Enhancing Seated Lower Limb Training: Evaluating an Exergame-Integrated Stepper for Weight-Shift and Muscle Activation.

Incorporating technology into exercise-based treatments is a prominent and promising strategy in rehabilitation. This study compares the biomechanics of the seated ankle dorsi-plantar flexion (ADPF) exercises performed without a stepper (WoS) to seated stepping-in-place exercises performed with an exergame-integrated stepper (WS). Does an exergame-integrated stepper device enhance seated lower limb training by providing the weight-shift and muscle activation compared to conventional ankle dorsi-plantar flexion exercises without a stepper? Ten healthy participants completed exercises at 0° and 45° tilted sitting conditions. Weight-shift, and electromyographic (EMG) activity of gait muscles were measured bilaterally during exercises. In the WS condition, weight-shift significantly increased by 72% during 0° sitting and increased by 22% during 45° sitting conditions ($\mathrm{p}<0.05$). EMG activation significantly decreased for all muscles in the WS condition ($\mathrm{p}<0.05$) except in the Rectus Femoris activation (Left RF: $\mathrm{p}={0. 6 4 6}$, Right RF: $\mathrm{p}={0. 4 4 5}$). This initial study combines bilateral training with the exergame-integrated stepper device, demonstrating its potential to provide weightshift and muscle training for the lower limb. Seated stepping exercises can be implemented on current rehabilitation protocols and developed device can be an alternative to conventional ADPF exercise in stroke rehabilitation.