Effectiveness of Home-Based Exergame Motor-Cognitive Rehabilitation Versus Outpatient Multidisciplinary Rehabilitation in Individuals With Traumatic Brain Injury: A Pilot Controlled Trial

Traumatic brain injury (TBI) is one of the leading causes of disability among young adults and is associated with a substantial economic burden on healthcare systems, as well as on patients and their families.

TBI may result in cognitive impairments, including deficits in attention, memory, and executive functions, as well as behavioral disturbances such as apathy, anxiety, and depression. In a smaller proportion of cases, motor dysfunctions, including gait and balance impairments, may also occur. These deficits negatively affect patients' independence and social participation and may also reduce caregivers' quality of life.

Conventional rehabilitation for individuals with TBI typically relies on multidisciplinary interventions, including cognitive training, physiotherapy, and occupational therapy. Although these approaches may improve specific functional domains, evidence supporting their effectiveness in enhancing overall independence and social participation remains limited. Therefore, there is a need to develop more targeted and personalized neurorehabilitation programs based on clinical, instrumental, and biological biomarkers, while ensuring continuity of care through integrated hospital-to-home rehabilitation pathways.

In the post-discharge setting, combined cognitive-motor rehabilitation has gained increasing attention due to the close interaction between motor and cognitive functions in everyday activities. In particular, telerehabilitation delivered through virtual reality-based exergames has shown promising results in improving mobility, cognitive performance, and functional independence in individuals with TBI. Compared with traditional face-to-face rehabilitation, which typically requires one-to-one therapist supervision, telerehabilitation enables patients to perform training at home through synchronous, asynchronous, or hybrid modalities, providing a more flexible and efficient model of care while reducing travel requirements and waiting times for rehabilitation services.

In light of the above, this pilot controlled, non-randomized, single-blind (assessor-blinded) clinical trial aims to investigate the effectiveness of home-based cognitive-motor telerehabilitation as a post-discharge continuity-of-care intervention compared with standard outpatient rehabilitation in individuals with traumatic brain injury (TBI) following discharge from intensive inpatient neurorehabilitation. We hypothesize that participants receiving the experimental intervention will demonstrate greater or at least comparable improvements in functional independence, cognitive performance, mobility, and quality of life than those receiving conventional outpatient rehabilitation, while also reducing caregiver burden.