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Table 3 Included studies reported by subjects, outcome measures, intervention, control and results

From: Cognitive and cognitive-motor interventions affecting physical functioning: A systematic review

STUDY SUBJECTS OUTCOME MEASURES INTERVENTION CONTROL RESULTS
Cognitive Rehabilitation Interventions
Batson et al, 2006 [44] - n = 6; community-dwelling elderly
- age range: 65-80 years
- Standardized measures of balance, gait speed and balance confidence
- BBS, ABC
- TUG
Mental imagery plus physical practice;
6 weeks: 2x/week for 50 min
Health education plus physical practice
6 weeks: 2x/week for 50 min
- Significant results for TUG only for the group as a whole
- No significant results for either group or for the group as a whole for remaining measures
Dunsky et al, 2008 [50] - n = 17; community-dwelling adults with hemiparetic stroke
- age range: 44-79 years
- Spatiotemporal and kinematic gait parameters
- Tinetti POMA
- FMA
- Modified FWCI
Motor imagery training;
6 weeks: 3 x/week for 20 min
None - Spatiotemporal parameters: significant improvements in mean gait speed at baseline and follow-up; stride length, paretic and non-paretic step length increased significantly at post-intervention
- Significant increase of sagittal ROM of the paretic knee joint
- Significant increase of gait symmetry after intervention
- Treatment effect size was moderate for most of the variables
Hamel & Lajoie, 2005 [51] - n = 20; older adults
- age range: 65-90 years
- A/P & M/L postural oscillations
- Reaction time to auditory stimuli
- BBS
- ABC
Mental imagery training;
6 weeks: daily practice
No involvement in any type of training - MI-group became more stable after training, while sway of control group increased when compared to pre-test.
- A/P postural oscillation significantly decreased in MI-group
- Significant decrease in reaction time task for MI-group
- No significant outcomes on BBS and ABC scales
Dual-task Interventions
Shigematsu et al, 2008 [58] - n = 63; community dwelling older adults
- age range: 65-74 years
- Physical tests of balance, leg strength and coordination
- Self-reported occurrence of falls or trips
- Step-recording with pedometers
Square-Stepping Exercise (SSE);
12 weeks: 2x/week for 70 min
Supervised walking (W);
12 week: 1x week for 70 min
- Functional fitness of lower extremities improved more in SSE than in W
- No significantly lower rate of falls per trip for SSE compared to W.
Shigematsu et al, 2008 [59] - n = 39; community-dwelling healthy adults
- age range: 65-74 years
- Chair stands, Leg extension power, Single-leg balance with eyes closed, functional reach, standing up from a lying position, stepping with both feet, walking around two cones, 10 m-walk, Sit&Reach Square-Stepping Exercise (SSE);
12 weeks: 2x/week for 70 min
Strength and balance training;
12 weeks: 2x/week for 70 min
- SSE: significant within-group improvement in one-leg balance
- SB: Significant improvement of functional reach
- Performances on remaining test were significantly better for both groups.
Silsupadol et al, 2006 [62] - n = 3 older adults with self-reported history of falls or concerns about impaired balance
- age: 82, 90 and 93 years
- Mediolateral COM displacement und single-task (ST) and dual-task (DT)
- BBS, ABC
- DGI
- TUG
Dual-task balance training with fixed- (FP) or variable-priority (VP);
4 weeks: 3x/week for 45 min
Single-task balance training;
4 weeks: 3x/week for 45 min
- Balance improved in all 3 participants, BBS, DGI and ABC scores increased
- Time to complete TUG decreased under both conditions (participants who received DT-Training showed more improvement in TUG under DT than under ST and vice versa)
- Subject who received DT-training using VP, showed improvements on other dual tasks that were not directly trained (novel task)
- Follow-up (2 weeks): time to perform TUG decreased for all subjects
- Follow-up (3 months): Clinical measures of balance were retained; TUG in subject with FP further improved (9%)
Silsupadol et al, 2009a&b [60, 61] - n = 21; elderly adults
- mean age: 75 ± 6.1 years
- Self-selected gait speed under single and dual task conditions
- Gait temporal-distance measurements
- BBS, ABC
- Average angle of frontal plane COM position and ankle joint center (AJC)
Dual-task balance training with fixed- (FP) or variable-priority (VP);
4 weeks: 3x/week for 45 min
Single-task balance training;
4 weeks: 3x/week for 45 min
- All participants improved gait speed under ST conditions.
- DT-groups walked significantly faster under DT conditions. No significant difference in gait speed under DT conditions for ST-group
- All participants improved balance under ST-conditions
- ABC Scale: ST group increased their level of confidence more than DT groups
- BBS Scale: improvements in BBS were comparable across training groups
- Follow-up: DT-training with VP instructions demonstrated a training effect on DT-gait speed at the end of the second week of training and also after 3 months follow-up
- All groups showed a significantly smaller AJC-angle after training when walking under ST conditions
- Under DT-conditions reduction of AJC-angle was significant for all groups, but was greater for the VP-group than for the ST-group and FP-group
- No significant effects on AJC-angle in a novel (untrained) DT-condition for all groups.
Vaillant et al, 2006 [66] - n = 68; community-dwelling older women with osteoporosis
- mean age: 73.5 ± 1.6 years
- TUG & TUG-DT
- One Leg Balance (OLB) and OLB with concurrent task (OLB-DT)
Physical exercise while counting, memorizing or reciting (dual task);
6 weeks: 2x/week
Physical exercises (single task);
6 weeks: 2x/week
- Adding cognitive tasks did not significantly alter the effects of the exercise program
- 2 weeks follow-up: Significant improvements for all outcome measures in both groups; TUG time improved more in single-task group than in dual-task group
- 3 months follow-up: Improvements in TUG-DT significantly greater in dual-task group than in the single-task group
You et al, 2009 [70] - n = 13; older adults with history of falls
- mean age: 68.3 ± 6.5 years
- Gait speed
- AP-/ML-COP deviation
Cognitive Gait Intervention (CGI);
6 weeks: 5x/week for 30 min
Placebo version of CGI;
6 weeks: 5x/week for 30 min
- No significant difference in the ML-COP or AP-COP deviation measures neither in control nor experiment group;
- Significant increase in gait speed in control group but not in experimental group
Computerized Interventions
Bisson et al, 2007 [32] - n = 24; community dwelling older adults
- mean age: VR 74.4 ± 3.65 years, BF 74.4 ± 4.92 years
- Static balance
- Simple auditory reaction time task
- CB&M
Dynamic balance training with visual biofeedback (BF) or in virtual reality (VR);
10 weeks: 2x/week for 30 min
None - Mean CB&M scores for both groups increased significantly from baseline to post-training and retention, no difference between groups
- Static balance: no differences between groups and no training effect on variability of COP displacement; Significant task effect and interaction between directions of sway and tasks
- Reaction time: no group effect; significant main effect of time; reaction time at baseline significantly higher compared to post-training and retention; both groups improved their reaction time equally
Broeren et al, 2008 [45] - n = 22; community dwelling persons with stroke
- mean age: 67 ± 12.5 years
- Manual Ability measurements (BBT and ABILHAND)
- Trail Making Test B
- Kinematics of upper extremities (velocity, hand-path ratio etc.)
3D computer game play with haptic device and unsupported upper extremities;
4 weeks: 3 x/week for 45 min
Continued participation in usual physical activities - BBT: Increase in treatment group by 9%
- ABILHAND: No significant changes in both groups
- TMT-B: median time decreased for completing the task in both groups
- Kinematics: Time to complete the VR task and HPR decreased significantly in treatment group
- Hand trajectories are qualitatively more restrained, self-controlled, smoother and less clutters after training
Buccello-Stout et al, 2008 [46] - n = 16; older adults
- age range: 66 - 81 years
- Time to complete an obstacle course with 13 soft obstacles
- Number of penalties on obstacle course
Walking straight on a treadmill in a rotating virtual room;
4 weeks: 2 x/week for 20 min
Walking straight on a treadmill in a static virtual room;
4 weeks: 2 x/week for 20 min
- Average time scores to complete obstacle course and average penalty scores significantly decreased in experimental group after intervention and at retention (4 weeks)
Clark et al, 2009 [47] - n = 1; woman resident of a nursing home with unspecified balance disorders
- age:89 years
- BBS, ABC
- DGI
- TUG
- MMSE
Nintendo Wii Bowling game;
2 weeks: 3x/week for 60 min
None - Improvements in all outcome measures
- Self-reported improvements in balance, ambulation ability and confidence
de Bruin et al, 2010 [48] - n = 35; older adults living in a residential care facility;
- mean age: CGD 85.2 ± 5.5 years, UC 86.8 ± 8.1 years
- Gait temporal-distance measurements
- Dual task costs of walking
- ETGUG -FES-I
Computer game dancing (CGD) plus progressive resistance training;
12 weeks: 2x/week for 45-60 min
Usual care physical intervention (UC);
12 weeks: 1x/week for 30-45 min
- DTC: Significant decrease in DTC of walking velocity and stride time in CGD-group. No significant changes in DTC of cadence and step time in both groups.
- ETGUG: no significant time effect in both groups
- FES-I: no significant time effect in both groups
Deutsch et al, 2009 [49] - n = 2; in chronic phase post-stroke patients
- age: 48 and 34 years
- Gait speed
- Six-minute walk test (meters)
- BBS, ABC
- DGI
- TUG and TGU-DT
Nintendo Wii Sports and Wii Fit Programs;
4 weeks: 3x/week for 60 min
Balance and coordination activities in different conditions;
4 weeks: 3x/week for 60 min
- Gait speed increased for both participants (retained at follow-up)
- Gait endurance increased modestly for both participants
- DGI and ABC scores increased for both participants
- TUG and TUG-DT time decreased for both participants; Control subject showed further improvement at post-test
Hatzitaki et al, 2009 [52] - n = 48; community-dwelling healthy older women
- mean age: 70.89 ± 5.67 years
- Static postural sway data: COP displacement in A/P and M/L direction
- Angular excursion of lower leg, pelvis and trunk
Balance training on platform with visual feedback in A/P or M/L direction;
4 weeks: 3x/week for 25 min
No involvement in any type of training - Normal quiet stance: No significant changes in COP displacement and angular kinematics in either of the two training groups.
- Significant effect of training on interlimb COP asymmetry in A/P-group
- Sharpened Romberg Stance: Significant reduction of COP displacement in A/P-group, no adaptations in M/L-group. A/P group showed significantly decreased peak amplitude and SD of lower leg rotation in the pitch direction and of trunk's mediolateral rotation. No significant changes in the M/L-group
Hinman, 2002 [53] - n = 88; community-dwelling elderly
- age range: 63-87 years
- BBS
- MFES
- Timed 50-foot walk test (TWT)
- Simple reaction time
Computerized Balance Training (CBT) or Home program of balance exercises (HEP);
4 weeks: 3 x/week for 20 min
No involvement in any type of training - Subjects in both training groups showed slight improvements in all measures. Subjects of control group improved to a lesser degree.
Jang et al, 2005 [54] - n = 10; patients with hemiparetic stroke
- mean age: 57.1 ± 4.5 years
- BBT
- FMA
- Manual Function Test
- Several fMRI data
VR game exercise with IREX system focusing on reaching, lifting and grasping;
4 weeks: 5x/week for 60 min
No involvement in any type of training - Significant difference between the groups, VR-group improved in motor functions, control group did not show any change
- Cortical activation was reorganized from contralesional to ipsilesional activation in the laterality index
Kerdoncuff et al 2004 [71] - n = 25; patients with stroke
- mean age: 59.5 ± 13.5
- FMA
- Gait evaluation
- Barthel Index
- Measurement of functional independence (MFI)
- Sway measurements on force platform
Progressive balance training with visual biofeedback plus traditional training;
3 weeks: 5x/week
Traditional training;
3 weeks: 5x/week
- Improvements in gait speed for control group, decrease for intervention group
- Improvements in FMA, MFI and Barthel Index for both groups
- Improvements of force platform parameters with closed eyes
Lajoie, 2003 [55] - n = 24; community-dwelling elderly
- mean age: IG 70.3 years, CG 71.4 years
- BBS, ABC
- Auditory-verbal reaction test
- Postural sway data
Computerized Balance Training;
8 weeks: 2x/week for 60 min
No involvement in any type of training - BBS: Significant difference for CBT-group after intervention
- ABC: No significant changes
- Significant decrease of reaction time in CBT-group after intervention
- Postural sway: No significant changes in both groups
Mumford et al, 2010 [56] - n = 3; patients with TBI
- mean age: 20.3 years
- Movement accuracy
- Movement speed
- Movement efficiency
- BBT
- MAND
Table-top VR-System for moving objects to cued locations with augmented movement feedback;
12 weeks: 1x/week for 60 min
None - Accuracy: Improvements after intervention and maintained in 2 of 3 patients
- Speed: No improvement after intervention for either hand
- Efficiency: Improved performance efficiency for all participants after intervention
-
BBT: moderate improvements
- MAND: moderate improvements
Sackley et al, 1997 [57] - n = 26; stroke patients
- age range: 41-85 years
- Stance symmetry and sway
- Rivermead Motor Assessment
- Nottingham 10 Point ADL Scale
Balance training using visual feedback;
4 weeks: 3x/week for 60 min
Balance training without visual feedback; 4 weeks: 3x/week for 60 min - Treatment group demonstrated significantly better performance when compared with controls for stance symmetry and for functional performance (ADL and Gross Function scores)
- Sway values showed a tendency to greater improvement
Srivastava et al, 2009 [63] - n = 45; stroke patients
- mean age: 45.51 ± 11.24 years
- BBS
- Balance Index
- Dynamic Limits of Stability scores
- Walking ability
- Barthel Index
Balance training on force platform with visual feedback;
4 weeks: 5x/week for 20 min
None - Statistically significant differences at the end of training for all outcome measures
- Statistically significant differences for all outcomes at 3 months follow-up
Sugarman et al, 2009 [64] - n = 1; woman 5 weeks after stroke
- age: 86 years
- BBS
- Functional Reach
- TUG
- Postural Stability Index (STI)
- Stability Score (ST)
Nintendo Wii Fit balance training plus standard physical therapy with emphasis on functional activities;
4 × 45 min
None - Modest improvements in BBS and Functional Reach tests
- TUG time decrease
- Modest improvements in postural stability tests
Talassi et al, 2007 [65] - n = 54; community-dwelling older adults with mild cognitive impairment (MCI) or mild dementia (MD)
- age range: 42-91 years
- PPT
- Basic and instrumental ADL
Computerized cognitive training (CCT), occupational therapy (OT) and behavioral training (BT);
3 weeks: 4x/week for 30-45 min
same program with physical rehabilitation program (PT) instead of CCT - Participants with MCI showed significant improvements in PPT
- Unspecific control program showed no significant effects
Wolf et al, 1997 [67] - n = 72; independently living older adults;
- mean age: CBT 77.7 ± 6.5 years, TC 77.7 ± 5.6 years, Control Group 75.2 ± 4.9 years
- Postural stability measurements under defined conditions
- Fear of Falling Questionnaire
Computerized Balance Training (CBT) or Tai Chi (TC);
15 weeks: CBT 1x/week for 60 min, TC 2x/week for 60 min
Educational intervention (ED); 15 weeks: 1x/week for 60 min - CBT: improved postural stability
- TC: no improvements in postural stability, but reduction of fear of falling occurred
Yang et al, 2008 [68] - n = 20; adults with stroke
- age range: 30-74 years
- Walking speed -Community walk test (CWT)
- Walking Ability Questionnaire (WAQ)
- ABC
Virtual reality-based treadmill training;
3 weeks: 3x/week for 20 min
Treadmill training; 3 weeks: 3x/week for 20 min - VR-Group: significant improvement in all outcomes post-training and significant improvements in walking speed, CWT and WAQ score 1 month after completion of program
- CG: significant improvements in CWT post-training and in follow-up period, significant improvements of WAQ score at follow-up
Yong Joo et al, 2010 [69] - n = 16; rehabilitation inpatients within 3 months post-stroke
- mean age: 64.5 ± 9.6 years
- FMA
- Motricity Index -Modified Ashworth Scale (MAS)
- Visual Analogue Scale for upper limb pain
Upper limb exercises with Nintendo Wii in addition to usual rehabilitation;
2 weeks: 6x/week for 30 min
None - Significant improvements in the FMA and Motricity Index scores
  1. Abbreviations: BBS = Berg Balance Scale; ABC = Activities-specific Balance Confidence Scale; CB&M = Functional Balance and Mobility; COP = Centre of Pressure; COM = Centre of Mass; DGI = Dynamic Gait Index; TUG = Timed Up and Go Test; TUG-DT = Timed Up and Go Test Dual Task; ETGUG = Expanded Timed Up and Go Test; MMSE = Mini Mental State Examination; ADL = Activities of Daily Living; BBT = Box and Block Test; MAND = Mc Carron Assessment of Neuromuscular Dysfunction; FMA = Fugl-Meyer Assessment of Upper Limb Motor Function; FES-I = Falls Efficacy Scale International; MFES = Tinetti's Modified Falls Efficacy Scale; POMA = Performance Oriented Mobility Assessment; FCWI = Functional Walking Categories Index; PPT = Physical Performance Test