Telemedicine and Virtual Reality for Cognitive Rehabilitation: A Roadmap for the COVID-19 Pandemic

Elisa Mantovani; Chiara Zucchella; Sara Bottiroli; Angela Federico; Rosalba Giugno; Giorgio Sandrini; Cristiano Chiamulera; Stefano Tamburin

doi:10.3389/fneur.2020.00926

Telemedicine and Virtual Reality for Cognitive Rehabilitation: A Roadmap for the COVID-19 Pandemic

Front Neurol. 2020 Sep 15:11:926. doi: 10.3389/fneur.2020.00926. eCollection 2020.

Authors

Elisa Mantovani¹, Chiara Zucchella², Sara Bottiroli^{3

4}, Angela Federico¹, Rosalba Giugno⁵, Giorgio Sandrini^{4

6}, Cristiano Chiamulera⁷, Stefano Tamburin¹

Affiliations

¹ Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
² Section of Neurology, Department of Neurosciences, Verona University Hospital, Verona, Italy.
³ Giustino Fortunato University, Benevento, Italy.
⁴ IRCCS Mondino Foundation, Pavia, Italy.
⁵ Department of Computer Science, University of Verona, Verona, Italy.
⁶ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
⁷ Department of Diagnostics and Public Health, University of Verona, Verona, Italy.

Abstract

The current COVID-19 pandemic presents unprecedented new challenges to public health and medical care delivery. To control viral transmission, social distancing measures have been implemented all over the world, interrupting the access to routine medical care for many individuals with neurological diseases. Cognitive disorders are common in many neurological conditions, e.g., stroke, traumatic brain injury, Alzheimer's disease, and other types of dementia, Parkinson's disease and parkinsonian syndromes, and multiple sclerosis, and should be addressed by cognitive rehabilitation interventions. To be effective, cognitive rehabilitation programs must be intensive and prolonged over time; however, the current virus containment measures are hampering their implementation. Moreover, the reduced access to cognitive rehabilitation might worsen the relationship between the patient and the healthcare professional. Urgent measures to address issues connected to COVID-19 pandemic are, therefore, needed. Remote communication technologies are increasingly regarded as potential effective options to support health care interventions, including neurorehabilitation and cognitive rehabilitation. Among them, telemedicine, virtual reality, augmented reality, and serious games could be in the forefront of these efforts. We will briefly review current evidence-based recommendations on the efficacy of cognitive rehabilitation and offer a perspective on the role of tele- and virtual rehabilitation to achieve adequate cognitive stimulation in the era of social distancing related to COVID-19 pandemic. In particular, we will discuss issues related to their diffusion and propose a roadmap to address them. Methodological and technological improvements might lead to a paradigm shift to promote the delivery of cognitive rehabilitation to people with reduced mobility and in remote regions.

Keywords: COVID-19; augmented reality; cognitive; rehabilitation; telemedicine; virtual reality.