Citation: Bonanno, M.; De Luca, R.; De Nunzio, A.M.; Quartarone, A.; Calabrò, R.S. Innovative Technologies in the Neurorehabilitation of Traumatic Brain Injury: A Systematic Review. Brain Sci. 2022, 12, 1678. https://doi.org/10.3390/ brainsci12121678 Academic Editor: Paola Marangolo Received: 27 October 2022 Accepted: 6 December 2022 Published: 7 December 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). brain sciences Systematic Review Innovative Technologies in the Neurorehabilitation of Traumatic Brain Injury: A Systematic Review Mirjam Bonanno 1 , Rosaria De Luca 1, *, Alessandro Marco De Nunzio 2 , Angelo Quartarone 1 and Rocco Salvatore Calabrò 1,2 1 IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Palermo, SS 113, C. da Casazza, 98124 Messina, Italy 2 Department of Research and Development, LUNEX International University of Health, Exercise and Sports, Avenue du Parc des Sports, 50, 4671 Differdange, Luxembourg * Correspondence: rosaria.deluca@irccsme.it Abstract: Motor and cognitive rehabilitation in individuals with traumatic brain injury (TBI) is a growing field of clinical and research interest. In fact, novel rehabilitative approaches allow a very early verticalization and gait training through robotic devices and other innovative tools boosting neuroplasticity, thanks to the high-intensity, repetitive and task-oriented training. In the same way, cognitive rehabilitation is also evolving towards advanced interventions using virtual reality (VR), computer-based approaches, telerehabilitation and neuromodulation devices. This review aimed to systematically investigate the existing evidence concerning the role of innovative technologies in the motor and cognitive neurorehabilitation of TBI patients. We searched and reviewed the studies published in the Cochrane Library, PEDro, PubMed and Scopus between January 2012 and September 2022. After an accurate screening, only 29 papers were included in this review. This systematic review has demonstrated the beneficial role of innovative technologies when applied to cognitive rehabilitation in patients with TBI, while evidence of their effect on motor rehabilitation in this patient population is poor and still controversial. Keywords: robotic device; virtual reality; innovations in neurorehabilitation; traumatic brain injury 1. Introduction Traumatic Brain Injury (TBI) is non-progressive damage to the brain followed by a violent and rapid external force applied to the skull. TBI affects around 64–74 million persons each year worldwide and causes a variety of physical, motor, speech, and cognitive deficits that can have a long-term detrimental impact [1,2]. In fact, beyond motor impair- ment, attention, memory, affectivity, behaviour and executive dysfunctions may occur after the brain damage involving the frontal and temporal lobes, especially in the basal areas [3]. Diffuse axonal injury is often the cause of the worst functional outcomes [2]. In this context, both motor and cognitive neurorehabilitation for TBI patients is fundamental to its beneficial and effective role in improving patient outcomes and quality of life [4]. Physiotherapy treatments are focused on recovering and/or improving balance and gait ability, activating the locomotor centres of the central nervous system (CNS) and, at the same time, strengthening the postural control needed for deambulation [5]. However, conventional rehabilitation techniques have some limits that may undermine the outcomes, including the absence of a standardised training environment, adaptable supports to more functionally train the patients as well as the ability to increase therapy intensity and dose with a reduced physical burden for the therapists [6]. Indeed, for example, physiotherapists have difficulties in ensuring spatial and temporal symmetry between the steps for severely affected patients, making the repeatability of the exercises imprecise [7]. New approaches for verticalization and gait training have been employed to overcome these problems, which are based on high-intensity training with a high number of task-oriented repetitions. Brain Sci. 2022, 12, 1678. https://doi.org/10.3390/brainsci12121678 https://www.mdpi.com/journal/brainsci