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

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

This randomized controlled trial aims to compare the effectiveness of Vestibular-Oriented Balance Training and Motor Dual Task Training on balance, postural control, and fall risk among chronic stroke survivors. Forty-six participants diagnosed with chronic stroke will be randomly allocated into two intervention groups. Both groups will receive conventional physiotherapy along with their assigned intervention for six weeks. Outcome measures will include the Biodex Balance System (Overall Stability Index, Anterior-Posterior Stability Index, Medial-Lateral Stability Index and Fall Risk Index), Modified clinical test of sensory interaction on balance( m-CTISB). The findings will provide evidence regarding the most effective rehabilitation strategy for improving, Overall stability, and functional balance and reducing fall risk in chronic stroke survivors.

Study Overview

• Status: Recruiting
• Conditions: Chronic Stroke Patients
• Intervention / Treatment: Other: Experimental; Other: Control

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hafsah Arshad, PhD*; Phone Number: 03315165234; Email: hafsah.arshad@uipt.iiui.edu.pk
• Study Contact Backup: Name: Ijaz Ahmed, MS-NMPT; Phone Number: +923437149637; Email: ejaza788@gmail.com

Study Locations

• Pakistan
  • Rawalpindi, Pakistan, 46000
    • Recruiting
    • Armed Forces Institute of Rehabilitation Medicine Rawalpindi, Pakistan
    • Contact: Ijaz Ahmed, MS-NMPT; Phone Number: +923437149637; Email: ejaza788@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

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.

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
Experimental: Vestibular-Oriented Balance Training; Participants will receive vestibular-oriented balance exercises together with conventional physiotherapy for five weeks	Other: Experimental; Participants will receive vestibular-oriented balance exercises together with conventional physiotherapy for five weeks
Active Comparator: Motor Dual Task Training; Participants will receive motor dual-task balance training together with conventional physiotherapy for five weeks	Other: Control; Participants will receive motor dual-task balance training together with conventional physiotherapy for five weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biodex Over all stability Index	Overall Stability Index (OSI) on the Biodex Balance System is a comprehensive score measuring how well a person controls their balance and keeps a moving platform level. Higher numbers mean more platform tilt and poorer balance control, while lower numbers show better stability and stronger neuromuscular coordination.	assessment at baseline and after 6 weeks
Biodex Fall Risk index	It measures a person's stability and risk of falling by tracking how much they sway on a moveable balance platform. Higher scores indicate poor stability and a higher likelihood of falls	at baseline and after 6 weeks
Modified clinical test of sensory interaction on balance	a clinical tool used to evaluate static postural control and identify which sensory systems (vision, vestibular, or somatosensory/proprioceptive) a patient relies on or struggles with to maintain balance.	at baseline and after 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biodex APSI	Anterior/Posterior Stability Index (APSI) on the Biodex Balance System measures front-to-back postural sway and balance ability. Higher scores indicate greater platform displacement and poorer stability, while lower scores reflect better front-to-back neuromuscular control and stability.	at baseline and after 6 weeks
Biodex Medial/Lateral Stability Index	A lower score indicates better stability, meaning the person stayed closer to the center level. A higher score represents greater side-to-side sway, indicating poor postural performance or a higher risk of falling.	at baseline and after 6 weeks

Collaborators and Investigators

• Sponsor: Ibadat International University, Islamabad

Study record dates

Study Major Dates

• Study Start (Estimated): July 10, 2026
• Primary Completion (Estimated): November 15, 2026
• Study Completion (Estimated): December 18, 2026

Study Registration Dates

• First Submitted: August 5, 2026
• First Submitted That Met QC Criteria: August 5, 2026
• First Posted (Actual): August 10, 2026

Study Record Updates

• Last Update Posted (Actual): August 10, 2026
• Last Update Submitted That Met QC Criteria: August 5, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: stroke; balance; fall; vestibular rehabilitation; biodex
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke
• Other Study ID Numbers: IIUI/RERC/ADT/2026/07/366

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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