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ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Neurocognitive Aging and Behavior
Volume 17 - 2025 | doi: 10.3389/fnagi.2025.1514594
This article is part of the Research Topic Enhancing Gait Therapy with Artificial Intelligence: Current Trends and Future Prospects View all articles
PEMOCS: Effects of a concept-guided, PErsonalized, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke -A randomized, controlled trial
Provisionally accepted
Simone K. Huber 1,2
Ruud Knols 1,2
Jerermia P.O. Held 3,4 Martina Betschart 5,6 Sierra Gartmann 1,2 Nadine Nauer 1,2
Eling D. de Bruin 2,5,7*- 1 University Hospital Zürich, Zurich, Switzerland
- 2 ETH Zürich, Zurich, Zürich, Switzerland
- 3 Rehabilitation Center Triemli Zurich, Valens Clinics, Zürich, Switzerland
- 4 Bellevue Medical Group, Zürich, Switzerland
- 5 Department of Health, OST Eastern Swiss University of Applied Sciences, Rapperswil, St. Gallen, Switzerland
- 6 Cantonal Hospital Winterthur, Winterthur, Zürich, Switzerland
- 7 Karolinska Institutet (KI), Solna, Stockholm, Sweden
Purpose: Motor-cognitive exergames may be beneficial for addressing both motor and cognitive residual impairments in chronic stroke, however, effective training schedules are yet to be determined. Therefore, this study investigates the effects of a concept-guided, personalized, motorcognitive exergame training on cognitive functions and gait in chronic stroke survivors.In this single-blind, randomized, controlled trial, stroke survivors (at least six-months poststroke and able to perform step-based exergaming) were allocated either to the intervention (usual care + concept-guided, personalized, motor-cognitive exergame training) or the control group (usual care only). Global cognitive functioning was primarily targeted, while health-related quality of life (HRQoL), cognitive functions, mobility, and gait were evaluated secondarily. Analyses were performed with linear-mixed effect models.Results: Effects on global cognitive functioning were non-significant, with no differences between responders (participants exhibiting a clinically relevant change) and non-responders (participants exhibiting no clinically relevant change). Among secondary outcomes, the mobility domain of the HRQoL questionnaire, intrinsic visual alertness, cognitive flexibility, working memory, and outdoor walking speed as well as swing width (unaffected side) showed significant interaction effects in favour of the exergame group.Discussion: Additional exergaming helped maintaining global cognitive functioning and showed encouraging effects in mobility and cognitive outcomes. Responders and non-responders did not differ in adherence, baseline values or age. Enhancing the frequency and intensity of sessions could unlock more substantial benefits. Adopting a blended therapy approach may be key to maximizing positive effects.Trial registry: clinicaltrials.gov (ID: NCT05524727).
Keywords: Stroke, exergaming, Rehabilitation, Cognition, Gait, dual-task
Received: 21 Oct 2024; Accepted: 27 Feb 2025.
Copyright: © 2025 Huber, Knols, Held, Betschart, Gartmann, Nauer and de Bruin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Eling D. de Bruin, ETH Zürich, Zurich, 8092, Zürich, Switzerland
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