**5. Conclusions**

*Assistive and Rehabilitation Engineering*

Buzzi et al. [73] propose a Web platform to offer accessible games to individuals with cognitive disabilities, such as people with Down Syndrome (DS). Some WCAG 2.0 guidelines are applied manually, but no tools are applied in accessibility evaluation. The results of this study highlight the importance of motivation and flexibility to personalize the content according to the limitations of each user. Based on this experience, some basic guidelines for refining protocols for accessibility testing with people with DS have been proposed to maximize engagement, increase

Richard Siegert et al. [75] indicate that little is known about Internet use among people with disabilities. This study explores how people with neurological conditions, such as multiple sclerosis, traumatic brain injury, or stroke use the new technologies. Some WCAG standards were applied in the research. The authors are not concerned with evaluating the accessibility per se. but the potential benefits of

Also, Bargagna et al. [76] describe a set of computerized exercises designed for cognitive training of adults with Down Syndrome. The objective of the study is to develop a tele-rehabilitation platform by following WCAG 2.0 guidelines for Web application. For future studies, the researchers propose to develop more training games to investigate the long-term effects of software use and assess its relevance in preserving cognitive capacity and individual autonomy in everyday activities.

usability, and gather feedback to improve the accessibility of game design. López et al. [74] argue that video games are not played just for fun, but are a useful tool for children's cognitive, emotional and social development. The article contributes to reducing accessibility barriers. The development game, called "Gaming NOMON" or (GNomon) is based on a guide of accessibility for videogames. It application has been evaluated for children with severe motor disabilities, so the study can serve as lessons learned for future research and design of accessible video games.

*PRISMA 2009 flow diagram chart showing the selection process.*

Internet for health and the well-being of people with disabilities.

**42**

**Figure 2.**

The main result of the usability review for tele-rehabilitation systems shows that the user experience predominates over the heuristic studies, and the most used questionnaire to assess user experience is the SUS. Even though it would be relevant to carry out user experiences with real patients and in real conditions, there are still few usability questionnaires proposed in tele-rehabilitation. Likewise, studies do not measure the performance of the patients in terms of completion time of the tasks and percentage of errors during the rehabilitation exercises.

Regarding the question of Web accessibility in tele-rehabilitation platforms, the review shows that this topic is still marginally studied. Many applications do not care about developing accessible and inclusive platforms. Some studies refer to Section 508 and WCAG 1.0 and 2.0 guidelines, but they are not applied in their entirety in addition, no work applies the WCAG 2.1, which is the most recent Web accessibility guideline. It is also to mention the fact that the analyzed studies lack the application of combined methods to ensure an adequate level of Web accessibility. Thus, our review suggests that the development of future e-Health applications should apply the guidelines of WCAG 2.1 that will allow access to all types of users regardless of their physical and cognitive abilities. This conclusion is particularly relevant in the case of the development of tele-rehabilitation platforms, which should include both usability and accessibility iterative tests.

*Assistive and Rehabilitation Engineering*
