The use of serious games (exergames) in rehabilitation is becoming increasingly popular among clinicians. These games are either embedded in commercial entertainment applications or specifically designed for clinical purposes. Maintaining a high level of therapy adherence during the rehabilitation process is a significant challenge for clinicians. Lack of motivation and difficulty in monitoring progress are two key issues they face. Therefore, the use of serious games could offer an interesting supplement to conventional treatments for these patients.

At REVAL, we test various types of interventions (non-immersive, semi-immersive, and fully immersive) for both motor and cognitive rehabilitation across different patient groups (e.g., multiple sclerosis, children with cerebral palsy, orthopedic conditions, normal and pathological aging).

Adherence to Therapy in Type 1 Diabetes Patients: Libre Project

Diabetes mellitus is a metabolic disorder characterized by high blood glucose levels due to either a lack of insulin production by the body (type 1) or a reduced effectiveness of the insulin produced (type 2). It is estimated that approximately 40,000 Belgians suffer from type 1 diabetes (IDF Diabetes Atlas, 8th Edition), a diagnosis that is typically made in childhood. If not properly managed, diabetes can lead to serious complications, including cardiovascular diseases, eye problems, kidney damage, and nerve conduction disorders.

While the exact cause of type 1 diabetes remains unclear, blood glucose levels can be stabilized through a combination of self-administered insulin injections, a healthy diet, and adequate exercise. As a result, individuals with type 1 diabetes can lead normal lives with a low risk of complications, provided they adhere to their prescribed treatment. Frequent monitoring of blood glucose levels and adjusting insulin doses based on current glucose readings is critical to this process.

Today, the majority of type 1 diabetes patients in Belgium use the FreeStyle Libre system to monitor their blood glucose levels. The Libre system is a flash monitoring method where a coin-sized sensor is worn on the upper arm. Glucose levels can be measured at any time by scanning the sensor, which needs to be replaced every 14 days. In addition to its ease of use, the advantage of this system over traditional finger-prick methods is that it not only displays the current glucose readings but also provides up to 8 hours of glucose history (Bailey, Bode, Christiansen, Klaff, & Alva, 2015).

Although this technology seems to encourage better adherence to therapy (patients check their glucose levels more frequently compared to the traditional finger-prick method; Ish-Shalom, Weinstein, Raz, & Mosenzon, 2016), clinical experience shows that this effect tends to decrease after about a year of use. Given the popularity of this technology and the critical importance of glucose monitoring in the self-management of type 1 diabetes, the aim of this study is to identify the factors that contribute to (or hinder) adherence to therapy among diabetes patients using the Libre monitoring system.

Artificial intelligence is increasingly being integrated into everyday applications and has the potential to be used more extensively in rehabilitation settings. One example is the use of deep learning algorithms to calculate joint angles based on simple 2D video footage. This means that, without the need for expensive equipment or complex protocols, it is possible to gain insights into how someone performs a specific movement—and whether it aligns with expectations. These deep learning techniques are often applied to pre-recorded footage.

A new development is the implementation of such calculations at the chip level (embedded intelligence). This enables real-time processing, allowing for immediate monitoring in healthcare settings, improving patient care through instant feedback and assessment.

If health is a human right, and human rights are "the rights of individuals simply because they are part of the human species," then all people, regardless of where they live, should have access to the same collective efforts that protect or improve their health. At REVAL, we believe that translating research into practice is a key milestone in our civic mission. According to the WHO, one of the main barriers in the rehabilitation process is the lack of access to specialized facilities or healthcare professionals. Therefore, we have sought to implement new and affordable solutions to expand access to rehabilitation programs.
The use of mobile technologies and electronic health (eHealth) can provide an alternative solution for rehabilitation or complement existing programs. We are already actively involved in several low- and middle-income countries (LMICs), including, but not limited to, Benin, Burundi, Ethiopia, and Nepal.