Rehabilitation With Exergames in Individuals With Moderate to Severe Cognitive Impairment: A Case Report

A strong correlation exists between the severity of motor impairment and cognitive impairment in people with cerebral palsy. Moreover, severe cognitive impairment is associated with lower capacity for motor learning and hinders motor rehabilitation. In this report, we describe the effects of a therapeutic exercise protocol with exergames (TEP-Exergame) on postural control and spasticity of two young adults with spastic tetraplegia and moderate to severe cognitive impairment. Spasticity was measured in the elbow flexors using the Modified Ashworth Scale, and postural control was assessed through the following center of pressure (COP) variables: CoP sway area (CoP_Sway), mediolateral velocity (V_ML), anteroposterior velocity (V_AP), mediolateral variability (SD_ML), and anteroposterior variability (SD_AP). These variables were obtained during four postural tasks: eyes open (EO), eyes closed (EC), and weight-shifting (WS) in the mediolateral and anteroposterior directions (WS_ML and WS_AP, respectively). We found that 18 sessions of TEP-exergame reduced muscle tone in the elbow flexors and improved postural control, as evidenced by a decrease in CoP_Sway in all conditions, SD_AP, V_ML, and V_AP in WS_ML; and SD_AP, SD_ML, and V_ML in WS_AP. For young adults with spastic tetraplegia and moderate to severe cognitive impairment, TEP-Exergame may enhance postural control and reduce spasticity.