A Cognitive-Balance Control Training Paradigm Using Wii Fit ... : Journal of Neurologic Physical Therapy (original) (raw)

Research Articles

A Cognitive-Balance Control Training Paradigm Using Wii Fit to Reduce Fall Risk in Chronic Stroke Survivors

Subramaniam, Savitha PT, MS; Wan-Ying Hui-Chan, Christina PT, PhD; Bhatt, Tanvi PT, PhD

Department of Physical Therapy, University of Illinois at Chicago.

Correspondence: Tanvi Bhatt, PT, PhD, Department of Physical Therapy, University of Illinois at Chicago, 1919, W Taylor St (M/C 898), Chicago, IL 60612 ([email protected]).

No commercial party having a direct financial interest in the research findings reported here has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jnpt.org).

The authors declare no conflicts of interest.

Abstract

Background and Purpose:

The impaired ability to maintain balance while performing higher-level cognitive tasks (cognitive-motor interference) significantly predisposes stroke survivors to risk of falls. We investigated adherence and intervention-related effects of gaming to improve balance control and decrease cognitive-motor interference in stroke survivors.

Methods:

Community-dwelling individuals with hemiparetic stroke (N = 8) received balance control training using Wii Fit in conjunction with cognitive training for approximately 110 min/d for 5 consecutive days. Changes in balance and cognitive performance were evaluated by the limits of stability test performed under single-task (ST) and dual-task (DT) conditions. The outcome measures from the limits of stability test included reaction time and movement velocity of the center of pressure. The cognitive performance was quantified by the number of errors. The DT cost was computed for the balance and cognitive outcome measures using [(ST − DT)/ST × 100]. Adherence was assessed by change on the Intrinsic Motivation Inventory scores postintervention. No commercial party having a direct financial interest in the research findings reported here has conferred orwill confer.

Results:

Posttraining, reaction time cost in the forward direction improved from 31 ± 8.02 to ±8.7 ± 6.6. Similarly, movement velocity cost improved from 33.7 ± 12.3 to 11 ± 1. Cognitive cost also decreased from 47.9 ± 13.9 to 20 ± 18.8. There were similar improvements in the backward direction for all the outcome measures. Scores on the Intrinsic Motivation Inventory improved from 16.6 ± 1.3 to 23.5 ± 1.5.

Discussion and Conclusions:

The results demonstrate good adherence and evidence of clinical value of this high-intensity, short-duration protocol for reducing cognitive-motor interference and improving balance control in stroke survivors. Future studies should examine the dose-response effects and long-term changes of such DT training paradigm applied to improve fall efficacy.

Video Abstract available. See Video (Supplemental Digital Content 1, https://links.lww.com/JNPT/A80) for more insights from the authors.