ABSTRACT NUMBER: ESOC2026LB153 SINGLE-SESSION PERTURBATION-BASED TRAINING FOLLOWED BY HOME-BASED EXERGAMING TO ENHANCE RESISTANCE TO FALLS AFTER STROKE

Abstract Background and aims Frequent falls are a major health concern after stroke, with impaired reactive stepping contributing to increased fall risk. Multi-session perturbation-based training (PBT) improves reactive stepping, but its clinical implementation is constrained by availability and costs. This study (NL-OMON56779) investigated whether a combination of novel home-based exergame training and single-session PBT is effective as well. Methods People with chronic stroke (>6 months) were recruited from six Dutch rehabilitation centers and randomized to an experimental group (EX-A and EX-B) or a control group (CON). Both experimental groups received one PBT session; only EX-A completed subsequent home-based exergame training (5 weeks). CON performed a voluntary step training at home (5 weeks). The primary outcome was reactive step quality following treadmill-delivered balance perturbations, assessed at baseline, post-intervention, and at 5-week follow-up. Secondary outcomes included standardized balance and mobility assessments. Between-group differences were evaluated using generalized least squares models. Here, post-intervention results are reported. Results Fifty-two participants (60±8yrs; 19F/33M; 47±62 months post-stroke) were included. Compared to CON (n=18), post-intervention improvements in EX-A (n=17) were significantly greater in forward reactive steps (p=0.008), whereas differences in backward steps did not reach significance. Marginal gains in EX-B (n=17) were not different from CON (p=0.153). EX-A also showed greater improvement in dynamic gait index scores than CON (p=0.010). Conclusions The results provide preliminary evidence that a single PBT session followed by home-based exergame training improves forward reactive balance after stroke. This intervention may offer a scalable approach to enhancing reactive balance, ultimately reducing fall risk and fall-related healthcare costs. Conflict of interest