Alternative Therapies for Improving Motor Impairment, Fall-risk and Overall Physical Function
Condition: Chronic Stroke; Healthy Aging
Study type: Interventional

Summary: 
      Neurological impairment such as stroke and aging is a leading cause of adult disability.
      Traditional rehabilitative therapies can help regain motor function and ameliorate
      disability. There are increasing community and other facilities offering rehabilitation in
      the form of conventional, recreational and alternative (Yoga, Tai-chi) therapy. However, the
      implementation of these conventional therapy techniques in individuals with a neurological
      disorder like stroke and the elderly population is tedious, resource-intensive, and costly,
      often requiring transportation of patients to specialized facilities. Based on recent
      evidence suggesting significant benefits of repetitive, task-orientated training,
      investigators propose to evaluate the feasibility of an alternative therapies such as
      exergaming based therapy to improve overall physical function of community-dwelling
      individuals with neurological impairments and the elderly, compared to conventional
      therapeutic rehabilitation. This pilot study aims to systematically obtain pilot data on
      compliance and efficacy as well as performing power analysis and sample size calculation for
      developing it into a randomized controlled trial for extramural funding purposes. The
      objective of the study is to determine the safety, feasibility, compliance and efficacy of
      exergaming therapy to improve overall physical function of community-dwelling chronic stroke
      individuals and the elderly population.
    

Detailed description: 
      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 methods while having the potential to translate it at home. A pilot
      study identified that supplementary cognitive training along with Wii-fit balance training
      resulted in improving dual-task volitional balance control post-stroke. Based on this
      preliminary finding, this current pilot study aimed to identify:

        1. The efficacy of cognitive-motor exergaming (with Wii-fit) compared to conventional
           balance training among people with chronic stroke

        2. Exergaming (with Kinect) on domains of balance control and cognition among people with
           chronic stroke

        3. The efficacy of Exergaming (with Kinect) compared to conventional balance training
           method on domains of balance control and cognition among healthy older adults

      This pilot study used Wii-fit Nintendo/ Microsoft Kinect, an off the shelf, commercially
      available and a cost-effective device that provides similar benefits of exergaming.
      Community-dwelling people with chronic stroke and healthy older adults involved in the study
      underwent 6 weeks of 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.
    

Intervention name(s): Cognitive-motor exergaming; Conventional balance Training; Dance Therapy for Stroke; Dance Therapy for Older adults; Home education for Older adults
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): Participants undergo 6 weeks of cognitive-motor exergaming using Wii-fit Nintendo. The 6 weeks included a total of 20 session distributed in the following manner: 5 sessions/week for 1-2 week, 3 session/week for 3-4 week, 2 sessions/week for 5-6 week. Each session lasted for about 90 minutes with rests included.; Participants undergo 6 weeks of conventional exercise training. The 6 weeks included a total of 20 session distributed in the following manner: 5 sessions/week for 1-2 week, 3 session/week for 3-4 week, 2 sessions/week for 5-6 week. Each session lasted for about 90 minutes with rests included.; Participants will receive therapy using the "Just Dance" using the commercially available Kinect gaming system (Microsoft Inc, Redmond, WA, USA. Each song involves repetitive action for each dance step (at least 20 repetitions over the entire song) and visual cues on the screen (a stick figure at the bottom right) indicating the upcoming dance step. Participant's playing the game to reduce risk of exercise related adverse effects. Participants will dance on 10 songs starting from a slow-pace progressing to a medium pace (each max 5 minutes long). Participants will receive 5 minutes rest after playing on each song. This will be conducted by two physical therapists.; Participants will receive therapy using the "Just Dance" using the commercially available Kinect gaming system (Microsoft Inc, Redmond, WA, USA. Each song involves repetitive action for each dance step (at least 20 repetitions over the entire song) and visual cues on the screen (a stick figure at the bottom right) indicating the upcoming dance step. Participant's playing the game to reduce risk of exercise related adverse effects. Participants will dance on 10 songs starting from a slow-pace progressing to a medium pace (each max 5 minutes long). Participants will receive 5 minutes rest after playing on each song. This will be conducted by two therapists.; Participants will receive a one-hour education on conventional physical exercises.
Other intervention name(s): Dual-task training; Wii-fit exergaming; Virtual-reality training; Balance training; Exergaming-based dance; Exergaming-based dance; Fall prevention
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: Dual-task training; Cognitive-motor training; Conventional training; Virtual-reality exergaming; Dance Therapy