{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T21:02:11Z","timestamp":1776114131549,"version":"3.50.1"},"reference-count":55,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T00:00:00Z","timestamp":1631577600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Electronics"],"abstract":"<jats:p>Schizophrenia is a chronic mental illness, characterized by the loss of the notion of reality, failing to distinguish it from the imaginary. It affects the patient in life\u2019s major areas, such as work, interpersonal relationships, or self-care, and the usual treatment is performed with the help of anti-psychotic medication, which targets primarily the hallucinations, delirium, etc. Other symptoms, such as the decreased emotional expression or avolition, require a multidisciplinary approach, including psychopharmacology, cognitive training, and many forms of therapy. In this context, this paper addresses the use of digital technologies to design and develop innovative rehabilitation techniques, particularly focusing on mental health rehabilitation, and contributing for the promotion of well-being and health from a holistic perspective. In this context, serious games and virtual reality allows for creation of immersive environments that contribute to a more effective and lasting recovery, with improvements in terms of quality of life. The use of machine learning techniques will allow the real-time analysis of the data collected during the execution of the rehabilitation procedures, as well as enable their dynamic and automatic adaptation according to the profile and performance of the patients, by increasing or reducing the exercises\u2019 difficulty. It relies on the acquisition of biometric and physiological signals, such as voice, heart rate, and game performance, to estimate the stress level, thus adapting the difficulty of the experience to the skills of the patient. The system described in this paper is currently in development, in collaboration with a health unit, and is an engineering effort that combines hardware and software to develop a rehabilitation tool for schizophrenic patients. A clinical trial is also planned for assessing the effectiveness of the system among negative symptoms in schizophrenia patients.<\/jats:p>","DOI":"10.3390\/electronics10182260","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T23:34:11Z","timestamp":1631662451000},"page":"2260","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Digital Technologies for Innovative Mental Health Rehabilitation"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9170-5078","authenticated-orcid":false,"given":"Rui Pedro","family":"Lopes","sequence":"first","affiliation":[{"name":"Research Center in Digitalization and Intelligent Robotics (CeDRI), Instituto Polit\u00e9cnico de Bragan\u00e7a (IPB), 5300-253 Bragan\u00e7a, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6323-2309","authenticated-orcid":false,"given":"B\u00e1rbara","family":"Barroso","sequence":"additional","affiliation":[{"name":"Research Center in Digitalization and Intelligent Robotics (CeDRI), Instituto Polit\u00e9cnico de Bragan\u00e7a (IPB), 5300-253 Bragan\u00e7a, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9944-4386","authenticated-orcid":false,"given":"Leonel","family":"Deusdado","sequence":"additional","affiliation":[{"name":"Research Center in Digitalization and Intelligent Robotics (CeDRI), Instituto Polit\u00e9cnico de Bragan\u00e7a (IPB), 5300-253 Bragan\u00e7a, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8583-0406","authenticated-orcid":false,"given":"Andr\u00e9","family":"Novo","sequence":"additional","affiliation":[{"name":"Research Center in Digitalization and Intelligent Robotics (CeDRI), Instituto Polit\u00e9cnico de Bragan\u00e7a (IPB), 5300-253 Bragan\u00e7a, Portugal"}]},{"given":"Manuel","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Departamento de Psiquiatria e Sa\u00fade Mental (DPSM), Unidade Local de Sa\u00fade no Nordeste, EPE (ULSNE, EPE), 5301-852 Bragan\u00e7a, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6679-5702","authenticated-orcid":false,"given":"Jo\u00e3o Paulo","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Research Center in Digitalization and Intelligent Robotics (CeDRI), Instituto Polit\u00e9cnico de Bragan\u00e7a (IPB), 5300-253 Bragan\u00e7a, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2151-7944","authenticated-orcid":false,"given":"Paulo","family":"Leit\u00e3o","sequence":"additional","affiliation":[{"name":"Research Center in Digitalization and Intelligent Robotics (CeDRI), Instituto Polit\u00e9cnico de Bragan\u00e7a (IPB), 5300-253 Bragan\u00e7a, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"key":"ref_1","unstructured":"Barbato, A., and World Health Organization (1997). Schizophrenia and Public Health, World Health Organization. Technical Report."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1590\/0047-2085000000059","article-title":"Virtual reality in assessment and treatment of schizophrenia: A systematic review","volume":"64","author":"Macedo","year":"2015","journal-title":"J. Bras. Psiquiatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s12984-021-00848-w","article-title":"Immersive virtual reality during gait rehabilitation increases walking speed and motivation: A usability evaluation with healthy participants and patients with multiple sclerosis and stroke","volume":"18","author":"Winter","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s12984-021-00885-5","article-title":"Augmented efficacy of intermittent theta burst stimulation on the virtual reality-based cycling training for upper limb function in patients with stroke: A double-blinded, randomized controlled trial","volume":"18","author":"Chen","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1007\/s10055-020-00495-x","article-title":"Immersive virtual reality as physical therapy in older adults: Present or future (systematic review)","volume":"25","author":"Cancela","year":"2021","journal-title":"Virtual Real."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Lasaponara, S., Marson, F., Doricchi, F., and Cavallo, M. (2021). A Scoping Review of Cognitive Training in Neurodegenerative Diseases via Computerized and Virtual Reality Tools: What We Know So Far. Brain Sci., 11.","DOI":"10.3390\/brainsci11050528"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Tuena, C., Serino, S., Pedroli, E., Stramba-Badiale, M., Riva, G., and Repetto, C. (2021). Building Embodied Spaces for Spatial Memory Neurorehabilitation with Virtual Reality in Normal and Pathological Aging. Brain Sci., 11.","DOI":"10.3390\/brainsci11081067"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12984-021-00830-6","article-title":"Performance in complex life situations: Effects of age, cognition, and walking speed in virtual versus real life environments","volume":"18","author":"Kafri","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Souza, B., Almeida, M., and Lopes, R. (2021, January 23\u201325). A Decision Game for Informal Learning. Proceedings of the 13th International Conference on Computer Supported Education, Prague, Czech Republic.","DOI":"10.5220\/0010492403600367"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pereira, R., Garcia da Luz, V., Matos, S., Lopes, R., and Borges, H. (2021, January 23\u201325). A Systematic Mapping of Serious Games for Oral Health. Proceedings of the 13th International Conference on Computer Supported Education, Prague, Czech Republic.","DOI":"10.5220\/0010502304000407"},{"key":"ref_11","unstructured":"Lopes, R. (2014, January 17\u201319). An Award System for Gamification in Higher Education. Proceedings of the 7th International Conference of Education, Research and Innovation, Seville, Spain."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12984-020-00801-3","article-title":"Immersive virtual reality health games: A narrative review of game design","volume":"18","author":"Tao","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s12984-021-00889-1","article-title":"Serious games for upper limb rehabilitation after stroke: A meta-analysis","volume":"18","author":"Doumas","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Deterding, S., Dixon, D., Khaled, R., and Nacke, L. (2011, January 28\u201330). From Game Design Elements to Gamefulness: Defining Gamification. Proceedings of the 15th International Academic MindTrek Conference on Envisioning Future Media Environments\u2014MindTrek, Tampere, Finland.","DOI":"10.1145\/2181037.2181040"},{"key":"ref_15","unstructured":"Michael, D., and Chen, S. (2006). Serious Games: Games that Educate, Train and Inform, Thomson Course Technology."},{"key":"ref_16","unstructured":"Sadock, B.J., and Sadock, V.A. (2011). Kaplan and Sadock\u2019s Synopsis of Psychiatry: Behavioral Sciences\/Clinical Psychiatry, Lippincott Williams & Wilkins."},{"key":"ref_17","unstructured":"American Psychiatric Association (2014). DSM-5: Manual Diagn\u00f3stico e Estat\u00edstico de Transtornos Mentais, Artmed Editora."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2174\/1745017902117010031","article-title":"Strategies for Psychiatric Rehabilitation and their Cognitive Outcomes in Schizophrenia: Review of Last Five-year Studies","volume":"17","author":"Rampino","year":"2021","journal-title":"Clin. Pract. Epidemiol. Ment. Health"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cheng, K.Y., and Yen, C.F. (2021). The social support, mental health, psychiatric symptoms, and functioning of persons with schizophrenia participating in peer co-delivered vocational rehabilitation: A pilot study in Taiwan. BMC Psychiatry, 21.","DOI":"10.1186\/s12888-021-03277-0"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"519","DOI":"10.2147\/NDT.S225643","article-title":"Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment","volume":"16","author":"Correll","year":"2020","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41537-021-00140-9","article-title":"Accuracy of self-assessment of real-life functioning in schizophrenia","volume":"7","author":"Rocca","year":"2021","journal-title":"npj Schizophr."},{"key":"ref_22","unstructured":"World Health Organization (2019). Rehabilitation in Health Systems: Guide for Action, World Health Organization."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.cnur.2016.01.011","article-title":"Psychosocial Recovery and Rehabilitation","volume":"51","year":"2016","journal-title":"Nurs. Clin. N. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e99462","DOI":"10.5812\/ijpbs.99462","article-title":"Short-term Social Skills Training in Schizophrenia Spectrum Disorders: A Clinical Trial in an Outpatient Setting","volume":"14","author":"Takaloo","year":"2020","journal-title":"Iran. J. Psychiatry Behav. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1089\/g4h.2017.0046","article-title":"Emerging Utility of Virtual Reality as a Multidisciplinary Tool in Clinical Medicine","volume":"6","author":"Pourmand","year":"2017","journal-title":"Games Health J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"607312","DOI":"10.3389\/fpsyg.2020.607312","article-title":"Using Virtual Reality as a Tool in the Rehabilitation of Movement Abnormalities in Schizophrenia","volume":"11","author":"Pavlidou","year":"2021","journal-title":"Front. Psychol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"414","DOI":"10.20344\/amp.1358","article-title":"Realidade Virtual na Reabilita\u00e7\u00e3o: Por Que Sim e Por Que N\u00e3o? Uma Revis\u00e3o Sistem\u00e1tica","volume":"25","author":"Dores","year":"2012","journal-title":"Acta Med. Port."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1007\/s10072-017-2995-5","article-title":"Effects of robot-assisted upper limb rehabilitation in stroke patients: A systematic review with meta-analysis","volume":"38","author":"Bertani","year":"2017","journal-title":"Neurol. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e10839","DOI":"10.2196\/10839","article-title":"Virtual Reality Clinical Research: Promises and Challenges","volume":"6","author":"Garrett","year":"2018","journal-title":"JMIR Serious Games"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"112974","DOI":"10.1016\/j.psychres.2020.112974","article-title":"Transforming treatments for schizophrenia: Virtual reality, brain stimulation and social cognition","volume":"288","author":"Gainsford","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.psychres.2011.04.003","article-title":"A virtual reality application in role-plays of social skills training for schizophrenia: A randomized, controlled trial","volume":"189","author":"Park","year":"2011","journal-title":"Psychiatry Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jbct.2019.12.001","article-title":"Developing an automated VR cognitive treatment for psychosis: Gamechange VR therapy","volume":"30","author":"Lambe","year":"2021","journal-title":"J. Behav. Cogn. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1192\/bjp.bp.115.176438","article-title":"Virtual reality in the treatment of persecutory delusions: Randomised controlled experimental study testing how to reduce delusional conviction","volume":"209","author":"Freeman","year":"2016","journal-title":"Br. J. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.schres.2018.02.031","article-title":"Virtual reality therapy for refractory auditory verbal hallucinations in schizophrenia: A pilot clinical trial","volume":"197","author":"Potvin","year":"2018","journal-title":"Schizophr. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1007\/s10597-017-0208-6","article-title":"Impact of a Pilot Videogame-Based Physical Activity Program on Walking Speed in Adults with Schizophrenia","volume":"54","author":"Leutwyler","year":"2018","journal-title":"Community Ment. Health J."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Shimizu, N., Umemura, T., Matsunaga, M., and Hirai, T. (2017). An interactive sports video game as an intervention for rehabilitation of community-living patients with schizophrenia: A controlled, single-blind, crossover study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0187480"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3389\/fpsyt.2016.00064","article-title":"A Serious Game to Improve Cognitive Functions in Schizophrenia: A Pilot Study","volume":"7","author":"Amado","year":"2016","journal-title":"Front. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.schres.2008.01.026","article-title":"The effect of internet video game play on clinical and extrapyramidal symptoms in patients with schizophrenia","volume":"103","author":"Han","year":"2008","journal-title":"Schizophr. Res."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Chrysafiadi, K., Papadimitriou, S., and Virvou, M. (2020, January 15\u201317). Fuzzy states for dynamic adaptation of the plot of an educational game in relation to the learner\u2019s progress. Proceedings of the 2020 11th International Conference on Information, Intelligence, Systems and Applications IISA, Piraeus, Greece.","DOI":"10.1109\/IISA50023.2020.9284380"},{"key":"ref_40","first-page":"3","article-title":"Adaptation in Affective Video Games: A Literature Review","volume":"16","author":"Bontchev","year":"2016","journal-title":"Cybern. Inf. Technol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1080\/13546805.2019.1706465","article-title":"Implicit and explicit processing of bodily emotions in schizophrenia","volume":"25","author":"Klein","year":"2020","journal-title":"Cogn. Neuropsychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Cao, Z., Simon, T., Wei, S.E., and Sheikh, Y. (2017). Realtime Multi-Person 2D Pose Estimation using Part Affinity Fields. arXiv.","DOI":"10.1109\/CVPR.2017.143"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1109\/TPAMI.2019.2929257","article-title":"OpenPose: Realtime Multi-Person 2D Pose Estimation using Part Affinity Fields","volume":"43","author":"Cao","year":"2019","journal-title":"IEEE Trans. Pattern Anal. Mach. Intell."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2574","DOI":"10.1093\/cercor\/bhaa375","article-title":"Face Tuning in Depression","volume":"31","author":"Kubon","year":"2021","journal-title":"Cereb. Cortex"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"633717","DOI":"10.3389\/fpsyt.2021.633717","article-title":"Facial Emotion Recognition in Schizophrenia","volume":"12","author":"Gao","year":"2021","journal-title":"Front. Psychiatry"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1109\/TETCI.2019.2917039","article-title":"Lip-Reading Driven Deep Learning Approach for Speech Enhancement","volume":"5","author":"Adeel","year":"2021","journal-title":"IEEE Trans. Emerg. Top. Comput. Intell."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Wilson, N., Brumm, M., and Grigat, R.R. (2019, January 8\u201310). Classification of mouth gestures in German sign language using 3D convolutional neural networks. Proceedings of the 10th International Conference on Pattern Recognition Systems (ICPRS-2019), Tours, France.","DOI":"10.1049\/cp.2019.0248"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Ladakis, I., Kilintzis, V., Xanthopoulou, D., and Chouvarda, I. (2021, January 11\u201313). Virtual Reality and Serious Games for Stress Reduction with Application in Work Environments. Proceedings of the 14th International Joint Conference on Biomedical Engineering Systems and Technologies, Vienna, Austria.","DOI":"10.5220\/0010300905410548"},{"key":"ref_49","first-page":"770","article-title":"Using Language Processing and Speech Analysis for the Identification of Psychosis and Other Disorders","volume":"5","author":"Corcoran","year":"2020","journal-title":"Biol. Psychiatry Cogn. Neurosci. Neuroimaging"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jneuroling.2009.05.002","article-title":"An automated method to analyze language use in patients with schizophrenia and their first-degree relatives","volume":"23","author":"Foltz","year":"2010","journal-title":"J. Neurolinguistics"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Tahir, Y., Yang, Z., Chakraborty, D., Thalmann, N., Thalmann, D., Maniam, Y., Binte Abdul Rashid, N.A., Tan, B.L., Lee Chee Keong, J., and Dauwels, J. (2019). Non-verbal speech cues as objective measures for negative symptoms in patients with schizophrenia. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0214314"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Chakraborty, D., Yang, Z., Tahir, Y., Maszczyk, T., Dauwels, J., Thalmann, N., Zheng, J., Maniam, Y., Amirah, N., and Tan, B.L. (2018, January 15\u201320). Prediction of Negative Symptoms of Schizophrenia from Emotion Related Low-Level Speech Signals. Proceedings of the 2018 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP), Calgary, AB, Canada.","DOI":"10.1109\/ICASSP.2018.8462102"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"6492","DOI":"10.1016\/j.eswa.2008.07.037","article-title":"An efficient classifier to diagnose of schizophrenia based on the EEG signals","volume":"36","author":"Boostani","year":"2009","journal-title":"Expert Syst. Appl."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/j.medengphy.2010.07.013","article-title":"Acoustic and temporal analysis of speech: A potential biomarker for schizophrenia","volume":"32","author":"Rapcan","year":"2010","journal-title":"Med. Eng. Phys."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1590\/S1516-44462007000300010","article-title":"The Portuguese version of the clinical global impression-schizophrenia scale: Validation study","volume":"29","author":"Soares","year":"2007","journal-title":"Braz. J. Psychiatry"}],"container-title":["Electronics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9292\/10\/18\/2260\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:02:50Z","timestamp":1760166170000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9292\/10\/18\/2260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,14]]},"references-count":55,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["electronics10182260"],"URL":"https:\/\/doi.org\/10.3390\/electronics10182260","relation":{},"ISSN":["2079-9292"],"issn-type":[{"value":"2079-9292","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,14]]}}}