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Responses and reliability of candidate intensity measures to different mental and motor load levels of an upper limb exergame in children and adolescents with neurological diagnoses

Year: 2025

Type: article

Abstract: Background: High-intensity therapy improves outcomes in (pediatric) neurorehabilitation, yet standardized intensity measures accounting for motor and/or mental demands remain scarce. Objectives: To evaluate the responses and test-retest reliability of heart rate variability (HRV), skin conductance (SC), activity counts and movement repetitions normalized for the maximal capacity (%ACmax and %MOVmax, respectively), and the NASA-TLX across personalized motor and mental load levels in children and adolescents with neurological diagnoses using upper limb exergames. Methods: In a cross-sectional study, participants engaged in two custom exergames at three intensity levels ("very easy," "challenging," "very difficult"), each lasting 3 min. Responses of the candidate intensity measures were analyzed across conditions, and intraclass correlation coefficients (ICC) assessed reliability across two consecutive sessions. Results: 30 children and adolescents with neurological diagnoses aged 9-19 years participated in the study. %MOVmax and NASA-TLX (overall, effort, mental) responded to both mental and motor intensity increases. HRV, %ACmax, and NASA-TLX physical subscale responded to motor load only. SC showed no consistent response. HRV and %ACmax demonstrated the highest reliability (ICC > 0.75), especially under motor conditions. NASA-TLX effort showed potential as a simplified surrogate for the full scale, though with variable reliability. Conclusion: Changes in motor intensity were better captured than changes in mental intensity. Combining HRV, %ACmax, and NASA-TLX effort could offer a multidimensional approach to quantify therapy intensity. However, many measures lacked sufficient reliability or feasibility for clinical implementation. Further research is needed to validate these measures in real-world therapeutic settings and clarify their relationship to individual capacity.

Source: Frontiers in Rehabilitation Sciences

DOI: 10.3389/fresc.2025.1641003

Authors: Gaizka Goikoetxea-Sotelo, Hubertus J. A. van Hedel

Institutions: University of Zurich, University Children's Hospital Zurich

Language: English

Topic: Stroke Rehabilitation and Recovery

Subfield: Rehabilitation

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,353