Cognitive-Focused Game-Based Compared to GameBased Circuit Exercise for Two Stroke Survivors: A Case Report

Abstract

Stroke survivors require continuous exercise therapy to minimize post-stroke cognitive impairment, eventually
affecting their functional decline and motivation. Game-based cognitive training has received much attention in
past research, and good evidence has been documented. Meanwhile, adding cognitive training into an exercise
in the form of circuit exercise has been recommended to improve strength, endurance, cognition, and sleep quality
and reduce depression post-stroke. Therefore, this study aimed to determine the effects of a cognitive-focused
game-based circuit exercise on functions, notably lower limb strength, postural stability and aerobic endurance
and the motivation level of stroke survivors in comparison to game-based circuit exercise. This research was a
case study involving two chronic stage post-stroke survivors (age = 54 to 58 years old; Montreal Cognitive
Assessment score = 26 to 28) conducted between January and March 2023. The participants performed a 40-
minute cognitive-focused or game-based circuit exercise using Othellocise or Checkercise® board, respectively.
Both therapies continued twice per week for eight weeks. Lower limb strength, postural stability and aerobic
endurance were measured using the 30-second chair rise test, Dynamic Gait Index and 6-minute walk test. The
outcome of the intervention concerning motivation level was measured with the use of the Intrinsic Motivation
Inventory. Cognitive-focused game-based circuit exercise using Othellocise was found to be feasible. It yielded
satisfactory outcomes with improved functions compared to game-based circuit exercises using Checkercise®
(9% in lower limb strength vs 10%, 10% in postural stability vs 33%, 41% in aerobic endurance vs 21%). Overall
motivation level increased by 30% vs 12% for the domain of interest/enjoyment, perceived competence and
perceived choice subscales. Further, subjects felt less pressure/tension, with a 63% vs 22% reduction in this
subscale. The increased of Montreal Cognitive Assessment was 8% vs 4%. In conclusion, cognitive-focused
game-based Othellocise is potentially improving the functions and motivation levels of stroke survivors and may
be used as a therapy option for this population.