PEMOCS: Evaluating the effects of a concept-guided, PErsonalized, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke – study protocol for a randomized controlled trial

Background Many stroke survivors remain with residual cognitive and motor impairments despite receiving timely acute and sub-acute rehabilitation. This indicates that rehabilitation following stroke should be continuous to meet the needs of individual stroke patients. Both, cognitive and motor functions are essential for mastering daily life and, therefore, should be aimed at with rehabilitation. Exergames, motor-cognitive exercises performed using video games, are an auspicious method to train both, motor and cognitive functions, and at the same time may foster the long-term motivation for training. This study aims to assess the effect of concept-guided, personalized, motor-cognitive exergame training on cognitive and motor functions in chronic stroke survivors. Methods This study is a single-blinded, randomized controlled trial. Assessments are performed at baseline, after a 12-weeks intervention and at a 24-weeks follow-up. Chronic stroke patients (≥ 18 years old, ≥ 6 months post-stroke) able to stand for three minutes, independently walk ten meters, follow a two-stage command, and without other neurological diseases apart from cognitive deficits or dementia, are included. Participants in the intervention group perform the exergame training twice per week for 30 (beginning) up to 40 (end) minutes additionally to their usual care program. Participants in the control group receive usual care without additional intervention(s). Global cognitive functioning (total Montreal Cognitive Assessment (MoCA) score) is the primary outcome. Secondary outcomes include health-related quality of life, specific cognitive functions, single- and dual-task mobility, and spatiotemporal gait parameters. Linear mixed models with the post-outcome scores as dependent variables, and group and time as fixed effects will be performed for analysis. Discussion Superior improvements in global cognitive functioning, and in the above mentioned secondary outcomes in the intervention group compared to the control group are hypothesised. The results of this study may guide future design of long-term rehabilitation interventions after stroke. Trial registration clinicaltrials.gov (NCT05524727). Registered on September 1st, 2022.