PRIMA PIETRA: Research, Integration, Enhancement, Assistance and Education Program for Autism Services and Rehabilitation Technologies

Background: It is commonly recognized that autism spectrum disorder (ASD) symptoms are as early as 12 months of age and that the best outcomes are often achieved through early diagnosis and early intervention. However, there are many challenges to delivering health care to parents with a child with ASD. Difficulties to service delivery and utilization are more intensified for families living in suburban or remote areas, often resulting in limited access to preventative mental health services in general and parenting ASD interventions in particular. As Vismara an Rogers suggested (Vismara, 2010), the use of technology could support long-distance clinical health care. PRIMA PIETRA Italian project is focused on early diagnosis and intervention providing Early Start Denver Model (Dawson et al., 2009) using tele-rehabilitation. PRIMA PIETRA is a collaborative project supported by the Minister of Health of the Sicilian Region, in collaboration with Basilicata and Tuscany Regions.

Objectives: - The main aims were: (a) to set up a screening methodology that allows an early recognition of ASD; (b) to provide a technological platform for continuous monitoring of the treatment protocol; (c) to improve the quality of life of children with ASD and of their family through a continuous support of  patients at their home.

Methods: 30 patients at their first diagnosis of autism will be enrolled in the project and randomly selected half of them treated with the support of technology. The tele-rehabilitation system will be developed so that a remote intervention under the supervision of the parents will be applied. The parents will administer the ESDM through a PC tablet provided with a decision support system and a user-friendly interface. The web-cam of the tablet will be used for the communication between parents and a remote operator. The observation room at the child’s home will be provided with a remote wireless web-cam for the audio/video registration of the therapeutic sessions. A wearable multisensory platform will be used for the acquisition of behavioural and physiological signals of the child during the treatment. Data will be collected in a web-service able to store them in a remote database and presented to the remote operator by a dedicated interface.

Results: The preliminary result of the study is the activation of a web platform for autism remote treatment (https://primapietra.ifc.cnr.it/) where therapysts have the opportunity to insert results of the on going assessment of children in an on line shared database. Wearable technologies have been already developed and tested with autistic children. They allow to acquire in a non-invasive way physiological and behavioral parameters useful to infer the emotive state of the child and objectivize the evaluation of the effect of the therapy.

Conclusions: The development of a web platform for the collection of data during the treatments sessions will allow a more accurate individualization of treatment. Moreover the use of tele-rehabilitation system could increase the effect of the therapy involving parents in the administration of a continuous intervention and so that parents, as results of Vismara pointed out, will implement the ESDM more skillfully.