Pinelopi Vlotinou

Serious Games (SGs) have increasingly been investigated as tools for education and intervention for individuals with Autism Spectrum Disorder (ASD), while emerging technologies such as Artificial Intelligence (AI), Virtual Reality (VR), Extended Reality (XR), and Human–Robot Interaction (HRI) are expanding their potential for personalization, immersion, and adaptive interaction. However, the literature remains fragmented across pedagogical theory, Serious Game design, and technology-focused interventions, making it difficult to understand how these dimensions are connected within the ASD context. This scoping review therefore maps the available literature on Serious Games for individuals with ASD, focusing on two complementary questions: (RQ1) Which learning theories, pedagogical approaches, and educational or developmental outcomes underpin the design and implementation of Serious Games for individuals with ASD? and (RQ2) How are intelligent and immersive technologies, including AI, VR, XR, and HRI/robotics, integrated into Serious Games, and what benefits and challenges are reported? A structured literature search was conducted across Scopus, ERIC, Web of Science, and the ACM Digital Library, with Google Scholar consulted as a supplementary source, covering publications from January 2005 to June 2025. Following duplicate removal, title/abstract screening, and full-text assessment, 40 studies constituted the formal evidence base. The evidence was organized through descriptive and thematic synthesis, with studies mapped according to theoretical foundations, Serious Game or intervention characteristics, technological modalities, and reported outcomes. The review identified substantial theoretical diversity, including constructivism, socio-cultural theory, social learning theory, self-determination theory, behaviorism, developmental approaches, and intervention-oriented frameworks. AI was mainly associated with personalization, learner modeling, behavioral analysis, and adaptive feedback, whereas VR/XR primarily supported immersive and controlled environments for experiential learning and skills practice. Robotics and HRI were associated with structured and embodied interaction. Reported challenges included accessibility, cost, privacy, cybersickness, methodological heterogeneity, and limited evidence concerning transfer and maintenance of skills. Overall, the review provides a structured overview of the field and indicates priorities for further empirical investigation.

Background and objectives: Cancer survivors continue to face significant psychological and quality-of-life challenges following the COVID-19 pandemic. This study aimed to investigate levels of depression, anxiety, stress, quality of life, and perceived social support among patients with cancer during the post-COVID-19 period and to examine their interrelationships. Materials and Methods: A cross-sectional study was conducted among 162 Greek adults with cancer. Participants completed questionnaires assessing psychological distress (Depression Anxiety Stress Scale-21), health-related quality of life (EORTC QLQ-C30), and perceived social support. Descriptive statistics, factor analysis, group comparisons, and correlation analyses were performed. Results: High levels of psychological distress were observed, with 32.1% of participants reporting severe or extremely severe depression, 40.1% severe or extremely severe anxiety, and 29.0% severe or extremely severe stress. Quality of life was moderate, with emotional and social functioning being the most impaired domains, while fatigue, insomnia, and financial difficulties were the most prominent symptoms. Depression, anxiety, and stress were strongly associated with poorer quality of life and greater symptom burden. Higher perceived social support, particularly from family and friends, was associated with better quality of life and lower psychological distress. Conclusions: These findings highlight the need for comprehensive oncology care that incorporates routine psychological assessment and psychosocial support to improve cancer survivorship outcomes.

Myotonic dystrophy, the most prevalent adult-onset muscular dystrophy, is multisystemic, linking progressive neuromuscular impairment and occupational restriction. Both types share myotonia, chronic fatigue, and executive dysfunction with apathy, but differ in weakness distribution and facial involvement. Over 9 years, participation declines in nutrition, fitness, personal care, mobility, community life, and recreation; 47% of DM1 patients do not work, 23% rate daily activities as affected, and 35% and 22% identify fatigue and muscle-locking as important. This review synthesises evidence within the Occupational Therapy Practice Framework: Domain and Process, Fourth Edition (PubMed, Scopus, Google Scholar; English, 2016–2026). Four participation-restriction drivers emerge: distal-to-proximal muscle weakness with grip myotonia; frontotemporal executive dysfunction and apathy; accelerating fatigue and daytime sleepiness; and progressive restrictions in community life, employment, and psychological functioning. 80% of disabled persons live in low- and middle-income countries, where high-income settings report 22 occupational therapists per 10,000. At the same time, 54 World Federation of Occupational Therapists member nations have fewer than one, and ratios as low as 0.001. OT rests on four pillars: COPM-based top-down evaluation; contextual adaptations (wearable ADL effect sizes 1.06 and 1.38; tailored smart-home solutions: 89% ADL improvement, 91% readiness for change at US$567 per participant; powered-wheelchair intervention transitioning 74.8% of 127 tasks to independent completion); energy conservation through pacing, planning, prioritising, and positioning; caregiver coaching anchored in the OPTIMISTIC trial's DM1-Activ-c endpoint. The disease trajectory is irreversible, but participation restrictions are modifiable; three priorities follow: longitudinal DM-specific outcome studies, DM-specific participation measures more sensitive than impairment tools, and scalable low-cost technology for resource-limited settings.

This systematic review evaluates the efficacy of interventions designed to enhance self-compassion in parents of children with neurodevelopmental disorders (NDDs), a population documented to experience elevated levels of parenting stress. Adhering to PRISMA guidelines, a search of PubMed, Scopus, and PsycINFO (covering the period 2015 to 2025) identified studies evaluating self-compassion educational programs, training, or workshops for parents of children with NDDs. Eligible studies included Randomized Controlled Trials (RCTs) and pre-post designs using a quantitative measure of self-compassion as the outcome. Eight studies were included, featuring varied interventions like Acceptance and Commitment Therapy (ACT), psychoeducation, and Mindfulness-Based approaches. The results suggest that these interventions are generally associated with significant short-term improvements in parental self-compassion and secondary outcomes including reduced stress and depression. However, the current evidence base is limited by methodological heterogeneity. Future research must prioritize rigorous RCTs and longitudinal follow-up to establish sustainable, evidence-based practices for this population.

Background/Objectives: Driving performance and competence represent a complex functional domain that may be affected in some individuals with schizophrenia. This scoping review aimed to map existing evidence characterizing driving-related functioning by identifying the cognitive, pharmacological and functional factors that influence driving ability and by synthesizing findings from experimental, neurocognitive and population-based studies. Methods: A structured search of the PubMed, Scopus and ScienceDirect databases was performed in accordance with PRISMA-ScR guidelines to identify studies published between 2015 and 2025 that examined cognitive, pharmacological and functional dimensions of driving in individuals with schizophrenia. Extracted data were narratively and thematically synthesized. Eleven studies met the inclusion criteria. Results: Findings clustered into three domains: cognitive, including attention, executive function, reaction time and visuospatial processing; pharmacological, encompassing drug comparisons, dosage, side effects and treatment stability; and functional, covering license status, driving participation, driving cessation, avoidance behaviors and self-regulation. Conclusions: This review integrates current evidence within a multidimensional and conditional framework, highlighting interactions between cognitive functioning, pharmacological factors, and compensatory self-regulation in individuals with schizophrenia. Understanding these interrelations may inform individualized fitness-to-drive evaluations and contribute to structured, context-sensitive interpretation of driving-related evidence in clinical and regulatory settings.

Background and Objectives: Employment is a major determinant of quality of life in people with multiple sclerosis (pwMS). This multicenter cross-sectional study aimed to identify which commonly studied demographic, disease-related, clinical, cognitive, and psychological variables, alongside the presence of lower urinary tract symptoms (LUTS), predict employment status in pwMS. Materials and Methods: Seventy-eight pwMS were classified as either full-time employed (n = 41) or non-employed (n = 37). Participants underwent clinical and neuropsychological assessment including disability status (Expanded Disability Status Scale; EDSS), fatigue (Modified Fatigue Impact Scale; MFIS), information processing speed (Symbol Digit Modalities Test; SDMT), depressive symptoms (Hospital Anxiety and Depression Scale-Depression; HADS-D), and LUTS status (presence/absence), alongside demographic and disease-related variables (sex, age, education level, relationship status, and disease duration). Results: Hierarchical binary logistic regression indicated that higher information processing speed was associated with higher odds of employment (OR = 1.11, p = 0.008), whereas the presence of LUTS was associated with lower odds of employment (OR = 0.13, p = 0.026). Disability severity, fatigue, depressive symptoms, demographic characteristics, and disease duration did not contribute in the final model (p > 0.05). Conclusions: Information processing speed and urinary dysfunction were associated with employment status in pwMS. Within the present sample, the multivariable model including these variables showed good discrimination between employed and non-employed participants. The findings should be interpreted as exploratory, and they require further confirmation in independent cohorts before any potential application is considered.

This study aimed to examine the association between physical activity and individuals’ health status, healthcare utilization, socio-demographic characteristics, and health behaviors in a large representative sample from Northern Greece. A cross-sectional study was conducted involving 1227 participants (47.4% males, mean age 49.94 ± 14.87 years) from Thrace, Greece, selected through a two-stage stratified sampling method. According to the Greek version of IPAQ, participants were classified as inactive/insufficiently active, sufficiently and highly active. Data on socio-demographic, lifestyle, and health-related variables were collected through structured interviews. Multivariate logistic regression analysis was performed to determine the independent effect of physical activity on subjects’ characteristics using SPSS ver. 19. Half of the participants (49.8%) were inactive/insufficiently active, 418 participants (34.1%) were sufficiently active, and 198 participants (16.1%) were highly active. In univariate analysis, smoking (p < 0.001), higher coffee consumption (p = 0.002), higher adherence to Mediterranean diet (p < 0.001), napping during the day (p = 0.017) and short sleep duration (p < 0.001) were associated with lower prevalence of high activity. In adjusted analyses, sufficiently active participants had a lower risk for bad self-rated health (aOR = 0.63), hypertension (aOR = 0.41), dyslipidemia (aOR = 0.42), diabetes (aOR = 0.53), obesity (aOR = 0.61), cardiovascular diseases (aOR = 0.43), anxiety (aOR = 0.65), depression (aOR = 0.56), daily sleepiness (aOR = 0.62), poor sleep quality (aOR = 0.71), as well as for primary (aOR = 0.54) and secondary (aOR = 0.40) healthcare utilization compared to inactive participants. Higher-intensity physical activity did not enhance these beneficial effects of sufficient activity on subjects’ characteristics. Physical inactivity significantly compromises health across multiple domains. Promoting even moderate-intensity physical activity may reduce chronic disease burden and healthcare utilization.

Background: Facial palsy constitutes a profoundly disabling condition, often leading to marked functional deficits and a decline in facial appearance, which substantially reduces the patient’s quality of life. A combined therapy of botulinum toxin (BoNTA), hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) appears promising in the pharmacological approach of these patients. Methods: We reported our single center experience of patients with facial palsy, either of central or peripheral etiology who were treated with the combination of BoNTA, HA and CaHA, during a 6-month period (January 2025–June 2025). Results: Eight consecutive adult patients [mean age: 49.50 ± 7.95 years, 6 (75%) female] with facial palsy, either of central (4 patients) or peripheral (4 patients) etiology, received the combination of BoNTA, HA and CaHA. No serious adverse reactions were documented. Localized bruising and swelling at injection sites resolved without requiring any additional intervention. Facial Disability Index (FDI) was assessed both prior to and following treatment. The functional subscale increased from 65.63 ± 16.13 to 80.63 ± 10.50 (improvement rate = 24.4%, p-value = 0.002), while the psychosocial subscale increased from 63.00 ± 17.34 to 74.50 ± 10.89 (improvement rate = 18.3%, p-value = 0.004). Consequently, the total FDI score improved from 128.63 ± 28.92 to 155.13 ± 17.96 (overall improvement = 20.6%, p-value = 0.001). Conclusions: The present case series underscores the potential therapeutic role of CaHA as an adjunct to BoNTA and HA injections in patients with central or peripheral facial palsy.

Introduction: Individuals living with neuromuscular disorders experience progressive functional decline that severely impacts their daily autonomy and quality of life. While restorative robotics and compensatory smart home systems (SHSs) offer potential solutions, there is a need for a synthesized clinical framework to guide their integration. This narrative review, supported by systematic search and PRISMA‐style selection, explores the synergy between these technologies and the specific role of occupational therapy in optimizing functional outcomes. Methods: A systematic narrative review was conducted by analyzing 20 primary studies focused on the application of assistive technologies in NMD populations. The synthesis categorized evidence into three primary domains: robotics and wearable systems, augmentative and alternative communication (AAC), and Internet of Things–driven smart home platforms. Clinical efficacy was evaluated based on quantitative performance metrics and qualitative user perspectives. Results: The review identifies significant functional gains associated with high‐tech interventions, including a large effect size (1.06) for robotic upper‐limb assistants. AI‐driven multimodal smart home platforms demonstrated high technical precision, with monitoring accuracies reaching approximately 94% for motor impairment stages. However, despite this high technical efficacy, real‐world utility remains complex, as clinical success is often moderated by nontechnical factors. Implementation is often hindered by barriers such as high costs, technical complexity, and privacy concerns. The findings highlight that successful integration depends on a “person–technology fit,” facilitated by occupational therapists through rigorous customization and task adaptation. Conclusion: Integrating SHSs with traditional assistive technologies significantly enhances independent living for individuals with NMD. However, to move beyond experimental success, future research must prioritize user‐centered codesign and the establishment of ethical mapping frameworks. Occupational therapists remain essential in bridging the gap between sophisticated technology and the practical, daily needs of patients.

The progressive nature of dementia necessitates early detection strategies capable of identifying preclinical cognitive decline. Gait disturbances, mediated by higher-order cognitive functions, have emerged as potential digital biomarkers in this context. This bibliometric review systematically maps the scientific output from 2010 to 2025 on the application of wearable sensor technologies and gait analysis in the early diagnosis of dementia. A targeted search of the Scopus database yielded 126 peer-reviewed studies, which were analyzed using VOSviewer for performance metrics, co-authorship networks, bibliographic coupling, co-citation, and keyword co-occurrence. The findings delineate a multidisciplinary research landscape, with major contributions spanning neurology, geriatrics, biomedical engineering, and computational sciences. Four principal thematic clusters were identified: (1) Cognitive and Clinical Aspects of Dementia, (2) Physical Activity and Mobility in Older Adults, (3) Technological and Analytical Approaches to Gait and Frailty and (4) Aging, Cognitive Decline, and Emerging Technologies. Despite the proliferation of research, significant gaps persist in longitudinal validation, methodological standardization, and integration into clinical workflows. This review emphasizes the potential of sensor-derived gait metrics to augment early diagnostic protocols and advocates for interdisciplinary collaboration to advance scalable, non-invasive diagnostic solutions for neurodegenerative diseases.