The Development of ICT-Based Exercise Rehabilitation Service Contents for Patients with Musculoskeletal Disorders and Stroke

PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example

Background

Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke.

Methods

The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed.

Results

A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept.

Conclusion

We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.

Exploring the Role of Community Exercise Rehabilitation Centers through the Rehabilitation Experiences of Patients with Musculoskeletal Disorders: A Qualitative Study

We investigated the perception of community sport rehabilitation centers by examining the experiences of living lab participants and discussing the centers' roles. From 50 living lab participants in the exercise rehabilitation center, in-depth interviews were conducted with the 10 among them (three males and seven females) who had high participation rates and consented voluntarily. The data collected through participant observation and a review of the literature were analyzed through inductive categorization. The findings show the points as follows: (a) owing to inadequate cognitive and physical accessibility, the older population faced challenges in utilizing the center, causing deficiency in the requisite information and knowledge essential for effective rehabilitation; (b) human and material services, including older adult rehabilitation instructors, systematic management, and service platforms were provided to the participants through the centers; (c) after 12-week program operation, participants experienced improved physical health, and by engaging in the rehabilitation exercise services, developed positive perception of the center. Participants desired to continue with the program and were willing to recommend it to others. These findings emphasize the importance of specialized instructors to older-adults' physical activities, implementing systematic data management and utilization practices, and the collaboration between healthcare institutions and local communities. This is particularly important because of the rapid rise in the older adult population.