SmartSTEP Stroke: Investigating the effect of a cognitive-motor step exergame program on balance and mobility in stroke survivors

Four-month cognitive-motor rehabilitation program involving step exergame training delivered through a home-based system (SmartSTEP). All intervention participants will receive the step exergame system (personal computer, software and instruction / safety booklet) and wireless step mat to interface with their television screen or provided computer monitor. The intervention involves unsupervised cognitive-motor training using the step exergame system. The intervention incorporates both stepping/balance exercises and cognitive training. The exergames require participants to make appropriately timed and accurate steps from both legs on the step mat. The program of games is designed to train balance and fast stepping responses in addition to cognitive function (selective attention, response inhibition, working memory, visuo-spatial processing and task switching). Trained research assistants with experience working with balance-impaired clinical groups and trained in exercise physiology, physiotherapy, nursing, neurosciences or biomedical sciences will set up the equipment in participants' homes during a 40-60 min initial home visit. They will then instruct participants on how to safely use the system. Intervention participants will receive a follow-up phone call (or email if no reply) two weeks after installation of their systems and again at eight weeks to ensure safe use and progression of training and to discuss any issues relating to system use. Additional phone calls (or home visits) during the intervention will be offered as needed. At all points of contact with the study team, participants will be asked if they face any difficulties using the program and appropriate measures will be taken to resolve any issues. Participants will be encouraged to undertake three to four 20–30-minute training sessions per week progressing to a target range of 80 to 120 minutes per week. We will initially encourage participants to undertake several short training sessions (e.g. 10 to 15min training sessions) per week to maximise confidence and long-term adherence. We will ask them to progress their training sessions duration (by 10% to 20% per week, considering both physical function and personal preferences / other commitments). Participants’ intervention usage data (minutes of game play each week) will be recorded on the system computer and later transferred onto an online server at Neuroscience Research Australia.