ORIGINAL RESEARCH article
Front. Rehabil. Sci.
Sec. Rehabilitation in Neurological Conditions
Volume 6 - 2025 | doi: 10.3389/fresc.2025.1641003
This article is part of the Research TopicEvaluating Exergames: Impacts on Physical Health and Activity LevelsView all articles
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
Provisionally accepted
- Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland
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Background: High-intensity therapy improves outcomes in (pediatric) neurorehabilitation, yet standardized intensity measures accounting for motor and/or mental demands remain. 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 minutes. 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 to 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.
Keywords: Intensity measures, Neurorehabilitation, movement repetitions, Heart rate variability, activity counts, Skin conductance, Perceived effort, NASA-TLX
Received: 04 Jun 2025; Accepted: 16 Sep 2025.
Copyright: © 2025 Goikoetxea-Sotelo and Van Hedel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hubertus J.A. Van Hedel, hubertus.vanhedel@kispi.uzh.ch
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