Telerehab Exerbrain: Bridging Physical and Cognitive Therapy in Stroke

Effects of Web-Based Physical-Cognitive Telerehabilitation Exergaming on Physical and Cognitive Performance in Chronic Stroke Survivors: Protocol for a Randomized Controlled Trial

The goal of this clinical trial is to learn if a web-based exercise and cognitive training (physical-cognitive) program works to improve movements and brain function in adults with long-term stroke. It will also learn whether the program is safe and enjoyable.

The main questions it aims to answer are:

Does the program improve walking, balance, strength, and reduce fall risk? Does the program improve cognitive skills such as memory, attention, and problem-solving? Researchers will compare the online exercise-and-cognitive training program to usual care to see if the program leads to greater improvements.

Participants will:

• Be randomly assigned to either the online training group or the usual care group
• If in the training group, complete the home-based program for 12 weeks.
• Take part in physical and cognitive tests before and after the program

Study Overview

• Status: Not yet recruiting
• Conditions: Stroke; Exercise; Cognitive Abilities; Tele-rehabilitation; Motor Abilities
• Intervention / Treatment: Behavioral: Web-Based Physical-Cognitive Telerehabilitation Exergaming

Detailed Description

The goal of this clinical trial is to evaluate whether a 12-week, web-based exercise and cognitive (physical-cognitive) training program can improve both physical abilities and brain function in adults with long-term stroke. The study will also examine whether the program is safe, practical to use at home, and enjoyable.

Many people who have had a stroke continue to experience problems with movement (such as walking, balance, weakness, and risk of falling) as well as problems with cognition (such as memory, attention, and problem-solving). Traditional rehabilitation often focuses mainly on physical recovery. This study tests a program that combines physical exercises and cognitive training at the same time using interactive online "exergames" delivered through telerehabilitation.

The main questions this study aims to answer are:

Does the program improve motor function, walking speed, balance, muscle power, and reduce fall risk? Does the program improve cognitive abilities, including global cognitive ability, executive function, memory, and attention? Is the program enjoyable and feasible for people with chronic stroke to use at home? In this study, 52 participants will be randomly assigned to one of two groups. One group will complete the 12-week web-based physical-cognitive training program at home. Another group will continue receiving their usual care. The researchers will compare changes in physical and cognitive performance between the two groups.

Participants in the training group will follow guided exercise sessions delivered online. All participants will complete physical and cognitive assessments before and after the 12-week period. The results of this study may help determine whether web-based physical-cognitive training is an effective and accessible rehabilitation option for people living with chronic stroke.

• Study Type: Interventional
• Enrollment (Estimated): 52
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Puntarik Keawtep, Ph.D., Primary investigator; Phone Number: 66 861822590; Email: puntarik.k@cmu.ac.th
• Study Contact Backup: Name: Somporn Sungkarat, PhD, Associate Professor; Phone Number: 66814458336; Email: somporn.sungkarat@cmu.ac.th

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• diagnosed with ischemic or hemorrhagic stroke at least 6 months before enrollment
• aged between 20 and 80 years
• able to walk at least 10 meters with or without assistive devices
• able to perform sit-to-stand safely with or without assistive devices
• can see the screen of a tablet or notebook computer at a distance of at least 60 cm
• have a stable medical condition and can follow study instructions
• frequent users of a mobile phone, tablet, or notebook computers

Exclusion Criteria:

• have medical conditions or complications that would be unsafe to exercise
• have neglect, impaired communication, or uncorrected visual problems [30], or - have severe spasticity of the upper or lower extremities (Modified Ashworth Scale ≥ 3)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control
Experimental: Web-Based Physical-Cognitive Telerehabilitation Exergaming; Physical-cognitive exergame via web-based platform at home setting for 60 min/session, 3 sessions/week for 12 weeks.	Behavioral: Web-Based Physical-Cognitive Telerehabilitation Exergaming; Perform a physical-cognitive exergame via ExerbrainCMU web-based platform at home setting for 60 min/session, 3 sessions/week for 12 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Executive function	Trail Making Test (TMT) part B-A will be evaluated at baseline and 3 months.	3 months
Fall risk	Fall risk will be assessed using the Timed Up and Go (TUG) test at baseline and 3 months. The time taken to complete TUG will be recorded in Sec.	3 months
Gait speed	10-Meter Walk test (10MWT) will be used to assessed gait speed at baseline and 3 months.	3 months.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Global cognitive function	Montreal Cognitive Assessment (MoCA) test will used to measured global cognitive function at baseline and 3 months.The total scores range from 0-30 points with higher scores indicating better global cognitive function.	3 months
Attention	Digit Span test will be used to assess memory and attention at baseline and 3 months.	3 months
Motor function	Motor Assessment Scale (MAS) will be used to evaluate motor function at baseline and 3 months.	3 months
Balance	Modified Functional Reach Test (MFRT) will be used to assessed balance at baseline and 3 months.	3 months
Muscle strength	Five-Time Sit to Stand will be used to evaluate lower limb muscle strength at baseline and 3 months.	3 months
Weight distribution	Stance Symmetry Test (SST) will be used to assess weight distribution at baseline and 3 months.	3 months
Enjoyment	Physical Activity Enjoyment Scale (PACES) will be used to assess enjoyment.	3 months

Collaborators and Investigators

• Sponsor: Chiang Mai University
• Investigators: Principal Investigator: Puntarik Keawtep, Chiang Mai Uiversity

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2026
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: February 18, 2026
• First Submitted That Met QC Criteria: February 25, 2026
• First Posted (Actual): March 3, 2026

Study Record Updates

• Last Update Posted (Actual): March 3, 2026
• Last Update Submitted That Met QC Criteria: February 25, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Behavior; Stroke; Motor Activity
• Other Study ID Numbers: N42A680192

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual Participant Data (IPD) will not be shared because the informed consent obtained from participants did not include permission for public data sharing. Additionally, due to the sensitive nature of the clinical data and the potential risk of participant re-identification, data sharing is not planned.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No