The need for faster and more accessible alternatives to laboratory microscopy is driving many innovations throughout the image and data acquisition chain in the biomedical field. Benchtop microscopes are bulky, lack communications capabilities, and require trained personnel for analysis. New technologies, such as compact 3D-printed devices integrated with the Internet of Things (IoT) for data sharing and cloud computing, as well as automated image processing using deep learning algorithms, can address these limitations and enhance the conventional imaging workflow. This review reports on recent advancements in microscope miniaturization, with a focus on emerging technologies such as photoacoustic microscopy and more established approaches like smartphone-based microscopy. The potential applications of IoT in microscopy are examined in detail. Furthermore, this review discusses the evolution of image processing in microscopy, transitioning from traditional to deep learning methods that facilitate image enhancement and data interpretation. Despite numerous advancements in the field, there is a noticeable lack of studies that holistically address the entire microscopy acquisition chain. This review aims to highlight the potential of IoT and artificial intelligence (AI) in combination with portable microscopy, emphasizing the importance of a comprehensive approach to the microscopy acquisition chain, from portability to image analysis.

Background: People with intellectual and developmental disabilities (IDDs) face difficulties in being included in activities with their peers due to differences in cognitive abilities and social skills. Video games offer a promising medium to support inclusion, physical activity, and social engagement, but current solutions struggle to provide equitable experiences to heterogeneous groups of users, especially in multiplayer real-time contexts. Objective: This study aims to co-design and develop an inclusive collaborative real-time multiplayer exergame, assessing its usability, the impact of accessibility features, and players’ satisfaction and enjoyment. Methods: The exergame Elemental was co-designed following the CeHRes (Centre for eHealth and Wellbeing Research) Roadmap, involving clinicians, educators, engineers, and individuals with IDDs. A total of 2 cooperative minigames were developed: Igloo (focused on stimulus collection) and Volcano (focused on enhancing collaboration), playable with 4 different input devices (buttons, tablet, hand-tracking, and full-body tracking). Customizable facilitation options were implemented to adapt gameplay to sensory, cognitive, and motor needs. Young adults with IDDs participated in a 2-phase study testing whether personalized accommodations could eliminate performance disparities: (1) Igloo in homogeneous groups, based on functioning and expected behavior and interaction with stimuli, without facilitations, using all devices to identify optimal input methods, and (2) Volcano in heterogeneous groups using their best-performing devices with individualized facilitations tailored by educators. Data collected included in-game performance (accuracy, reaction time, and collaboration contributions), behavioral observations, and questionnaires on satisfaction and usability from players. Nonparametric analyses were used to assess relationships between disability severity, performance, and the impact of facilitations. Results: A total of 11 individuals (2 male and 9 female; mean age 25.1, SD 4.4 years) with different IDD diagnoses were recruited from an association supporting individuals with cognitive impairments. In the Igloo sessions, performance was negatively correlated with intellectual disability severity (ρ=–0.87, 95% CI –1.00 to –0.56; P<.001) and reaction time was positively correlated (ρ=0.69, 95% CI 0.08-0.94; P=.02). Instead, no significant correlation between performance and intellectual disability severity was observed in the Volcano sessions (ρ=0.24, 95% CI –0.48 to 0.79; P=.48). These results highlight that tailored support (personalized facilitations and best-suited devices) can foster equitable participation even in heterogeneous groups. Behavioral analysis revealed frequent peer collaboration. Participants reported high usability and satisfaction (median 4/5, IQR 0.5). Conclusions: This study introduces an inherently accessible, co-designed multiplayer exergame. Unlike approaches that adapt games or create separate disability-specific solutions, Elemental was conceived as inclusive from the outset. By demonstrating that personalized features can eliminate performance disparities, this work highlights how inclusive co-design can transform an activity into an inclusive, collaborative, and enjoyable experience for individuals with different abilities and intellectual impairments, supporting the shift from fitting individuals into existing digital spaces to designing environments able to embrace diversity.

BACKGROUND People with intellectual and developmental disabilities (IDD) face difficulties in being included in activities with their peers due to differences in cognitive abilities and social skills required for group interaction. While existing accessibility policies attempt to accommodate their needs, these adaptations may result in experiences that differ from those of neurotypical peers, limiting true inclusion. Videogames offer a promising medium to support inclusion, physical activity, and social engagement, but current solutions struggle to provide equitable experiences to heterogeneous group of users, especially in a multiplayer real-time context. OBJECTIVE This work aims to co-design and develop an inclusive collaborative real-time multiplayer exergame, assessing its usability, the impact of accessibility features, and players’ satisfaction and enjoyment. METHODS The exergame Elemental was co-designed following the CeHRes Roadmap, involving clinicians, educators, engineers, and individuals with IDDs. Two cooperative minigames were developed: Igloo (focused on collecting reaction time data), and Volcano (focused on enhancing collaboration), each playable with four different input devices (buttons, tablet, hand-tracking, and full-body tracking). Customizable facilitation options were implemented to adapt gameplay to sensory, cognitive and motor needs. Young adults with IDDs participated in a two-phase study testing whether personalized accommodations could eliminate performance disparities: 1) Igloo in homogeneous groups without facilitations, using all devices to identify optimal input methods; 2) Volcano in heterogeneous groups using their best-performing devices with individualized facilitations tailored by educators. Data collected included in-game performance (accuracy, reaction time, collaboration contributions), behavioral observations, and questionnaires on usability and enjoyment from both players and operators. Non-parametric analyses were used to assess relationships between disability severity, performance, and the impact of facilitations. RESULTS 11 individuals aged 19-36 with different IDD diagnosis were included in the testing. In the Igloo sessions performance was correlated with their intellectual disability severity (r = –0.87, P < .001), while in the Volcano sessions no correlation was retrieved (P = .45). These results highlight that tailored support (personalized facilitations and best-suited devices) can foster equitable participation even in heterogeneous groups. Behavioral analysis revealed frequent peer collaboration, and both participants and operators reported high usability, satisfaction, and enjoyment. CONCLUSIONS This study demonstrates the effectiveness of inclusive co-design and personalized features to transform an activity into an inclusive and collaborative experience that is enjoyable by individuals with different abilities and intellectual impairments. This work proves the importance of shifting the focus from fitting individuals into existing digital spaces, to designing digital spaces able to embrace diversity.