title: Cognitive effects of weight-shifting controlled exergames in patients with chronic stroke: a pilot randomized comparison trial.
abstract: BACKGROUND
  The exergaming training involves motor as well as cognitive stimulation. Although exergame studies have been reported to have benefits in motor function, the effects of exergames on improving cognitive function remain inconclusive. Moreover, no study has been reported in stroke patients.
  
  
  OBJECTIVE
  The objective of this study was to compare the cognitive effects of 2 weight-shifting controlled exergaming systems and conventional weight- shifting training in patients with chronic stroke.
  
  
  METHODS
  This was a single-blind randomized controlled trial.
  
  
  METHODS
  All participants were recruited from a rehabilitation department of a tertiary hospital.
  
  
  METHODS
  Patients (N.=37) with chronic hemiplegic stroke.
  
  
  METHODS
  Patients were randomly allocated to one of the Wii Fit, Tetrax biofeedback, or conventional weight-shifting training groups. All interventions were administered 30 minutes per session, twice a week for 12 weeks. We used total score and the 9 domain scores of Cognitive Abilities Screening Instrument Chinese version (CASI C-2.0), and Berg Balance Scale (BBS) as the outcome measures. The outcome measures were assessed before and after training, and at 3 months follow-up.
  
  
  RESULTS
  There were no significant differences among the 3 groups in the percentage of change in CASI total score and BBS, either post intervention or at the 3-month follow-up. At assessing the percentage of change in each domain of CASI, we found significant differences among the 3 groups in the abstraction/judgment domain after intervention (Wii Fit 16.25 [9.77, 37.50]% vs. Tetrax 0.00 [-10.00, 0.00]% vs. weight-shift 11.00 [0.00, 14.38]%, P=0.01], and at the 3-month follow-up (Wii Fit 20.00 [10.83, 31.25]% vs. Tetrax -10.00 [-11.11, 10.00]% vs. weight-shifting 0.00 [-2.27, 11.46]%, P=0.01). The differences came from the differences between Wii Fit and Tetrax mainly. There were significant differences among the 3 groups in language domain after intervention (Wii Fit 0.00 [0.00, 5.54]% vs. Tetrax 0.00 [-3.00, 0.00]% vs. weight-shift 0.00 [0.00, 0.00]%, P=0.045), but not at the 3-month follow-up (P=0.13). There was no correlation between the percentage of change in BBS and CASI total score postintervention ( r=-0.15 P=0.38).
  
  
  CONCLUSIONS
  Wii Fit games training might be beneficial in some cognitive functions, such as abstraction/judgment, language in patients with chronic stroke. Wii Fit games, the commercial entertainment exergames, had superior effect in abstract/judgment and language domains as compared to the rehabilitation exergame (Tetrax balance system). Hence, Wii Fit games might be considered as a tool in post-stroke cognitive rehabilitation programs.
authors.affiliation: Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan - hung0702@cgmh.org.tw.|Chang Gung University College of Medicine, Taoyuan, Taiwan - hung0702@cgmh.org.tw.
authors.forename: Jen-Wen
authors.initials: JW
authors.lastname: Hung
authors.affiliation: Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chiung-Xia
authors.initials: CX
authors.lastname: Chou
authors.affiliation: Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Hsueh-Feng
authors.initials: HF
authors.lastname: Chang
authors.affiliation: Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Wu
authors.affiliation: Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yen-Wei
authors.initials: YW
authors.lastname: Hsieh
authors.affiliation: Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Po-Chih
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Min-Yuan
authors.initials: MY
authors.lastname: Yu
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan.|Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
authors.forename: Chiung-Chih
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Jr-Rung
authors.initials: JR
authors.lastname: Lin
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D001676:Biofeedback, Psychology; D001835:Body Weight; D002908:Chronic Disease; D003071:Cognition / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D004856:Postural Balance / Q000502:physiology*; D012016:Reference Values; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy; D000071939:Stroke Rehabilitation / Q000295:instrumentation / Q000379:methods*; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D018910:Video Games