PEMOCS：一项概念引导、个性化、运动认知型电子游戏训练对慢性卒中患者认知功能和步态影响的随机对照试验
PEMOCS: effects of a concept-guided, PErsonalized, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-a randomized, controlled trial.
作者信息
Huber S K, Knols R H, Held J P O, Betschart M, Gartmann S, Nauer N, de Bruin E D
机构信息
Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zürich, Switzerland.
Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland.
出版信息
Front Aging Neurosci. 2025 Mar 13;17:1514594. doi: 10.3389/fnagi.2025.1514594. eCollection 2025.
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, motor-cognitive exergame training on cognitive functions and gait in chronic stroke survivors.
METHODS
In this single-blind, randomized, controlled trial, stroke survivors (at least six-months post-stroke 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.
CLINICAL TRIAL REGISTRATION
clinicaltrials.gov, identifier NCT05524727.
目的
运动认知类电子游戏可能有助于解决慢性中风患者的运动和认知残留障碍，然而，有效的训练方案尚未确定。因此，本研究调查了概念引导、个性化的运动认知类电子游戏训练对慢性中风幸存者认知功能和步态的影响。
方法
在这项单盲、随机、对照试验中，中风幸存者（中风后至少六个月且能够进行基于步骤的电子游戏）被分配到干预组（常规护理+概念引导、个性化的运动认知类电子游戏训练）或对照组（仅常规护理）。主要针对整体认知功能，次要评估与健康相关的生活质量（HRQoL）、认知功能、活动能力和步态。采用线性混合效应模型进行分析。
结果
对整体认知功能的影响不显著，有反应者（表现出临床相关变化的参与者）和无反应者（未表现出临床相关变化的参与者）之间没有差异。在次要结果中，HRQoL问卷的活动能力领域、内在视觉警觉性、认知灵活性、工作记忆、户外步行速度以及摆动宽度（未受影响侧）显示出有利于电子游戏组的显著交互作用。
讨论
额外的电子游戏有助于维持整体认知功能，并在活动能力和认知结果方面显示出令人鼓舞的效果。有反应者和无反应者在依从性、基线值或年龄方面没有差异。增加训练课程的频率和强度可能会带来更多实质性的益处。采用综合治疗方法可能是最大化积极效果的关键。
临床试验注册
clinicaltrials.gov，标识符NCT05524727。
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