The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial

Abstract

Background It is currently unknown whether exergaming is efficacious in people with major neurocognitive disorder (MNCD) residing in long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality of life, and daily life functioning in people with MNCD residing in long-term care facilities. Methods Participants were randomly assigned to 8 weeks, three times weekly, 15 min of exergaming versus watching preferred music videos. The exergame device consisted of a pressure-sensitive step training platform on which participants performed stepping movements to play the games. The device automatically adapted the training level to the participants’ capabilities. The Short Physical Performance Battery (SPPB), step reaction time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Dementia Quality of Life (DQoL), and Katz Activities of Daily Living (Katz ADL) were assessed at baseline and post-intervention. A Quade’s non-parametric ANCOVA controlling for baseline values with post hoc Bonferroni correction (p < 0.00625) was used to analyze pre- and post-differences between the groups. Partial eta-squared (η2p) effect sizes were calculated. Results Forty-five of 55 randomized inpatients with mild to moderate MNCD (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70–91; 35 women) completed the study. The exergame group (n = 23) demonstrated improvements in gait speed (p < 0.001, η2p = 0.41), total SPPB (p < 0.001, η2p = 0.64), SRTT (p<0.001, η2p = 0.51), MoCA (p<0.001, η2p = 0.38), and reductions in CSDD (p<0.001, η2p = 0.43) compared to the control group (n = 22). There were no differences in NPI (p = 0.165, η2p = 0.05), DQoL (p = 0.012, η2p = 0.16), and ADL (p = 0.008, η2p = 0.16) post-intervention scores between the experimental and control group, albeit DQol and ADL measures showed large effect sizes in the exergame group. The mean attendance rate was 82.9% in the exergame group and 73.7% in the music control group. There were no study-related adverse events reported by the participants, nor observed by the research team. Conclusions The findings of this pilot RCT suggest that an individually adapted exergame training improves lower extremity functioning, cognitive functioning and step reaction time and symptoms of depression in inpatients with MNCD residing in long-term care facilities. Trial registration ClinicalTrials.gov, NCT04436302

The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study

“…The use of NPI allow us to evaluate the presence of several BPSD and to rate their frequency and severity. NPI evaluates different BPSD as described in [36,37] and namely delusions, apathy, hallucinations, disinhibition, agitation/aggression, irritability, depression/dysphoria, aberrant motor behaviour, anxiety, night time behaviour disturbances, euphoria, and appetite and eating abnormalities. Each item receive a score on a 4-point scale for the frequency (0 = never, 1 = less than once a week, 2 = at least once a week, 3 = more than one a week, but less than once a day, 4 = every day).…”

Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder – A Methodological Paper

“…Preferably, the specific components of the exergame interventions are tailored to the individual, based on objective assessments of individual capabilities such as cognitive abilities, physical fitness, motor abilities, as well as demographic characteristics (e.g., age, gender, health status, and the socioemotional status including motivation, mood, or stress) ( Herold et al, 2018 ). Furthermore, the preferred postural modality in which exercise is performed should be in a vertical body loading position ( Swinnen et al, 2021 ). Exercise performed in standing position that requires a changing base of support to play the games better meets the specifics for training postural control ( Tahmosybayat et al, 2018 ) and puts a higher demand on spatial processing demands ( Dodwell et al, 2019 ) next to enhancing both processing speed and attentional selectivity ( Rosenbaum et al, 2017 ).…”

“…Step 4: Technology Scoping A previous study showed good results in people with major neurocognitive disorders using a Dividat Senso platform (Swinnen et al, 2021). We will use this device and can thus use some of the existing exergames by adapting these to the determined requirements for our future studies.…”

CogniViTra, a Digital Solution to Support Dual-Task Rehabilitation Training

“…Table 1 presents relevant studies [3,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] related to the use of digital solutions to support physical activities or cognitive and physical activities with different purposes (i.e., postural control and prevention of falls [51,53,54,58,59,65], assistance in physical exercises [52,56,61], physical activity adherence [55], improvement of physical performance [58][59][60]63,64], and improvement of cognitive performance [3,57,60,62,64]). The studies are supported in various types of technologies, namely exergames and virtual reality [51,53,54,[57][58][59][60][61][62][63]…”

“…The studies are supported in various types of technologies, namely exergames and virtual reality [51,53,54,[57][58][59][60][61][62][63]65], robotics [52,56,61], and mobile devices [3]. In turn, some of these articles report interactions mechanisms based on the recognition of body movements (e.g., using Kinect [51,52,57,58,65], Nintendo Wii Fit [53], or wearable devices [59,60]), feet movements using step training platforms [54,63], or leg movements on a training bicycle [55]. When compared with stat-of-the-art technological solutions, the study reported by this article presents two important advantages: (i) support tools and clinical information integration and (ii) automatic quantification of patient's cognitive performance during dual-task training.…”