# What Children with Neuromotor Disabilities Need to Play with Technological Games
## 2 Materials and Methods  
### Survey Design and Distribution  
In order to assess how children with neurological impairments (i.e., cerebral palsy (CP) and acquired brain injuries) interact with technology-based games, a survey was developed by means of REDCap, a web application that allows the management of online questionnaires and databases [41].  
FightTheStroke, a foundation born in 2014 that supports young stroke survivors, children with CP, and their families, recruited families who have children with neurological impairments. The questionnaire was shared in April 2020 via a Facebook closed-group of the FightTheStroke foundation that could reach up to 1000 families who have children with neurological impairments, and parents completed it anonymously to ensure maximum privacy. The survey was administered to parents and not directly to children, since it was decided to include children with severe cognitive impairment. This allowed collecting reliable answers, also considering the impossibility of having direct contact with families and of explaining the questions to the children due to the online mode distribution of the survey forced by the COVID-19 pandemic. When possible, parents were asked to show their child pictures included in the survey in order to collect children's opinions as faithfully as possible.  
The questionnaire was co-designed with families with a child with neuromotor impairments, involved by FightTheStroke, together with expert clinicians, engineers, and designers. Children were not directly involved in the survey design due to the severe cognitive impairment of some of them. However, the involvement of their families allowed designing a questionnaire suitable for them.  
The survey was organized into three sections. The first one regarded child profiling in terms of pathology, type of damage, functional skills, grasping abilities, and role of technology and play in their lives; the functional skills and grasping abilities were evaluated by analyzing how children interact with daily life objects (e.g., pencil, tray, mouse, tennis ball, etc.). The second section collected information on how children play with and without technology (e.g., what does the child use to play? Does he/she play alone or with someone? Are the games competitive or cooperative?), with particular attention to the known/used consoles, the type of preferred videogames, and the feelings experienced during the game. Finally, the third section was dedicated to identifying the most suitable game design considering children with neurological impairments as final users: with the goal of collecting information on preferences, several sketches of possible game environments, characters, and control devices were proposed to the families. In addition, this section investigated how much parents would be willing to pay for inclusive videogames and consoles specifically designed for children with neurological impairments.  
The survey included both open and closed-ended questions (for details, see the Supplementary Materials). Five-point Likert scales were used in the first section of the survey with two purposes:to evaluate the importance of the technologies in children with neurological impairments concerning specific activities (1: strongly disagree, 5: strongly agree);
* to select the difficulty level (1: no difficulties, 5: high difficulties) in doing some daily life activities (e.g., handling a pencil, a table tennis bat, etc.) in order to investigate children's gross-motor functions and their grasping abilities.  
A 5 point Likert scale was also used in the second section of the survey to evaluate children's feelings during playing (both with and without technologies).  
The research was approved by the institutional review board of IRCCS Medea as well as by the institute data protection officer (EU Regulation 2018/1725). Data were collected in a completely anonymous aggregated form with no personal information being collected.