Feasibility and Perceptions of Telerehabilitation Using Serious Games for Children with Disabilities in War-Affected Ukraine

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this article.

The manuscript addresses an interesting and timely topic - the use of video games in rehabilitation of children with disabilities in a war context - and overall, the authors have prepared a high quality submission. The article is well-written, well-structured, and clear, making it easy to follow. However, several aspects could be improved to strengthen the paper.

First, the article does not clearly specify what specific rehabilitation gains were achieved as a result of the intervention; these should be explicitly stated and discussed in both the results and the conclusions.

Second, the methodology section does not clarify whether the platform includes a diagnostic system, even though the text contains multiple references suggesting diagnostic features (e.g., “daily assessment of patient progress”); the authors should explain what this assessment entails and how it is implemented.

Finally, the conclusions could be made more specific and concise by directly summarizing the key findings of the study, rather than reiterating general points.

Author Response

See attached document

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Although this paper presents a very interesting and pertinent content, its scientific organisation is not rigorous. Instead of a scientific paper, I would consider this as a report. In order to improve scientific contribution, I would recommend reflection on the following aspects:

•  the tittle of the paper seems to direct to the assessment of rehabilitation gains through the use os SG, and in fact, that is not assessed. Therefore, I would recommend to rephrase it.
• if the aim is to assess children and their families perception about the use of SG, families characterisation should be presented: who answered the survey, indeed? I believe it is not clear.
• if the tool to assess families perception was a questionnaire/survey, shouldn´t it be presented? 
• overall, results are very scarce and poorly presented;
• how was the data objectively and scientifically treated. Explanation about data processing is almost inexistent
• as a consequence of scarce results presentation, discussion is poorly developed

Author Response

See attached document

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This study proposes several serious games for telerehabilitation. The games are aimed at children. Consequently, the children could follow their therapy from their homes. Questionnaires were applied in order to know the children’s progress and their opinions of the games.

Please find below some comments:

Abstract.

The abstract introduces the proposal of the authors. Some comments are:

Comment 1. Please provide the number of serious games that were played in the experiments. Moreover, briefly mention the body movements that were used to play them.

Comment 2. Please provide numerical results at the abstract.

 

Introduction

Comment 3. Please add a subsection “1.1. Research questions”. In this subsection, please list the research questions that the study aims to answer.

Comment 4. Please add a subsection “1.2. Contribution of the study”. In this subsection, please explain the contributions of the study in-depth.

Comment 5. Please add a subsection “1.3. Literature review”. In this subsection, it would be convenient to expand the state-of-the-art, so that a broader range of recent and relevant state-of-the-art studies could be included and strengthen the manuscript. Articles from the past five years related to the area could be searched in the web of science.

2. Materials and Methods

Comment 6. Please add the minimum RAM required for the computer to execute the game properly (line 110)

Comment 7. For each game used in the study (Table 1), please provide the following: i) the type of feedback given to the player (for instance: visual, auditory, etc.), and the game environment (for instance: 2D or 3D). Additionally, please explain how the control commands are executed through body movements, i.e., which body movement corresponds to each control command.

Comment 8. It would be convenient to explain how the body movements used to play the game were identified (i.e., whether artificial intelligence techniques were used to identify the body movements)

Comment 9. Please move the details on the sample: number of volunteers that participate in the experiments, the mean age and the standard deviation of the participants (subsection 2.2. Patients), etc. to the subsection “2.2. Patients”. Currently, this information is presented in Results (lines 175- 186)

Comment 10. It would be convenient to mention the software used in the study (for instance: software used to implement the games).

Comment 11. Please add a subsection “2.5. Metrics and Instruments”. In this subsection,  please explain the questionnaires applied to the children (e.g., the questions, type of questions),  and the variables that were measured.

 

3. Results

The authors reported only descriptive data. It is highly recommended to report results in-depth.

Comment 12. Please conduct a statistical analysis of the results, so that the findings can be more reliable and ensure that results are not due to random chance. Perhaps, a Spearman Correlation test can be applied to the results of the questionnaire; consequently, associations between variables could be found.

Comment 13. It would be convenient to provide results per game since it is mentioned in Table 1 that various games were used in the experiments.  Moreover, a comparison of the questionnaire’s outcomes between games could be conducted. It would be interesting to analyze the children’s feedback for each game.

4. Discussion

Comment 14. In this section, the research questions presented in the Introduction should be answered.

Comment 15. It would be recommended to compare the results of the authors’ proposal with results of previous studies.

 

5. Conclusions

Comment 16. It would be convenient to provide numerical results to support the conclusions

References

Please revise comment 5

Comments on the Quality of English Language

Please revise the manuscript carefully, as there are several typos in the Introduction (e.g., words separated by hyphens)

Please do not mix American and British English (there is a word written using British English (favourite); nevertheless, most of the manuscript is written using American English)

Author Response

See attached document

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for taking into consideration the suggestions!

The tittle seems more appropriated now.

In the abstract, first sentence, I would suggest to rephrase for "This study aimed to evaluate the feasibility of serious games for (tele)rehabilitation of children with disabilities..."

The Results section seems more detailed and well developed.

Author Response

Dear reviewer,

Thank you for this second round of review and for acknowledging our efforts to improve the manuscript’s quality based on your valuable feedback. We have revised the abstract accordingly.

Best regards,

Bruno

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have addressed all the comments.

Please revise  how-ever in line 61

Author Response

Dear reviewer,

Thank you for this second round of review and for acknowledging our efforts to improve the manuscript’s quality based on your valuable feedback.

Best regards,

Bruno