Effect of a Six-Week Task-Oriented Balance Training Programme on Balance and Fall Risk in Chronic Stroke Survivors

Many stroke survivors who return to the outpatient department months after their stroke still walk with a balance problem: they hesitate to accept weight on the affected leg, reach poorly without losing their base of support, and quietly stop going out because they are afraid of falling. This BPT final-year study evaluates a six-week supervised task-oriented balance training programme for chronic stroke survivors (six months or more post-stroke) attending the physiotherapy OPD of a teaching hospital.

Task-oriented training practises whole, meaningful tasks — sit-to-stand, forward and lateral reaching, stepping on and off a step, walking over obstacles — with progressive difficulty, instead of treating balance as an isolated impairment exercise. The design is a single-group pre–post study with about 30 participants recruited by purposive sampling. Balance is measured with three validated clinical instruments: the Berg Balance Scale (14 functional items), the Timed Up and Go (timed rise–walk–turn–sit) and the Functional Reach Test, with the lower-limb section of the Fugl-Meyer Assessment recording motor impairment. Fall history and any new falls are tracked with a diary.

Assessments happen at baseline and after six weeks of training delivered three days a week. The team checks the change with a paired t-test or the Wilcoxon signed-rank test as the data require, and reports effect sizes so the results can be read against clinically important change values published for these scales. The study runs under the approval of the Institutional Ethics Committee, with written informed consent and anonymised, aggregate reporting of all patient data.

Chronic stroke survivors in India are usually discharged from hospital within weeks, and families continue whatever home exercises they remember. Balance deficits persist: the person shifts weight away from the affected side, loses balance while dressing or bathing, and begins to restrict activity out of fear of falling. Falls then cause injury, loss of confidence and further deconditioning, and the family either restricts the patient's activity or supervises constantly. Outpatient therapy time is short, so it must be spent on training that is proven and practical.

There is a need to test, in a typical Indian rehabilitation OPD, whether a structured, low-cost, six-week task-oriented balance training programme produces measurable improvement on validated balance outcome measures (Berg Balance Scale, Timed Up and Go, Functional Reach Test) in chronic stroke survivors, and whether the programme is safe and feasible to deliver within routine OPD conditions.

Abstract

Balance deficits after stroke limit independence long after discharge. This study tests whether a structured, six-week, task-oriented balance training programme improves balance and reduces fall risk in chronic stroke survivors attending a physiotherapy OPD, measured with the Berg Balance Scale, Timed Up and Go and Functional Reach Test.

Introduction

Stroke is a leading cause of acquired adult disability in India, and most survivors live in the community with residual impairments. Among these, impaired balance is the one that shapes daily life most: it decides whether a person can stand to bathe, walk to the shop, or climb the step into an autos. Much of the spontaneous neurological recovery happens in the first months after stroke, so a chronic-phase (six months and beyond) population is the right one in which to attribute change to training rather than natural recovery.

Need and literature gap

Systematic reviews, including Cochrane reviews of physical rehabilitation approaches and of task-oriented circuit training after stroke, conclude that rehabilitation with a mix of treatment components improves function and that task-oriented practice improves gait and balance-related activities. However, Indian OPD-based studies that report a complete standard outcome battery (BBS, TUG and FRT together), document progression rules, and track safety and adherence in the chronic phase remain relatively few. This study fills that local-evidence gap with a programme a district hospital could run with a step, mats, cones and a stopwatch.

Aim and hypothesis

Aim: to evaluate the effect of a six-week task-oriented balance training programme on balance and fall risk in chronic stroke survivors. Hypothesis: the programme produces a statistically significant improvement in BBS, TUG and FRT scores after six weeks.

Proposed method

A single-group pre–post design: baseline assessment, six weeks of supervised circuit training (three 45-minute sessions per week: sit-to-stand, weight shifts and reaching, step-ups, obstacle and tandem walking, foam-surface standing), a mid-point adherence check, and re-assessment with the same battery. Analysis uses paired tests with significance at p < 0.05 and effect sizes.

Expected outcomes and clinical implication

Improvement across all three balance measures, with the strongest change expected on the tasks the circuit practises most directly. If confirmed, the programme is a low-cost, reproducible OPD protocol that therapists can adopt directly and that families can be trained to support at home.

Feasibility

Recruitment comes from the OPD's own records and consultant referrals; the six-week window fits within a 14-week academic project; equipment is already available in the department; the three-member team splits assessment and treatment roles. The main risks — dropouts and scheduling — are managed with make-up sessions and a written protocol.

In scope

• Chronic stroke survivors (six months or more post first stroke), aged 40–70, able to stand with assistance and follow two-step commands, attending the physiotherapy OPD of the attached teaching hospital.
• A single-group pre–post design over six training weeks within a 14-week project.
• Clinical balance outcome measures and a fall/adherence diary; no laboratory equipment.

Out of scope

• Acute or subacute inpatients and participants with severe aphasia or cognitive impairment that prevents safe participation or consent.
• A control or comparison group (acknowledged as a design limitation).
• Instrumented balance analysis (force plates, motion capture) or gait-laboratory outcomes.
• Long-term follow-up beyond the post-intervention assessment (listed as future scope).

Research design: pre-experimental, single-group pre–post study. Setting: physiotherapy OPD / neurological rehabilitation unit of the attached teaching hospital. Sampling: non-probability purposive sampling from OPD records and consultant referrals; a target of 30 completed participants is set following comparable published pre–post studies and departmental feasibility, and the final sample is reported with the flow of dropouts. Duration: 14 weeks in total — approvals and recruitment (weeks 1–4), six training weeks (weeks 5–10), post-assessment and analysis (weeks 11–14).

Progression and safety: a task is progressed (more repetitions, narrower base, less hand support) only after it is performed safely at the current level, per the written protocol. Every session uses a gait belt and therapist guarding, non-slip mats and a cleared floor; blood pressure is checked before each session; any dizziness, chest pain or near-fall ends the session and is logged.

Ethics: the protocol, consent forms (English and the regional language) and case-record forms are approved by the Institutional Ethics Committee before recruitment; participation is voluntary; all data are anonymised with participant codes and reported only in aggregate.

The study design below appears as the study-flow figure in the methodology chapter.

flowchart TD
  A["Screening from physiotherapy OPD records and consultant referrals"] --> B{"Meets inclusion criteria and gives written consent?"}
  B -- no --> C["Excluded, reason recorded in screening log"]
  B -- yes --> D["Baseline assessment: BBS, TUG, FRT, FMA-LE, fall history"]
  D --> E["Six-week task-oriented balance circuit: three sessions per week"]
  E --> F["Week 3: adherence check, progression review, adverse-event log"]
  F --> G["Post-intervention assessment: same battery, same testers"]
  D --> H["Master chart in Excel, anonymised with participant codes"]
  G --> H
  H --> I["Analysis in SPSS / Jamovi: normality, paired test, effect size"]
  I --> J["Results, discussion, report and viva"]

Outcome-measure battery

Every testing condition — chair height, walkway marking, instructions, footwear — is fixed at baseline and repeated identically at post-assessment, so the comparison measures the programme rather than the testing conditions.

• Add a comparison group receiving conventional balance exercises and randomise allocation, turning the study into a randomised controlled trial.
• Follow participants for 12 weeks after the programme to test retention of the balance gains and record falls prospectively.
• Add a dual-task component (balancing while performing a cognitive or manual task) to reflect real community conditions.
• Extend the programme to a home-based or tele-rehabilitation format with caregiver training and video check-ins for rural participants.
• Add a walking-capacity measure and a cost-per-session analysis so hospital administrators can see the programme's value.