Patricia Sánchez-Herrera Baeza

Background: The prevalence of neurological disorders is increasing worldwide. In recent decades, the conventional rehabilitation for people with neurological disorders has been often reinforced with the use of technological devices (robots and virtual reality). The aim of this systematic review was to identify the evidence on the economic cost of rehabilitation with robotic and virtual reality devices for people with neurological disorders through a review of the scientific publications over the last 15 years. Methods: A systematic review was conducted on partial economic evaluations (cost description, cost analysis, description of costs and results) and complete (cost minimization, cost-effectiveness, cost utility and cost benefit) studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The main data sources used were PubMed, Scopus and Web of Science (WOS). Studies published in English over the last 15 years were considered for inclusion in this review, regardless of the type of neurological disorder. The critical appraisal instrument from the Joanna Briggs Institute for economic evaluation and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) were used to analyse the methodological quality of all the included papers. Results: A total of 15 studies were included in this review. Ten papers were focused on robotics and five on virtual reality. Most of the studies were focused on people who experienced a stroke. The robotic device most frequently used in the papers included was InMotion® (Bionik Co., Watertown, MA, USA), and for those focused on virtual reality, all papers included used semi-immersive virtual reality systems, with commercial video game consoles (Nintendo Wii® (Nintendo Co., Ltd., Kyoto, Japan) and Kinect® (Microsoft Inc., Redmond, WA, USA)) being used the most. The included studies mainly presented cost minimization outcomes and a general description of costs per intervention, and there were disparities in terms of population, setting, device, protocol and the economic cost outcomes evaluated. Overall, the methodological quality of the included studies was of a moderate level. Conclusions: There is controversy about using robotics in people with neurological disorders in a rehabilitation context in terms of cost minimization, cost-effectiveness, cost utility and cost benefits. Semi-immersive virtual reality devices could involve savings (mainly derived from the low prices of the systems analysed and transportation services if they are applied through telerehabilitation programmes) compared to in-clinic interventions.

The EYEFUL system represents a pioneering initiative designed to leverage multisensory systems for the automatic evaluation of functional ability and determination of dependency status in people performing activities of daily living. This interdisciplinary effort, bridging the gap between engineering and health sciences, aims to overcome the limitations of current evaluation tools, which often lack objectivity and fail to capture the full range of functional capacity. Until now, it has been derived from subjective reports and observational methods. By integrating wearable sensors and environmental technologies, EYEFUL offers an innovative approach to quantitatively assess an individual’s ability to perform activities of daily living, providing a more accurate and unbiased evaluation of functionality and personal independence. This paper describes the protocol planned for the development of the EYEFUL system, from the initial design of the methodology to the deployment of multisensory systems and the subsequent clinical validation process. The implications of this research are far-reaching, offering the potential to improve clinical evaluations of functional ability and ultimately improve the quality of life of people with varying levels of dependency. With its emphasis on technological innovation and interdisciplinary collaboration, the EYEFUL system sets a new standard for objective evaluation, highlighting the critical role of advanced screening technologies in addressing the challenges of modern healthcare. We expect that the publication of the protocol will help similar initiatives by providing a structured approach and rigorous validation process.