Does square-stepping exercise improve balance in unilateral middle cerebral artery stroke survivors? A randomized controlled clinical trial

Abstract

Poststroke balance impairment adversely affects rehabilitation outcomes in chronic stroke survivors. Balance impairment heightens the risk of falls after stroke with negative consequences such as fall-related injuries including fracture, fear of falling, depression, social isolation, and even mortality. This study investigates the effectiveness of the square-stepping exercise as a balance training strategy for reducing the risk of falls among unilateral middle cerebral artery stroke survivors. In this randomized controlled trial, 42 chronic stroke survivors between the age group of 50 and 70 years were enrolled and assigned into 2 groups. Stroke survivors in the control group received conventional therapy, and the intervention group received conventional therapy and square-stepping exercise. Berg Balance Scale, timed up and go test, and Fall Efficacy Scale were included as outcome measures at baseline and post-intervention. The pre and post within-group analysis using paired t-test revealed a statistically significant difference in the Berg Balance Scale (P = 0.000), timed up and go test (P < 0.000), and Fall Efficacy Scale (P < 0.002) for participants in the intervention group. In between-group analysis using an independent t-test, square-stepping exercise participants demonstrated significant improvement for the Berg Balance Scale (P < 0.03). There are no significant changes in dynamic balance and fall risk outcomes between the groups. Combining square-stepping exercises in conventional rehabilitation could be beneficial in improving balance among chronic stroke survivors.