Measured and perceived exercise intensity during the performance of single-task, cognitive-motor dual-task and exergame training: a transversal study (Preprint)

UNSTRUCTURED The physical and cognitive loads during exergaming may differ from more conventional cognitive-motor dual-task trainings. The aim of this pilot transversal study was to compare exercise intensity during exergame, cognitive-motor dual-task and single-task training sessions. We recruited healthy young adults who carried out one session of each t type of training: exergaming, cognitive-motor dual-tasking and single-tasking. We used a custom-made exergame as support. The sessions lasted 30 minutes, were spaced at least 24 hours, and took place in random order for each group of 4 participants. We used heart rates to assess exercise intensity, and the modified Borg scale to assess their perception of intensity. Sixteen healthy young participants carried out all sessions. There was no difference between the different types of training in mean heart rates (p = 0.3), peak heart rates (p = 0.5) or Borg scale scores (p = 0.4). Our custom-made exergames measured and perceived physical load did not differ between cognitive-motor dual-task and single-task training. As a result, our exergame can be considered as intense as more traditional physical training. Future studies should be conducted in seniors with or without cognitive impairments and should incorporate an assessment of cognitive performance.

Exergaming for Lower Limb Stroke Rehabilitation: A Game Controller for Lower Limb Stroke Rehabilitation

<p><b>The success of stroke rehabilitation requires the patient engage in early, long-term high repetitions and intensive treatment. When comparing clinical and literature statistics, it is confirmed that clinical rehabilitation is not achieving required repetitions and intensity for effective rehabilitation of basic motor skills as prescribed in physiotherapy literature. It is then the patient’s responsibility to carry out the rehabilitation at home without supervision. These exercises can also be very mundane and repetitive, which reduces the patient’s motivation to exercise. Exergames have been found (Alankus et al., 2010, p. 21130, (King, Hijmans, Sampson, Satherley, & Hale, 2012 Deutsch et al., 2009), (Mortazavi et al., 2014), (Shirzad et al., 2015).to improve patients’ engagement with their therapies at home.</b></p> <p>Currently there are systems to facilitate lower limb stroke rehabilitation,but none includes Strength for Task Training (STT). STT is a novel physiotherapeutic method for lower limb rehabilitation and comprises of two main phases: first being the strength training (priming) and second being the task training. Priming is brief weight lifting to excite the neural pathways (neuroplasticity) in the affected region, which primes the brain for learning; this is then promptly followed by task training to maximise gains in the locomotor ability.</p> <p>This project builds up on the research and development of a game controller by Duncan (2016) for lower limb stroke rehabilitation to facilitate STT. This project is a collaboration with Regan Petrie who designed the media aspect of the exergame system.</p> <p>A game controller was developed and this was part of a complete exergaming system which was designed to specifically facilitate STT. This project compiles more research findings together with feedback from the user and the clinicians to help improve the system. This was to ensure that the design is aligned to the specific requirements of functional STT rehabilitation and contextual needs of the patient.</p> <p>The final output is a pair of prototype shoes which included a sensor to measure movement, a pair of weighted sleeve and a pair of balance sole. The weighted sleeve has removable weights and facilitates the strength part of the training. The shoes are the adaptors which allow the user to the balance soles which is used to constantly challenge the user’s balance. The sensors translate limb movement and are for the user to interact with the game. This system provides a simple and safe method to engage in unsupervised STT.</p> <p>Feedback from clinicians indicates that the shoes can facilitate the strength part of the exercise, the sensors the task part of the training, and the balance sole is useful for challenging and improving balance. User testing sessions offer information about: the usability of the system, including ease of use and intuitive design; the aesthetics of the physical objects and whether the system is engaging patients in their therapies.</p>

Exergaming for Lower Limb Stroke Rehabilitation: A Game Controller for Lower Limb Stroke Rehabilitation

<p><b>The success of stroke rehabilitation requires the patient engage in early, long-term high repetitions and intensive treatment. When comparing clinical and literature statistics, it is confirmed that clinical rehabilitation is not achieving required repetitions and intensity for effective rehabilitation of basic motor skills as prescribed in physiotherapy literature. It is then the patient’s responsibility to carry out the rehabilitation at home without supervision. These exercises can also be very mundane and repetitive, which reduces the patient’s motivation to exercise. Exergames have been found (Alankus et al., 2010, p. 21130, (King, Hijmans, Sampson, Satherley, & Hale, 2012 Deutsch et al., 2009), (Mortazavi et al., 2014), (Shirzad et al., 2015).to improve patients’ engagement with their therapies at home.</b></p> <p>Currently there are systems to facilitate lower limb stroke rehabilitation,but none includes Strength for Task Training (STT). STT is a novel physiotherapeutic method for lower limb rehabilitation and comprises of two main phases: first being the strength training (priming) and second being the task training. Priming is brief weight lifting to excite the neural pathways (neuroplasticity) in the affected region, which primes the brain for learning; this is then promptly followed by task training to maximise gains in the locomotor ability.</p> <p>This project builds up on the research and development of a game controller by Duncan (2016) for lower limb stroke rehabilitation to facilitate STT. This project is a collaboration with Regan Petrie who designed the media aspect of the exergame system.</p> <p>A game controller was developed and this was part of a complete exergaming system which was designed to specifically facilitate STT. This project compiles more research findings together with feedback from the user and the clinicians to help improve the system. This was to ensure that the design is aligned to the specific requirements of functional STT rehabilitation and contextual needs of the patient.</p> <p>The final output is a pair of prototype shoes which included a sensor to measure movement, a pair of weighted sleeve and a pair of balance sole. The weighted sleeve has removable weights and facilitates the strength part of the training. The shoes are the adaptors which allow the user to the balance soles which is used to constantly challenge the user’s balance. The sensors translate limb movement and are for the user to interact with the game. This system provides a simple and safe method to engage in unsupervised STT.</p> <p>Feedback from clinicians indicates that the shoes can facilitate the strength part of the exercise, the sensors the task part of the training, and the balance sole is useful for challenging and improving balance. User testing sessions offer information about: the usability of the system, including ease of use and intuitive design; the aesthetics of the physical objects and whether the system is engaging patients in their therapies.</p>

Gamified Dual-Task Training for Individuals with Parkinson Disease: An Exploratory Study on Feasibility, Safety, and Efficacy

Objectives: The feasibility and safety of the use of neurorehabilitation technology (SMARTfit® Trainer system) by physical therapists in implementing a gamified physical-cognitive dual-task training (DTT) paradigm for individuals with Parkinson disease (IWPD) was examined. Additionally, the efficacy of this gamified DTT was compared to physical single-task training (STT), both of which were optimized using physio-motivational factors, on changes in motor and cognitive outcomes, and self-assessed disability in activities of daily living. Methods: Using a cross-over study design, eight participants with mild-to-moderate idiopathic PD (including one with mild cognitive impairment) completed both training conditions (i.e., gamified DTT and STT). For each training condition, the participants attended 2–3 sessions per week over 8.8 weeks on average, with the total amount of training being equivalent to 24 1 h sessions. A washout period averaging 11.5 weeks was inserted between training conditions. STT consisted of task-oriented training involving the practice of functional tasks, whereas for gamified DTT, the same task-oriented training was implemented simultaneously with varied cognitive games using an interactive training system (SMARTfit®). Both training conditions were optimized through continual adaptation to ensure the use of challenging tasks and to provide autonomy support. Training hours, heart rate, and adverse events were measured to assess the feasibility and safety of the gamified DTT protocol. Motor and cognitive function as well as perceived disability were assessed before and after each training condition. Results: Gamified DTT was feasible and safe for this cohort. Across participants, significant improvements were achieved in more outcome measures after gamified DTT than they were after STT. Individually, participants with specific demographic and clinical characteristics responded differently to the two training conditions. Conclusion: Physical therapists’ utilization of technology with versatile hardware configurations and customizable software application selections was feasible and safe for implementing a tailor-made intervention and for adapting it in real-time to meet the individualized, evolving training needs of IWPD. Specifically in comparison to optimized STT, there was a preliminary signal of efficacy for gamified DTT in improving motor and cognitive function as well as perceived disability in IWPD.

A Game Controller for Stroke Rehabilitation

<p>Successful stroke rehabilitation relies on early, long-term, repetitive and intensive treatment. Repetitions conducted during clinical rehabilitation are significantly lower than that suggested by physiotherapeutic literature to relearn lost motor capabilities. This leaves patients to achieve this quantity in their home environment. Exercises can be monotonous and repetitive, making it difficult to maintain patient motivation. Exergames have been promoted for use in the home to make rehabilitation entertaining, increasing patients engagement with their therapy. Marketed exergaming systems for lower limb rehabilitation are hard to find, and none as of yet, facilitate Strength for Task Training (STT), a novel physiotherapeutic method for lower limb stroke rehabilitation. Strength for Task Training involves performing brief but intensive strength training (priming) prior to task-specic training to promote neural plasticity and maximise the gains in locomotor ability. This research investigates how the design of a game controller for lower limb stroke rehabilitation can facilitate unsupervised STT to compliment clinical contact time. The game controller was developed as part of a complete exergaming system designed to specifically facilitate STT. This involved working closely with co-researcher Scott Brebner who designed the exergame media. A user centered design approach was followed to include clinicians and stroke patients in the design process. This ensured the design aligned with the functional requirements of STT and the contextual needs of the patient. Workshops with stroke clinicians and neurophysiologists pointed to the specific areas of STT that a designed system could address. An iterative design process was used to develop, compare and improve concepts through testing with participants and clinicians. User testing involved participants using the game controller to interact with the digital game. The final output was a prototype pair of smart shoes with an attachable weighted sole. The design used removable sensors to translate lower limb movement into ingame interactions. The design of the shoes and weighted sole provided a simple and safe way to engage in unsupervised STT. Research findings suggest that while not all of the STT therapy can be incorporated in an unsupervised and home-based exergame system, there are some essential elements that can. Adaptable hardware was found to be integral to facilitating intensive priming. Barriers to use can be reduced through considering the diverse physiological and cognitive abilities of stroke patients and aesthetic consideration can help create a meaningful game controller that promotes its use in the home.</p>

A Game Controller for Stroke Rehabilitation

<p>Successful stroke rehabilitation relies on early, long-term, repetitive and intensive treatment. Repetitions conducted during clinical rehabilitation are significantly lower than that suggested by physiotherapeutic literature to relearn lost motor capabilities. This leaves patients to achieve this quantity in their home environment. Exercises can be monotonous and repetitive, making it difficult to maintain patient motivation. Exergames have been promoted for use in the home to make rehabilitation entertaining, increasing patients engagement with their therapy. Marketed exergaming systems for lower limb rehabilitation are hard to find, and none as of yet, facilitate Strength for Task Training (STT), a novel physiotherapeutic method for lower limb stroke rehabilitation. Strength for Task Training involves performing brief but intensive strength training (priming) prior to task-specic training to promote neural plasticity and maximise the gains in locomotor ability. This research investigates how the design of a game controller for lower limb stroke rehabilitation can facilitate unsupervised STT to compliment clinical contact time. The game controller was developed as part of a complete exergaming system designed to specifically facilitate STT. This involved working closely with co-researcher Scott Brebner who designed the exergame media. A user centered design approach was followed to include clinicians and stroke patients in the design process. This ensured the design aligned with the functional requirements of STT and the contextual needs of the patient. Workshops with stroke clinicians and neurophysiologists pointed to the specific areas of STT that a designed system could address. An iterative design process was used to develop, compare and improve concepts through testing with participants and clinicians. User testing involved participants using the game controller to interact with the digital game. The final output was a prototype pair of smart shoes with an attachable weighted sole. The design used removable sensors to translate lower limb movement into ingame interactions. The design of the shoes and weighted sole provided a simple and safe way to engage in unsupervised STT. Research findings suggest that while not all of the STT therapy can be incorporated in an unsupervised and home-based exergame system, there are some essential elements that can. Adaptable hardware was found to be integral to facilitating intensive priming. Barriers to use can be reduced through considering the diverse physiological and cognitive abilities of stroke patients and aesthetic consideration can help create a meaningful game controller that promotes its use in the home.</p>

Limited Add-On Effects of Unilateral and Bilateral Transcranial Direct Current Stimulation on Visuo-Motor Grip Force Tracking Task Training Outcome in Chronic Stroke. A Randomized Controlled Trial

Background: This randomized controlled trial investigated if uni- and bihemispheric transcranial direct current stimulation (tDCS) of the motor cortex can enhance the effects of visuo-motor grip force tracking task training and transfer to clinical assessments of upper extremity motor function.Methods: In a randomized, double-blind, sham-controlled trial, 40 chronic stroke patients underwent 5 days of visuo-motor grip force tracking task training of the paretic hand with either unilateral or bilateral (N = 15/group) or placebo tDCS (N = 10). Immediate and long-term (3 months) effects on training outcome and motor recovery (Upper Extremity Fugl-Meyer, UE-FM, Wolf Motor Function Test, and WMFT) were investigated.Results: Trained task performance significantly improved independently of tDCS in a curvilinear fashion. In the anodal stimulation group UE-FM scores were higher than in the sham group at day 5 (adjusted mean difference: 2.6, 95%CI: 0.6–4.5, p = 0.010) and at 3 months follow up (adjusted mean difference: 2.8, 95%CI: 0.8–4.7, p = 0.006). Neither training alone, nor the combination of training and tDCS improved WMFT performance.Conclusions: Visuo-motor grip force tracking task training can facilitate recovery of upper extremity function. Only minimal add-on effects of anodal but not dual tDCS were observed.Clinical Trial Registration:https://clinicaltrials.gov/ct2/results?recrs=&amp;cond=&amp;term=NCT01969097&amp;cntry=&amp;state=&amp;city=&amp;dist=, identifier: NCT01969097, retrospectively registered on 25/10/2013.