Interactive cognitive-motor step training to improve balance and mobility in clinical groups at risk of falls
Year: 2026
Type: article
Abstract: Impairments in balance, stepping and executive function are apparent in many neurological conditions. To address these key risk factors for falls, we have developed an interactive cognitive-motor training program (SmartStep), integrating fast, multidirectional stepping in response to cognitively challenging stimuli. We are now investigating its effectiveness in cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN) (CanSTEP trial) and in people post stroke (SmartStepStroke trial).More than 30 % of cancer survivors are affected by CIPN at six months post neurotoxic chemotherapy treatment. CIPN manifests in sensory and neuromuscular impairments, which in the lower limbs lead to balance and mobility deficits. Despite the ever-increasing burden of CIPN-related disability in cancer survivors, current management is inadequate. There is evidence from small-scale trials of the benefits of exercise, particularly balance training, on neuropathy symptoms in cancer survivors. No studies have examined the effect of exercise on cognitive performance, which is another common complaint raised by 20 to 30 % of CIPN patients and attributed to cancer and/or its treatments. Yet people with CIPN show cognitive-motor function deficits, evidenced by slow and variable stepping response and movement times in tests of choice-stepping reaction time (Menant et al., 2021). The CanSTEP randomised-controlled trial will determine whether four months of the SmartStep training can reduce neuropathy symptoms and improve balance and mobility, compared with usual care (wait-list controls), in people with CIPN. This multi-centre trial is ongoing (n= 106 of target 178), involving adults at least six months post-completion of neurotoxic chemotherapy treatment for cancer, with CIPN symptoms affecting lower limbs.Stroke is a leading cause of long-term physical disability, with over 12 million stroke incidents occurring worldwide each year. Many stroke survivors face balance and mobility challenges and functional dependency due to impaired lower limb muscle strength, control, and coordination. Traditional rehabilitation methods, like repetitive task training, can improve mobility and balance. However, they often require frequent visits to rehabilitation clinics and involve monotonous exercises, making it difficult for people to adhere to the recommended routines, thereby limiting functional improvements. Exergames are increasingly being used in stroke rehabilitation, as they are designed to be enjoyable and to encourage continued participation. However, most programs to date have been centre-based (Lapanan et al., 2026). Hence our pilot trial aims to investigate the effectiveness of four-months of home-based SmartStep training, versus usual care (wait-list controls), balance and mobility, in people with chronic stroke. The trial is ongoing (n=37 of target 86), involving adults at least six months post-stroke reporting balance and mobility difficulties.I will first give a brief overview of our recent research findings that demonstrated the effectiveness of home-based interactive cognitive-motor step training on falls in older adults (Sturnieks et al., 2024) and stepping performance in people with multiple sclerosis (Hoang et al., 2024). I will then present baseline data from both trials highlighting participants' physiological, cognitive and psychological determinants of their impaired functional mobility. I will also discuss potential mechanisms underlying the hypothesized benefits of this intervention on balance and mobility in these clinical groups, based on recent research.
Source: Communications in Kinesiology
Institutions: UNSW Sydney, Neuroscience Research Australia
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225155472