Single-session perturbation-based training followed by home-based exergaming to enhance resistance to falls after stroke

Introduction: Frequent falling is a major health concern for people post-stroke, with poor reactive stepping contributing to increased fall risk. Perturbation-based training (PBT) effectively improves reactive stepping, but its clinical implementation is constrained by availability and costs. This randomized study (NL-OMON56779) investigated whether reactive step quality may also be enhanced by single-session PBT followed by five weeks of home-based training using a custom-designed exergame based on action observation with motor simulation of reactive stepping. Methods: People with chronic stroke (>six months) were recruited from six Dutch rehabilitation centres and randomly assigned to an experimental group (EX-A and EX-B, n=17 each) or the control group (n=18). Both experimental groups received a single PBT session; only EX-A subsequently received home-based exergame training. The control group performed five weeks of home-based voluntary step training. The primary outcome was forward and backward reactive step quality in response to treadmill-delivered balance perturbations, assessed at baseline, post-intervention, and at 5-weeks follow-up. Secondary outcomes included standardized balance and mobility assessments. Between-group differences were evaluated using generalized least squares models. Results: Fifty-two participants (60 ± 8 yrs; 37 %f; 47 ± 62 months post-stroke) were included. Group EX-A demonstrated a significantly greater improvement in forward reactive step quality compared to the control group at post-intervention (p=0.004) and at follow-up (p=0.012), which difference was not observed for EX-B. No significant between-group differences were observed for the backward direction. Furthermore, group EX-A showed greater improvements in forward single-step success rates and in dynamic gait index scores than the control group. Conclusions: The results provide preliminary evidence that single-session PBT with subsequent home-based exergame training improves forward reactive stepping after stroke. This intervention may offer a scalable and less burdensome alternative to traditional methods for improving reactive stepping. The ultimate goals are to prevent falls and fall-related injuries after stroke and reduce fall-related healthcare costs. Acknowledgements: The study was funded by grant from ZonMW/DVCA (104021002) and InterregNWE (NWE0100082).