-immersive telerehabilitation systems and should represent a step forward in the field