Aesthetics and Creativity to support the vaLidation of an e-health rehabIlitation protoCol for neurological patients - Finanziamento dell’Unione Europea – NextGenerationEU – missione 4, componente 2, investimento 1.1.

Post-stroke and degenerative neurological conditions are becoming more common in Italy with an ageing population. Stroke and dementia represent two of the leading causes of lifelong disability due to long-term cognitive and motor sequelae. According to Società Italiana Ipertensione Arteriosa, it is estimated that 913.000 patients currently live with cognitive consequences of a stroke episode. Similarly, data from Istituto Superiore di Sanità showed that, only in Italy, 900.000 of elderly are affected by Mild Cognitive Impairment (MCI), a condition potentially prodromal to dementia. Cognitive impairments have a significant impact on everyday-life skills. While motor rehabilitation still needs to be carried out in-person by medical personnel, cognitive rehabilitation could be performed remotely, and in the last few years, there has been a significant effort to develop e-health rehabilitation tools. However, such tools seem to show some weaknesses. In particular, commercial software is not superior to in-presence rehabilitation approaches, while at-home computerized cognitive training protocols still suffer from a significant lack of motivation and compliance, limiting their overall effectiveness. To overcome the shortcomings of the existing applications, CLICk project aims at validating a novel e-health tool for the rehabilitation of cognitive impairments in a population of patients affected by MCI and stroke. CLICk platform will be composed of a suite of digital, gamified cognitive exercises, matched with a motivation protocol (called Pleaseme), based on aesthetic gratification and creativity enhancement. Recent studies demonstrated that aesthetic gratification increase individuals’ intrinsic motivation and improve learning outcomes. We expect, therefore, that Pleaseme will enhance the success of our rehabilitation, representing a driver of compliance and possibly limiting drop-outs. CLICk game exercises, accessible through a tablet, will be directed to improve attention and memory, executive functions, reading and comprehension skills. CLICk rehabilitation protocol will be composed of 20 home-training sessions (1 hour each), with 15 minutes dedicated to the motivation protocol (Pleaseme) and 45 minutes to the game exercises. Notably, both protocols will be personalized according to each patient's specific impairments and aesthetic preference. CLICk effects will be measured through neuropsychological testing, behavioural and electrophysiological experimental protocols. The main innovative aspects of CLICk training concern: (1) the possibility of choosing the preferred motivational protocol (Pleaseme); (2) the ad-hoc digital game-exercises to be selected according to individuals’ cognitive profiles; (3) its at home, self-administered modality. Overall CLICk will represent a technologically innovative tool of personalized medicine, able to improve patients’ autonomy and quality of life, and suitable for reducing health costs.