RESPIVR
The management of patients with spinal cord injury who require continuous mechanical ventilation is a complex and, fortunately, uncommon situation. In these cases, patient safety and continuity of care depend on highly specialized skills that are difficult to acquire through traditional training programs and even more difficult to maintain over time. The low frequency of actual cases, combined with the complexity of the procedures, increases the risk of inefficiencies and errors, with potential repercussions on the quality of care and clinical outcomes.
To address this need, the Spinal Unit in Pietra Ligure, in collaboration with DIBRIS and the JETS laboratory at the Advanced Simulation Center (SIMAV) of the University of Genoa, has developed RespiVR, a virtual reality simulator designed for the training and assessment of healthcare professionals, students, and caregivers.
The simulator recreates a highly realistic hospital environment where the user can interact with avatars, control panels, and monitoring systems. To date, RespiVR offers four main clinical scenarios that allow users to practice ventilation procedures and critical care management in complete safety.
Why Virtual Reality Offers Added Value
Traditional learning allows students to acquire theoretical knowledge and observe real-world procedures. However, opportunities for hands-on experience are limited, and when the time comes to act on their own, their level of confidence may be insufficient. Virtual reality bridges this gap with significant advantages:
- Unlimited and safe practice
- Simulation of critical scenarios: it is possible to train in managing emotionally intense emergency situations where speed and precision are critical.
- Reduced stress for the therapist in emergencies
Virtual reality is a powerful and innovative training tool capable of bridging the gap between theory and practice, offering a safe yet realistic environment in which to learn, experiment, and grow. In this sense, virtual reality is not merely an innovative tool: it is an essential resource for ensuring the quality and continuity of care in highly complex settings such as those involving spinal cord injury requiring mechanical ventilation.
PREVENTION OF DIVING ACCIDENTS
SCIL is part of a working group dedicated to developing guidelines for the prevention of diving accidents and for the management of emergency care for injured individuals. This mandate was assigned within the framework of the National Observatory for the Development of a Strategy to Prevent Drowning and Accidents in Bathing Waters, established by the Ministry of Health.
The international sources consulted confirm that spinal cord injuries resulting from diving in aquatic environments represent a persistent public health problem. Such incidents are rare but highly disabling and often result in permanent tetraplegia. The demographic profile of the at-risk population is characterized by a clear prevalence of young males, typically under 30 years of age, with a correlation to reckless behavior and the consumption of alcohol and/or drugs. These accidents commonly occur due to a poorly executed dive in shallow water and/or in the presence of submerged objects, in a summer recreational context, especially in unmonitored environments. The psychosocial dynamics of dangerous diving are a critical factor: the act is often interpreted as a rite of passage or a test of courage, fueled by the pursuit of thrills and social approval.
In Italy, data on diving-related accidents are extremely scarce and inconsistent. It is therefore essential to establish an official and recognized national registry with the aim of collecting data and recording incidents prospectively.
To combat the incidence of these injuries, a national prevention program based on education, awareness, regulation, and surveillance is necessary. Our proposals focus on multimodal communication, tailored by target audience and channel.
1. Revision of Signage
To enhance the deterrent effect, the following strategies are proposed:
- • Quantitative increase and placement
- • Improvement in quality and salience (including an explicit warning about the most serious consequences)
- • Countering habituation (periodic rotation of signs and alternating different communication styles)
- • Emotional and Direct Signs
Here is our proposed sign:
2. Education
- • Awareness-raising initiatives in schools.
- • During swimming lessons, students should be taught not only diving techniques but also the potential risks and consequences associated with diving.
- • A section dedicated to parents/guardians.
3. Media-Based Campaigns
Social media is the most effective channel for reaching the primary target audience.
- I. Targeted digital campaigns on platforms such as TikTok and Instagram, using targeted ad formats to reach specific age groups.
- II. Viral and Narrative Content: micro-videos, short narrative formats, and safe viral challenges (#SafeDiveChallenge) to transform risky behavior into conscious and safe behavior.
- III. Impactful Testimonials: The effectiveness of educational interventions is enhanced by including survivors who share their stories. The use of a 3-minute short film showing the transition from the excitement of the challenge to the nightmare of spinal cord injury is an idea with strong emotional impact and can be featured on TV, radio, and in schools.
- IV. Risk and Alcohol Education: Campaigns must help people understand the risks associated with alcohol and drug abuse, which impair perception and judgment regarding distance, height, depth, and risk.
DRONE PROJECT – Drone Pilot Training Course for People with Spinal Cord Injuries
The Spinal Unit, in collaboration with Prof. G. Vercelli of the DIBRIS at the University of Genoa and the Stella Alpina Association, has launched a project dedicated to drone pilot training for people with spinal cord injuries. The project involves organizing a free course that will combine theoretical instruction and practical training, with the goal of preparing participants to obtain a two-level drone pilot certification.
The project has three objectives: rehabilitation, social integration, and education, offering technical skills that can potentially be applied in professional settings as well.
During the theoretical lessons, participants will be provided with the knowledge necessary to take the A1 and A3 certification exams.
A central element of the project will be the use of a drone flight simulator, installed at SCIL, which will allow participants to practice in a safe and controlled environment to become familiar with the control consoles.
Finally, a practical piloting phase with real drones is planned, which will allow participants to complete the training program through hands-on field experience, with the goal of making them autonomous and confident in the use of drones.
During the activities, the Spinal Unit professionals will focus on assessing any postural or motor difficulties related to the use of the flight controls. Based on individual needs, specific strategies and adaptations will be identified and implemented to mitigate challenges and facilitate the activity, ensuring maximum accessibility and effectiveness of the training program.
At the same time, the simulator can also serve as a tool to introduce the activity to acute inpatients, allowing them to safely experience piloting and learn about the project, opening the possibility of participating in the course during later stages of their rehabilitation.
In addition, a flight simulator featuring actual flight controls of an ultralight aircraft—kindly designed and developed by engineer Cristiano Trabuio—will be installed at the SCIL.
VR FENCING
The project, in collaboration with Prof. M. Casadio and Eng. D. Canepa of DIBRIS, proposes the use of adapted fencing in virtual reality as an innovative tool for the rehabilitation of people with spinal cord injuries. The approach is integrated and takes into account not only motor recovery but also the patient’s psychological and emotional well-being. Wheelchair fencing is chosen for its physical benefits (strength, coordination, balance) and social benefits (inclusion, motivation, participation).
The VR platform is designed to be immersive, interactive, and multisensory, with real-time feedback systems and monitoring tools such as EMG, IMU, and range-of-motion analysis. It includes single-player and multiplayer modes to increase engagement and foster social interaction.
The project emphasizes the importance of involving fencing instructors, who are essential for ensuring technical accuracy, exercise customization, protocol validation, and motivational support.
A gradual transition path from VR to real-world practice is planned, structured in phases ranging from virtual familiarization to integration into Paralympic sports teams.
Finally, the value of multidisciplinary collaboration among fencing coaches, physiatrists, and physical therapists is highlighted; this collaboration allows for the integration of clinical and athletic goals, improving the effectiveness of rehabilitation and promoting an innovative, personalized, and replicable model.
SOCIAL ROBOT IN THE HOMES OF PEOPLE WITH SPINAL CORD INJURIES
The project is carried out in collaboration with Prof. A. Sgorbissa and Dr. L. Grassi of the RICE lab (Robots and Intelligent systems for Citizens and the Environment), and Eng. D. Canepa of NeuroLab, both within DIBRIS. It addresses the human and emotional burden of caring for people with spinal cord injuries, which often places significant strain on caregivers, exposing them to chronic stress, burnout, and a deterioration in the caregiving relationship.
In this context, the caregiving relationship, especially in cases of severe disability, can become fragile and difficult to sustain over time, making additional support necessary.
At the core of the project is CAIR (Culture-aware AI and Robotics), a cloud-based system developed by RICE that enables autonomous, adaptive interaction between the robot and the person, tailoring communication to individual needs. Within this framework, the NAO social robot is introduced directly into people’s homes, embedding the system in their everyday living environment. This choice is central: interaction does not take place in a laboratory or clinical setting, but at home, within real-life routines, personal rhythms, and authentic family dynamics.
Through its connection to CAIR, NAO becomes a daily presence capable of engaging the person in dialogue, offering companionship, stimulating cognitive abilities, and helping to structure moments of the day.
Home-based deployment also helps overcome the novelty effect typical of controlled trials, allowing for a more natural, continuous, and meaningful use of the robot over time.
The robot does not replace the caregiver but rather integrates as a third element in the caregiving relationship, offering a constant, predictable presence free from emotional strain. In this way, it helps reduce the relational pressure on the caregiver and improve the well-being of the person receiving care.
From an ethical standpoint, the project maintains the centrality of the human relationship, using technology as a means of making it more sustainable and of higher quality.
More broadly, CAIR is not limited to this specific application, but can also support autonomous and adaptive interaction in other contexts and through other robotic platforms. In this project, the innovation lies in enabling socially assistive robotics to enter the home environment in a concrete, continuous, and integrated way.
ART AND VIRTUAL REALITY
To mark the anniversary of the Spinal Unit, scheduled for late May 2026, Dr. Massone has chosen to dedicate the day to the theme “Art, Body, and Disability,” with the aim of exploring the value of art in its many dimensions: as a therapeutic tool, as a form of bodily expression, and as a means through which disability is represented and reinterpreted.
In this context, particular emphasis will be placed on art therapy: among the event’s speakers are two professionals who will share their direct experience in this field, offering concrete insights into how art can be integrated into treatment and rehabilitation programs. This contribution is fully aligned with the direction the Spinal Unit intends to pursue, namely the implementation of innovative therapeutic approaches that enhance the expressive and creative dimensions of the individual.
With this in mind, a pilot program has been launched featuring artistic applications accessible via VR headsets, which have been made available to patients. Among these are Open Brush, which allows users to create three-dimensional works in immersive environments, and Vermillion, a realistic simulation of oil painting that enables users to paint on canvas using virtual palettes and brushes, faithfully reproducing the traditional artistic experience.
The use of virtual reality thus represents a concrete opportunity to expand the possibilities of art therapy, making it accessible even to patients with motor limitations and offering new tools to personalize rehabilitation pathways. Based on these premises, a pilot study was launched involving patients and healthcare professionals, who tested the applications, highlighting their potential in terms of engagement, motivation, and personal expression.
OUTREACH FOR SCHOOLS
Our outreach activities in the local community continue. Specifically, two local high schools visited SCIL, where we presented the experience we have gained in recent years, fostering an opportunity for discussion and raising awareness about rehabilitation, inclusion, and innovation in the healthcare sector.
A driving simulator for training people with Spinal Cord Injury to re-learn driving while in hospital.
Adapted driving simulators offer Spinal Cord Injury (SCI) survivors a mean to re-learn driving in a safe and controlled environment. Commercial, high-end driving simulators cost runs in the one hundred-thousand-dollar range, require large amounts of space and are hence not useful in a clinical environment. Furthermore, most of the systems are not directly accessible to wheelchairs and many lack of immersivity, thus not providing a fully realistic driving experience. The Spinal Cord Italian Lab aims to develop an accessible, highly realistic driving simulator that will:
- Allow patients to freely practice driving during their hospital stay;
- Offer an immersive virtual reality environment;
- Allow to investigate how patients recover their ability to drive;
- Allow developing a quantitative assessment of individual driving skills;
- Allow to verify the effects of different medications that can impact driving abilities;
A powered wheelchair controlled by upper body motions to enable cervical Spinal Cord Injury patients to move freely and independently.
High-level spinal cord injuries (SCIs), specifically injuries to the cervical spinal cord, result in sever motor loss. Despite this, many individuals retain some movement ability, allowing for control of assistive devices such as power wheelchairs. The majority of power wheelchair users rely on a hand-controlled joystick as the method to control the movement of the power wheelchair. However, many individuals with cervical spinal cord injuries may have limited arm and hand control or coordination. This can result in either a decreased ability to control the power wheelchair or the need to use alternative controllers. The goal of the Spinal Cord Italian Lab is to develop a body-machine interface (BMI) capable of providing a highly customizable control by transforming the patient residual upper body movements into signals to control both the speed and direction of a powered wheelchair.
A sensorized system capable of measuring the pressure and the tangential shear forces at the level of the body-wheelchair interface to relieve pressure and decrease the potential of skin breakdown.
Pressure ulcers (PU) significantly affect the quality of life of wheelchair users with SCI and are among the most frequent causes of re-hospitalization of people with SCI. PUs result from localized injury to the skin and underlying tissue and usually occurs over a bony prominence as a result of pressure in combination with shear forces. Both pressure magnitude and duration are thought to be key risk factors in the occurrence of ulcers, thus exposing wheelchair-bound subjects to high risk of PU development. At present, a solution commercially provided are “pressure-release wheelchairs”, which provide the user with the possibility to tilt the chair in order to redistribute the pressure. However, the decision of when and how long to tilt the chair is completely left to the user, who doesn’t always have the knowledge needed to take such decision. Current available pressure-release wheelchairs are not equipped with the technology to inform the user on its condition. This laboratory aims to design and develop a sitting sensorized system capable of measuring the pressure and the tangential shear forces at the level of the body-wheelchair interface to automatically alarm the user when the wheelchair seat needs to be tilted.
