Effects of Vestibular-Oriented Balance Training Versus Motor Dual Task Training on Balance, Postural Control, and Fall Risk in Chronic Stroke Survivors

Stroke is one of the leading causes of long-term disability worldwide and is associated with significant impairments in balance, postural control, mobility, and functional independence. Balance dysfunction remains one of the most challenging complications in chronic stroke survivors despite conventional rehabilitation interventions.

Vestibular-Oriented Balance Training (VOBT) is an evidence-based rehabilitation approach designed to improve balance by stimulating the vestibular system and enhancing sensory integration. This intervention includes exercises involving head movements, gaze stabilization, balance challenges on stable and unstable surfaces, dynamic postural tasks, and coordinated body movements.

Although both Vestibular-Oriented Balance Training and Motor Dual Task Training have demonstrated beneficial effects individually, there is limited high-quality evidence directly comparing their effectiveness in improving balance, postural control, and fall risk among chronic stroke survivors. Identifying the more effective rehabilitation strategy would assist physiotherapists in selecting evidence-based interventions that optimize patient recovery and functional independence.

The present study is designed as a randomized controlled trial to compare the effects of Vestibular-Oriented Balance Training and Motor Dual Task Training on balance, postural control, and fall risk in individuals with chronic stroke. A total of 50 eligible participants diagnosed with chronic stroke will be recruited using predefined inclusion and exclusion criteria. Participants will be randomly allocated into two parallel intervention groups using a computer-generated randomization sequence.

Participants allocated to the experimental group will receive Vestibular-Oriented Balance Training in addition to conventional physiotherapy. The intervention will consist of progressive vestibular exercises including gaze stabilization, head movement exercises, balance training on different support surfaces, weight-shifting activities, dynamic standing balance tasks, reaching activities, stepping exercises, and functional gait activities. The intensity and difficulty of the exercises will be progressively increased according to each participant's performance and tolerance throughout the intervention period.

Participants allocated to the active comparator group will receive Motor Dual Task Training together with the same conventional physiotherapy program. The intervention will include simultaneous performance of balance and mobility tasks combined with functional motor activities such as walking while carrying objects, obstacle negotiation, reaching during standing, stepping while manipulating objects, and other progressively challenging motor dual-task exercises. Exercise progression will be individualized according to participant performance to ensure safety and maximize functional improvement.

Both groups will receive intervention sessions three times per week for five consecutive weeks. Each treatment session will last approximately 45 to 60 minutes. Conventional physiotherapy will be standardized across both groups to ensure that the only difference between groups is the assigned experimental intervention.

Inclusion criteria

• Diagnosis of ischemic stroke.
• Stroke duration ≥6 months.
• Rhomberg scale
• MMSE ≥ 24
• Able to walk with or without assistive device.
• Able to understand commands
• Willing to participate and provide consent aged between 40-70 years.

Exclusion criteria

• Severe visual impairements which effect balance.
• Participants with acute or sub acute stroke <6 moths.
• Uncontrolled hypertension
• Uncontrolled diabetes
• Other neurological disorders such as Parkinson's disease or multiple sclerosis and Alzheimer's
• Participation in any other interventional trail.