Cognitive-motor Exergaming for Reducing Fall Risk in People With Chronic Stroke
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - 90 |
| Updated: | 12/2/2018 |
| Start Date: | December 4, 2014 |
| End Date: | October 25, 2016 |
Cognitive-motor Exergaming for Reducing Fall Risk in People With Chronic Stroke: a Randomized Controlled Trial
Post-stroke, people suffer various sensorimotor and cognitive deficits that lead to impaired
balance control and gait functions thereby increasing the risk of falls. Despite undergoing
exercise training in stroke rehabilitation to enhance balance control and gait functions, the
risk of falls in the community-dwelling chronic stroke population persists. Given that motor
and cognitive functions are required as a part of daily living, performing activities at home
and in the community become challenging. Additionally, performance of daily living activities
involves the simultaneous performance of motor and cognitive tasks known as dual-tasking.
Based on previous literature, dual-tasking leads to deteriorated motor and/or cognitive task
performance known as cognitive-motor interference. The pattern of cognitive-motor
interference varies with the complexity and type of motor or cognitive task being performed.
Dual-task gait and balance training has been adopted by many and identified to be a
beneficial method to enhance overall functions. These studies have used Virtual-reality
interface that provides immediate biofeedback, and may implicitly address certain domains of
cognition (visuospatial awareness, attention) associated with risk of falls. However, such
training is unable to train explicit cognitive domains such as executive functions that are
highly associated with balance control, gait functions, daily living activities, and fall
risk. Therefore, this pilot study aimed to identify the efficacy of cognitive-motor training
using Wii-fit Nintendo to reduce cognitive-motor interference during dual-tasking.
balance control and gait functions thereby increasing the risk of falls. Despite undergoing
exercise training in stroke rehabilitation to enhance balance control and gait functions, the
risk of falls in the community-dwelling chronic stroke population persists. Given that motor
and cognitive functions are required as a part of daily living, performing activities at home
and in the community become challenging. Additionally, performance of daily living activities
involves the simultaneous performance of motor and cognitive tasks known as dual-tasking.
Based on previous literature, dual-tasking leads to deteriorated motor and/or cognitive task
performance known as cognitive-motor interference. The pattern of cognitive-motor
interference varies with the complexity and type of motor or cognitive task being performed.
Dual-task gait and balance training has been adopted by many and identified to be a
beneficial method to enhance overall functions. These studies have used Virtual-reality
interface that provides immediate biofeedback, and may implicitly address certain domains of
cognition (visuospatial awareness, attention) associated with risk of falls. However, such
training is unable to train explicit cognitive domains such as executive functions that are
highly associated with balance control, gait functions, daily living activities, and fall
risk. Therefore, this pilot study aimed to identify the efficacy of cognitive-motor training
using Wii-fit Nintendo to reduce cognitive-motor interference during dual-tasking.
While conventional balance training facilitates balance control and gait functions, the
exercises involved in the training are labor intensive, highly repetitious leading to
monotonicity and decreased motivation levels. Therefore, many health care researchers are
involved in identifying various methods to reduce the risk of falls addressing the barriers
in conventional training method while having the potential to translate it at home. A pilot
study identified that a supplementary cognitive training along with Wii-fit balance training
resulted in improving dual-task volitional balance control. Based on this preliminary
finding, this current pilot study aimed to identify the efficacy of cognitive-motor
exergaming (with Wii-fit) on domains of balance control and cognition among people with
chronic stroke to reduce the cognitive-motor interference during dual-tasking. This pilot
study used Wii-fit Nintendo, an off the shelf, commercially available and a cost-effective
device that provides similar benefits of Virtual-reality training. Community-dwelling people
with chronic stroke involved in the study underwent 6 weeks of cognitive-motor exergaming or
conventional balance training in a tapering manner in a laboratory setting. Participants were
assessed for motor and cognitive performance in the laboratory during volitional and reactive
balance control while performing a secondary cognitive task. The performance outcome
determined the effect on cognitive-motor interference during dual-tasking.
exercises involved in the training are labor intensive, highly repetitious leading to
monotonicity and decreased motivation levels. Therefore, many health care researchers are
involved in identifying various methods to reduce the risk of falls addressing the barriers
in conventional training method while having the potential to translate it at home. A pilot
study identified that a supplementary cognitive training along with Wii-fit balance training
resulted in improving dual-task volitional balance control. Based on this preliminary
finding, this current pilot study aimed to identify the efficacy of cognitive-motor
exergaming (with Wii-fit) on domains of balance control and cognition among people with
chronic stroke to reduce the cognitive-motor interference during dual-tasking. This pilot
study used Wii-fit Nintendo, an off the shelf, commercially available and a cost-effective
device that provides similar benefits of Virtual-reality training. Community-dwelling people
with chronic stroke involved in the study underwent 6 weeks of cognitive-motor exergaming or
conventional balance training in a tapering manner in a laboratory setting. Participants were
assessed for motor and cognitive performance in the laboratory during volitional and reactive
balance control while performing a secondary cognitive task. The performance outcome
determined the effect on cognitive-motor interference during dual-tasking.
Inclusion Criteria:
- Presence of Chronic stroke (onset of stroke more than six months) confirmed by a
physician
- Ability to stand independently for 5 minutes without an assistive device or any
physical assistance
- Ability to understand English
Exclusion Criteria:
- A Score of less than 25 on Mini-mental state examination
- Heel bone density with T-score less than <-2.0
- Self-reported metal implants due to any orthopedic conditions
- Presence of any other neurological impairments such as Parkinsons disease, Alzheimers
disease, vestibular dysfunction, peripheral neuropathy or unstable epilepsy
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