Cognitive-Motor Gaming for Reducing Fall Risk among Chronic Stroke Survivors: A Randomized Control

Background: The purpose of our study was to determine the efficacy of a cognitive-motor training (CMT) paradigm (Wii-fit Nintendo played in conjunction with a cognitive task) on different domains of balance control (volitional and reactive) and cognition (executive function and attention) to reduce falls among community-dwelling individuals with chronic stroke. Methods: Hemiparetic ambulatory individuals with chronic stroke were randomly assigned to either CMT (n=12) or conventional training (CT) (n=12) group. They underwent 6 weeks of high intensity tapering balance training where CMT group performed 6 Wii-fit games in conjunction with 6 cognitive tasks in a randomized order, while CT group received customized progressive balance training exercises. The efficacy of CMT versus CT was determined by performance on limits of stability test (LOS-volitional), the slip-perturbation test (SPT-reactive) and letter number task (LNS- cognition) in single task and dual task conditions. Secondary measues such as clinical balance scales level pre- to post-intervention were also assessed. Results: Post-intervention improvement in the volitional balance and reactive balance test was observed in both CMT and CT groups. However, only CMT group showed improvement under dual task conditions in the volitional balance test. Conclusion: Cognitive-motor training appears to be an effective method to improve domains of balance control and cognition associated with falls-risk among individuals with chronic stroke. Such paradigm may be implemented in clinical settings for stroke rehabilitation.