Exergaming in the comprehensive rehabilitation of patients with cerebral small vessel disease
Abstract
Aim: To evaluate the effects of exergaming added to comprehensive rehabilitation on cognitive, motor, balance, emotional, and selected cerebrovascular haemodynamic outcomes in patients with cerebral small vessel disease (CSVD). Materials and Methods: Sixty-four patients with MRI-confirmed CSVD (mean age, 67.4 ± 5.8 years) were randomized to an intervention group receiving standard rehabilitation plus exergaming or a control group receiving conventional rehabilitation. The exergaming programme consisted of 45–60-minute sessions, three times weekly for 12 months, using a stabilometric platform with motion feedback. Outcomes were assessed at baseline, 6 months, and 12 months using the MMSE, MoCA, Schulte test, Digit Symbol Substitution Test, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, stabilometric indices, Geriatric Depression Scale, Hamilton Anxiety Rating Scale, and transcranial Doppler parameters. Results: At 12 months, the intervention group showed greater improvements than the control group in MMSE scores (+15.0% vs +5.5%; p < 0.001), MoCA scores (+23.1% vs +8.8%; p < 0.001), and balance (BBS: +8.8 vs +3.2 points). TUG time decreased by 20.1% in the intervention group, compared with 5.7% in controls (p = 0.001). CoP sway area decreased by 30.9% in the intervention group and by 10.9% in controls. Depressive and anxiety symptom scores also decreased more markedly in the intervention group. PSV and EDV increased, whereas PI decreased by 11.1%; lower PI values were correlated with greater improvement in MoCA scores (r = −0.57; p < 0.01). Conclusions: Exergaming added to conventional rehabilitation was associated with greater improvements in cognitive function, balance, mobility, postural control, emotional status, and selected cerebrovascular haemodynamic measures in patients with CSVD. It may be a feasible adjunct to comprehensive rehabilitation; larger controlled studies are needed to confirm its long-term effects and underlying mechanisms.