title: A cognitive-balance control training paradigm using wii fit to reduce fall risk in chronic stroke survivors.
abstract: OBJECTIVE
  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.
  
  
  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, http://links.lww.com/JNPT/A80) for more insights from the authors.
authors.affiliation: Department of Physical Therapy, University of Illinois at Chicago.
authors.forename: Savitha
authors.initials: S
authors.lastname: Subramaniam
authors.forename: Christina
authors.initials: C
authors.lastname: Wan-Ying Hui-Chan
authors.forename: Tanvi
authors.initials: T
authors.lastname: Bhatt
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D003071:Cognition / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005684:Gait / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology; D040242:Risk Reduction Behavior; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D017741:Survivors; D016896:Treatment Outcome; D018910:Video Games