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Impact of motor-cognitive interventions on selected gait and balance outcomes in older adults : ǂa ǂsystematic review and meta-analysis of randomized controlled trials
Kaja Teraž, Luka Šlosar, Armin Paravlić, Eling D. de Bruin, Uroš Marušič, 2022, review article

Abstract: Background: Efficient performance of most daily activities requires intact and simultaneous execution of motor and cognitive tasks. To mitigate age-related functional decline, various combinations of motor and cognitive training have shown promising results. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy of different types of motor-cognitive training interventions (e.g., sequential and simultaneous) on selected functional outcomes in healthy older adults. Methods: Six online academic databases were used to retrieve eligible RCTs up to April 2021, following PRISMA guidelines and PICO criteria. A random-effects model was used for all meta-analyses conducted on selected functional outcomes: single- and dual-task gait speed, the Timed Up and Go Test (TUG), and Berg Balance Scale (BBS) score. Effect size (ES) was calculated as Hedges' g and interpreted as: trivial: <0.20, small: 0.20–0.60, moderate: 0.61–1.20, large: 1.21–2.00, very large: 2.01–4.00 or extremely large >4.00. Results: From 2,546 retrieved records, 91 RCTs were included for meta-analysis (n = 3,745 participants; 64.7–86.9 years). The motor-cognitive interventions included differed according to the type of training (e.g., sequential, simultaneous with additional cognitive task or exergame training. The results showed that motor-cognitive interventions can improve gait speed under single-task conditions (small ES = 0.34, P = 0.003). The effect of the intervention was moderated by the type of control group (Q = 6.203, P = 0.013): passive (moderate ES = 0.941, P = 0.001) vs. active controls (trivial ES = 0.153, P = 0.180). No significant effect was found for dual-task walking outcomes (P = 0.063). Motor-cognitive intervention had a positive effect on TUG (small ES = 0.42, P < 0.001), where the effect of intervention was moderated by control group [passive (moderate ES = 0.73, P = 0.001) vs. active (small ES = 0.20, P = 0.020)], but not by the type of training (P = 0.064). Finally, BBS scores were positively affected by motor-cognitive interventions (small ES = 0.59, P < 0.001) with however no significant differences between type of control group (P = 0.529) or intervention modality (P = 0.585). Conclusions: This study provides evidence for the effectiveness of various types of motor-cognitive interventions on performance-based measures of functional mobility in healthy older adults. With respect to significant effects, gait speed under single-task condition was improved by motor-cognitive interventions, but the evidence shows that this type of intervention is not necessarily more beneficial than motor training alone. On the other hand, motor-cognitive interventions are better at improving multicomponent tasks of dynamic balance and mobility function, as measured by the TUG. Because of substantial heterogeneity and the current limited availability of different types of interventions, the conclusions should be interpreted with caution.
Keywords: motor-cognitive interventions, dual-task, elderly, mobility, postural control
Published in DiRROS: 21.06.2022; Views: 61; Downloads: 63
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A perspective on implementation of technology-driven exergames for adults as telerehabilitation services
Cécil J. W. Meulenberg, Eling D. de Bruin, Uroš Marušič, 2022, review article

Abstract: A major concern of public health authorities is to also encourage adults to be exposed to enriched environments (sensory and cognitive-motor activity) during the pandemic lockdown, as was recently the case worldwide during the COVID-19 outbreak. Games for adults that require physical activity, known as exergames, offer opportunities here. In particular, the output of the gaming industry nowadays offers computer games with extended reality (XR) which combines real and virtual environments and refers to human-machine interactions generated by computers and wearable technologies. For example, playing the game in front of a computer screen while standing or walking on a force plate or treadmill allows the user to react to certain infrastructural changes and obstacles within the virtual environment. Recent developments, optimization, and minimizations in wearable technology have produced wireless headsets and sensors that allow for unrestricted whole-body movement. This makes the virtual experience more immersive and provides the opportunity for greater engagement than traditional exercise. Currently, XR serves as an umbrella term for current immersive technologies as well as future realities that enhance the experience with features that produce new controllable environments. Overall, these technology-enhanced exergames challenge the adult user and modify the experience by increasing sensory stimulation and creating an environment where virtual and real elements interact. As a therapy, exergames can potentially create new environments and visualizations that may be more ecologically valid and thus simulate real activities of daily living that can be trained. Furthermore, by adding telemedicine features to the exergame, progress over time can be closely monitored and feedback provided, offering future opportunities for cognitive-motor assessment. To more optimally serve and challenge adults both physically and cognitively over time in future lockdowns, there is a need to provide long-term remote training and feedback. Particularly related to activities of daily living that create opportunities for effective and lasting rehabilitation for elderly and sufferers from chronic non-communicable diseases (CNDs). The aim of the current review is to envision the remote training and monitoring of physical and cognitive aspects for adults with limited mobility (due to disability, disease, or age), through the implementation of concurrent telehealth and exergame features using XR and wireless sensor technologies.
Keywords: older adults, telemedicine, virtual reality, rehabilitation, active video games
Published in DiRROS: 17.03.2022; Views: 146; Downloads: 133
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Additional exergames to regular tennis training improves cognitive-motor functions of children but may temporarily affect tennis technique : a single-blind randomized controlled trial
Luka Šlosar, Eling D. de Bruin, Eduardo Bodnariuc Fontes, Matej Plevnik, Rado Pišot, Boštjan Šimunič, Uroš Marušič, 2021, original scientific article

Abstract: This study evaluated the effects of an exergame program (TennisVirtua-4, Playstation Kinect) combined with traditional tennis training on autonomic regulation, tennis technique, gross motor skills, clinical reaction time, and cognitive inhibitory control in children. Sixty-three children were randomized into four groups (1st % two exergame and two regular trainings sessions/week, 2nd % one exergame and one regular training sessions/week, 3rd % two regular trainings sessions/week, and 4th % one regular training session/week) and compared at baseline, 6-month immediately post intervention and at 1-year follow-up post intervention. At 6-month post intervention the combined exergame and regular training sessions revealed: higher breathing frequency, heart rate (all ps % 0.001) and lower skin conductance levels (p = 0.001) during exergaming; additional benefits in the point of contact and kinetic chain elements of the tennis forehand and backhand technique (all ps % 0.001); negative impact on the shot preparation and the follow-through elements (all ps % 0.017); higher ball skills (as part of the gross motor skills) (p < 0.001); higher percentages of clinical reaction time improvement (1st %9.7% vs 3rd group %7.4% and 2nd %6.6% vs 4th group %4.4%, all ps % 0.003) and cognitive inhibitory control improvement in both congruent (1st %20.5% vs 3rd group %18.4% and 2nd %11.5% vs 4th group %9.6%, all ps % 0.05) and incongruent (1st group %19.1% vs 3rd group %12.5% and 2nd group %11.4% vs 4th group %6.5%, all ps % 0.001) trials. The 1-year follow-up test showed no differences in the tennis technique, clinical reaction time and cognitive inhibitory control improvement between groups with the same number of trainings per week. The findings support exergaming as an additional training tool, aimed to improve important cognitive-motor tennis skills by adding dynamics to the standardized training process. Caution should be placed to planning this training, e.g., in a mesocycle, since exergaming might decrease the improvement of specific tennis technique parts of the trainees. (; ID: NCT03946436).
Keywords: tennis, training, performance, children, motor learning, cognitive learning, teaching, strategies
Published in DiRROS: 17.03.2021; Views: 699; Downloads: 472
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