{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T21:54:07Z","timestamp":1791323647230,"version":"4.3.1"},"reference-count":35,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T00:00:00Z","timestamp":1744934400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Background\/Objectives: Rett Syndrome (RTT) is a rare neurodevelopmental disorder that causes the loss of motor, communicative, and cognitive skills. While no cure exists, rehabilitation plays a crucial role in improving quality of life. Virtual Reality (VR) has shown promise in enhancing motor function and reducing stereotypic behaviors in RTT. This study aims to assess the impact of VR training on upper limb motor skills in RTT patients, focusing on reaching and hand-opening tasks, as well as examining its role in motivation and engagement during rehabilitation. Methods: Twenty RTT patients (aged 5\u201333) were randomly assigned to an experimental group (VR training) and a control group (standard rehabilitation). Pre- and post-tests evaluated motor skills and motivation in both VR and real-world contexts. The VR training involved 40 sessions over 8 weeks, focusing on fine motor tasks. Non-parametric statistical methods were used to analyze the data. Results: Results indicated significant improvements in the experimental group for motor parameters, including reduced stereotypy intensity and frequency, faster response times, and increased correct performance. These improvements were consistent across VR and ecological conditions. Moreover, attention time increased, while the number of aids required decreased, highlighting enhanced engagement and independence. However, motivation levels remained stable throughout the sessions. Conclusions: This study demonstrates the potential of VR as a tool for RTT rehabilitation, addressing both motor and engagement challenges. Future research should explore the customization of VR environments to maximize the generalization of skills and sustain motivation over extended training periods.<\/jats:p>","DOI":"10.3390\/pediatric17020049","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T08:24:07Z","timestamp":1744964647000},"page":"49","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Virtual Reality as a Tool for Upper Limb Rehabilitation in Rett Syndrome: Reducing Stereotypies and Improving Motor Skills"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7065-1528","authenticated-orcid":false,"given":"Rosa Angela","family":"Fabio","sequence":"first","affiliation":[{"name":"Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98100 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Semino","sequence":"additional","affiliation":[{"name":"Airett Innovation and Research Center, 37100 Verona, Italy"},{"name":"TICE Cooperativa Sociale, Via De Meis 25, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2727-6464","authenticated-orcid":false,"given":"Michela","family":"Perina","sequence":"additional","affiliation":[{"name":"Airett Innovation and Research Center, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3929-5055","authenticated-orcid":false,"given":"Matteo","family":"Martini","sequence":"additional","affiliation":[{"name":"Department of Informatics, Bioengineering, Robotics, and Systems Engineering, University of Genoa, 16100 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Riccio","sequence":"additional","affiliation":[{"name":"Airett Innovation and Research Center, 37100 Verona, Italy"},{"name":"TICE Cooperativa Sociale, Via De Meis 25, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Pili","sequence":"additional","affiliation":[{"name":"Department of Electrical and Electronic Engineering, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1924-0875","authenticated-orcid":false,"given":"Danilo","family":"Pani","sequence":"additional","affiliation":[{"name":"Department of Electrical and Electronic Engineering, University of Cagliari, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3098-5894","authenticated-orcid":false,"given":"Manuela","family":"Chessa","sequence":"additional","affiliation":[{"name":"Department of Informatics, Bioengineering, Robotics, and Systems Engineering, University of Genoa, 16100 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1038\/13810","article-title":"Rett syndrome is caused by mutations in X-linked MECP2, encoding methyl-CpG-binding protein 2","volume":"23","author":"Amir","year":"1999","journal-title":"Nat. Genet."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e000731","DOI":"10.1136\/bmjpo-2020-000731","article-title":"Multisystem comorbidities in classic Rett syndrome: A scoping review","volume":"4","author":"Fu","year":"2020","journal-title":"BMJ Paediatr. Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/mrdd.10020","article-title":"Clinical manifestations and stages of Rett syndrome","volume":"8","author":"Hagberg","year":"2002","journal-title":"Ment. Retard. Dev. Disabil. Res. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1159\/000337637","article-title":"Rett Syndrome","volume":"2","author":"Smeets","year":"2012","journal-title":"Mol. Syndromol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1100\/tsw.2006.249","article-title":"Rett syndrome. A review with emphasis on clinical characteristics and intervention","volume":"6","author":"Lotan","year":"2006","journal-title":"Sci. World J."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Fabio, R.A., Gangemi, A., Semino, M., Vignoli, A., Priori, A., Canevini, M.P., Di Rosa, G., and Capr\u00ec, T. (2020). Effects of combined transcranial direct current stimulation with cognitive training in girls with Rett syndrome. Brain Sci., 10.","DOI":"10.3390\/brainsci10050276"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"103891","DOI":"10.1016\/j.ridd.2021.103891","article-title":"Longitudinal cognitive rehabilitation applied with eye-tracker for patients with Rett Syndrome","volume":"111","author":"Fabio","year":"2021","journal-title":"Res. Dev. Disabil."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Capr\u00ec, T., Fabio, R.A., Iannizzotto, G., and Nucita, A. (2020). The TCTRS project: A holistic approach for telerehabilitation in rett syndrome. Electronics, 9.","DOI":"10.3390\/electronics9030491"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1352\/1944-7558-125.6.493","article-title":"A psychometric evaluation of the motor-behavioral assessment scale for use as an outcome measure in Rett syndrome clinical trials","volume":"125","author":"Raspa","year":"2020","journal-title":"Am. J. Intellect. Dev. Disabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"459","DOI":"10.3390\/disabilities1040032","article-title":"The importance of collaboration in pediatric rehabilitation for the construction of participation: The views of parents and professionals","volume":"1","author":"Kinnunen","year":"2021","journal-title":"Disabilities"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1080\/17518420902991719","article-title":"Virtual reality in paediatric rehabilitation: A review","volume":"12","author":"Parsons","year":"2009","journal-title":"Dev. Neurorehabil."},{"key":"ref_12","first-page":"441","article-title":"Immersive virtual reality in traumatic brain injury rehabilitation: A literature review","volume":"42","author":"Aida","year":"2018","journal-title":"NeuroRehabilitation"},{"key":"ref_13","first-page":"467","article-title":"La rehabilitaci\u00f3n f\u00edsica y sus avances con realidad virtual: Una revisi\u00f3n sistem\u00e1tica","volume":"60","year":"2024","journal-title":"Retos Nuevas Perspect. Edu. F\u00eds. Dep. Recreac."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"198","DOI":"10.30935\/cet.554501","article-title":"Effects of augmented reality in teaching old Turkish language mementoes on student achievement and motivation","volume":"10","author":"Sahin","year":"2019","journal-title":"Contemp. Educ. Technol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1111\/jir.13177","article-title":"Immersive virtual reality is more effective than non-immersive devices for developing real-world skills in people with intellectual disability","volume":"68","author":"Franze","year":"2024","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ventura, S., Brivio, E., Riva, G., and Ba\u00f1os, R.M. (2019). Immersive Versus Non-immersive Experience: Exploring the Feasibility of Memory Assessment Through 360\u00b0 Technology. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.02509"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e20066","DOI":"10.2196\/20066","article-title":"Serious game design and clinical improvement in physical rehabilitation: Systematic review","volume":"9","author":"Vieira","year":"2021","journal-title":"JMIR Serious Games"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1016\/j.rasd.2013.07.010","article-title":"Promoting adaptive behaviors by two girls with Rett syndrome through a microswitch-based program","volume":"7","author":"Stasolla","year":"2013","journal-title":"Res. Autism Spectr. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ridd.2015.07.005","article-title":"Computer and microswitch-based programs to improve academic activities by six children with cerebral palsy","volume":"45","author":"Stasolla","year":"2015","journal-title":"Res. Dev. Disabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1080\/17483107.2018.1467972","article-title":"Assistive technology for promoting adaptive skills of children with cerebral palsy: Ten cases evaluation","volume":"14","author":"Stasolla","year":"2019","journal-title":"Disabil. Rehabil. Assist. Technol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"152","DOI":"10.6000\/2292-2598.2016.04.03.2","article-title":"The effects of virtual reality on the upper extremity skills of girls with rett syndrome: A single case study","volume":"4","author":"Mraz","year":"2016","journal-title":"J. Intellect. Disabil. Diagn Treat."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"539","DOI":"10.36713\/epra20360","article-title":"Systematic review on AI in special education: Enhancing learning for neurodiverse students","volume":"11","author":"Deckker","year":"2025","journal-title":"EPRA Int. J. Multidiscip. Res. (IJMR)"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1212\/01.wnl.0000259086.34769.78","article-title":"Stereotypies in Rett syndrome: Analysis of 83 patients with and without detected MECP2 mutations","volume":"68","author":"Temudo","year":"2007","journal-title":"Neurology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s13023-022-02259-z","article-title":"The GAIRS Checklist: A useful global assessment tool in patients with Rett syndrome","volume":"17","author":"Fabio","year":"2022","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_25","first-page":"257","article-title":"Construction and standardization of the RARS (rett assessment rating scale) tool","volume":"8","author":"Fabio","year":"2005","journal-title":"Ciclo Evol. Disabil."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Downs, J., Stahlhut, M., Wong, K., Syhler, B., Bisgaard, A.M., Jacoby, P., and Leonard, H. (2016). Validating the Rett syndrome gross motor scale. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0147555"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1111\/j.1469-8749.2010.03636.x","article-title":"Level of purposeful hand function as a marker of clinical severity in Rett syndrome","volume":"52","author":"Downs","year":"2010","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_28","first-page":"271","article-title":"Accuracy, reliability and refractoriness in a coincidence anticipation task","volume":"34","author":"Belisle","year":"2013","journal-title":"Res. Q. Exerc. Sport."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1167\/16.14.1","article-title":"Eye movement accuracy determines natural interception strategies","volume":"16","author":"Fooken","year":"2016","journal-title":"J. Vis."},{"key":"ref_30","unstructured":"Van der Maat, S. (1992). Communicatie Tussen Personen Met Een Diep Mentale Handicap En Hun Opvoed (st) Ers, Garant."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Catania, V., Rundo, F., Panerai, S., and Ferri, R. (2023). Virtual Reality for the Rehabilitation of Acquired Cognitive Disorders: A Narrative Review. Bioengineering, 11.","DOI":"10.3390\/bioengineering11010035"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Tobaiqi, M.A., Albadawi, E.A., Fadlalmola, H.A., and Albadrani, M.S. (2023). Application of Virtual Reality-Assisted Exergaming on the Rehabilitation of Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12227091"},{"key":"ref_33","first-page":"1","article-title":"Enhancing walking ability in individuals with Rett syndrome through the use of applied behavioral analysis (ABA): Review and a case study","volume":"8","author":"Lotan","year":"2015","journal-title":"Open Rehabil. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"146","DOI":"10.3390\/biomed4020012","article-title":"Assistive Communication Devices in Rett Syndrome: A Case Report and Narrative Review","volume":"4","author":"Lee","year":"2024","journal-title":"BioMed"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Romano, A., Ippolito, E., Risoli, C., Malerba, E., Favetta, M., Sancesario, A., Lotan, M., and Moran, D.S. (2022). Intensive postural and motor activity program reduces scoliosis progression in people with Rett syndrome. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030559"}],"container-title":["Pediatric Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7503\/17\/2\/49\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:17:29Z","timestamp":1760030249000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7503\/17\/2\/49"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,18]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["pediatric17020049"],"URL":"https:\/\/doi.org\/10.3390\/pediatric17020049","relation":{},"ISSN":["2036-7503"],"issn-type":[{"value":"2036-7503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,18]]}}}