HOLISTIC STROKE SOLUTIONS Episode 4: Surprising Truth About Balance Training After Stroke

 

 

Balance Recovery After Stroke: A Guide for Survivors and Caregivers 

Understanding Your Balance Recovery Journey 

If you or a loved one has experienced a stroke, you've likely discovered that balance issues are among the most challenging aspects of recovery. Up to 83% of stroke survivors face balance difficulties, making it one of the most common consequences of stroke (Khan & Chevidikunnan, 2021). The good news is that with the right approach and consistent practice, significant improvements in balance are achievable—even years after your stroke. 

This guide will help you understand why balance issues arise after a stroke and introduce you to effective training methods that may seem counterintuitive at first but are supported by scientific research. Most importantly, we'll show you safe ways to practice these techniques at home with proper support. 

⚠️ IMPORTANT SAFETY DISCLAIMER ⚠️ 

Before starting any balance training program, you should: 

Consult your doctor, physical therapist, or healthcare team. 

Ensure that you have adequate supervision during exercises. 

Always have sturdy support available, such as a wall, railing, or trained caregiver. 

Stop immediately if you feel dizzy, unsafe, or experience pain. 

Never attempt exercises alone if you have a history of falls. 

Start slowly and progress gradually under professional guidance. 

This guide is for educational purposes only and does not replace professional medical advice. Every stroke survivor's situation is unique, and what works for one person may not be suitable for another. 

 

Why Balance Problems Occur After a Stroke 

When a stroke occurs, it damages the part of your brain that helps control movement and balance. Think of your brain as the conductor of an orchestra – when part of the conductor's ability is affected, the musicians (your muscles and senses) have trouble working together harmoniously. 

What Happens to Your Body's Balance System 

Your balance relies on three main systems working together: 

Your eyes – providing visual information about your surroundings 

Your inner ear – detecting head movement and position 

Your body's sensors – sensing where your limbs are in space and detecting pressure from your feet. 

However, having these three systems work properly isn't enough on its own. The most crucial – and least understood – part of balance is how your central nervous system processes and integrates all this information. Think of it like having three excellent musicians (your senses) but needing a skilled conductor (your brain's integration system) to create beautiful music. 

 

The Hidden Challenge: Central Integration 

After a stroke, the most significant balance issue is often not that your senses stop functioning – it's that your brain struggles with: 

 

Processing the information it receives from your senses 

 

Integrating all the various signals into a complete picture 

 

Perceiving what is actually happening with your body position 

 

Deciding which information to trust when signals conflict. 

 

This central integration challenge is why stroke survivors frequently report: 

 

"I know I'm leaning, but I can't tell how much" 

"My balance feels different even when I'm sitting." 

"I don't trust my body anymore." 

"Everything feels 'off' even when I'm not moving." 

 

Research indicates that this integration challenge affects how stroke survivors process sensory information for balance control, leading to increased reliance on certain senses over others (Bonan et al 2012) 

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Why This Matters for Your Recovery 

Understanding that stroke affects your brain's ability to process balance information helps explain why: 

• You might feel unbalanced even when you're actually stable 

• Some days your balance feels worse despite no physical changes 

• Traditional "safe" positions might not feel safe to your brain 

• Recovery requires retraining your brain's processing, not just your muscles 

After a stroke, these systems may not communicate effectively with your brain, leading to: 

• Feeling unsteady when standing or walking 

• Leaning to one side 

• Difficulty shifting weight from one foot to the other 

• Increased fear of falling 

• Relying more heavily on vision to maintain balance 

• Most importantly: Your perception of balance being "off" even when you're physically stable 

Understanding Your Center of Pressure 

Imagine standing on a bathroom scale – the point where all your weight presses down is called your "center of pressure." In healthy individuals, this point fluctuates within a safe zone as they make minor adjustments to maintain balance (Quijoux et al., 2021). 

After stroke, your center of pressure often shifts in predictable patterns: 

Most Common Stroke (Middle Cerebral Artery): 

• Your weight shifts toward your stronger side 

• You may lean backward and away from your affected side 

• The area you feel "safe" in becomes smaller 

• Research shows these patients predominantly display posterior and lateral shifts toward the non-paretic side (Roelofs et al., 2018) 

Cerebellar Strokes: 

• You may lean forward more than normal 

• Standing feels unstable in all directions 

Understanding these patterns is crucial because traditional thinking might suggest avoiding these "danger zones." However, recent research shows that carefully training IN these challenging areas – with proper safety measures, may actually lead to better recovery. 

The Revolutionary Approach: Training INTO Your Challenges 

Why This Approach Works 

Traditional balance training often focuses on keeping you safe by avoiding movements that feel unstable. While safety is always paramount, this approach can prevent your brain from learning how to handle real-world balance challenges. 

The Central Integration Problem 

The key insight from recent research is that stroke doesn't just affect your muscles or individual senses – it primarily affects your brain's ability to process and integrate information related to balance. This central integration system is the least understood part of balance, but it's often the most important for recovery. 

Your brain needs to: 

• Take in information from multiple sources (eyes, ears, body sensors) 

• Figure out which information is most reliable in each situation 

• Create an accurate picture of where your body is in space 

• Make split-second decisions about how to maintain stability 

After a stroke, this integration process becomes compromised, which explains why many survivors say "I just don't feel right" even when they're objectively stable. 

Why Challenging Your "Comfort Zone" Helps 

The new approach involves carefully and safely practicing movements toward your affected side and in directions that feel less stable. This helps your brain: 

• Relearn integration skills by experiencing controlled challenges 

• Develop new neural pathways for processing balance information (Lee & Choi, 2021) 

• Improve communication between your senses and brain 

• Build confidence in handling unexpected balance challenges 

• Reduce dependence on "safe" positions that may increase fall risk 

• Recalibrate perception so your brain's understanding matches your actual stability 

The Science Behind the Method 

Your brain has a fantastic ability called "neuroplasticity" – its capacity to rewire itself and create new connections. When you challenge your balance system in a controlled, safe way, you're encouraging your brain to develop backup systems and improve existing pathways. 

The Central Integration Challenge 

What makes balance recovery so complex is that stroke often affects the brain's central integration system – the part that processes and makes sense of all your balance information. This is the least understood aspect of balance, but researchers are discovering it's often the most critical for recovery. 

Think of it this way: You might have perfectly functioning sensors (like having good eyesight and normal inner ear function), but if the brain's "processing center" is damaged, it's like having a computer with good hardware but corrupted software. 

Why Traditional "Safe" Training May Not Be Enough 

If your brain's integration system is compromised, staying only in "safe" positions might actually reinforce the problem by: 

• Not challenging the brain to relearn integration skills 

• Allowing compensation patterns to become permanent 

• Failing to address the root cause of balance perception problems 

• Missing opportunities for neural recovery 

Research shows that stroke survivors who practice challenging balance tasks (with proper safety measures) often achieve better long-term outcomes than those who only practice "safe" movements (Kannan et al., 2021). This is because controlled challenges help retrain the brain's integration system. 

Safe Home Training Strategies 

Essential Equipment You'll Need 

• Wall or sturdy railing – for immediate support 

• Resistance bands (light to moderate resistance) 

• Stable chair without wheels 

• Non-slip mat for standing exercises 

• A trained caregiver or family member to supervise 

Understanding Your Stroke Type 

Different types of strokes create different balance challenges, particularly in how your brain processes balance information: 

If you had a stroke affecting the side of your brain (most common): 

• You likely shift weight away from your affected side 

• Your brain may have trouble integrating information from your affected side 

• You might feel like you're falling toward your affected side even when you're stable 

• Training should focus on gentle movements toward your affected side 

• If your right brain was affected, you may rely more heavily on vision for balance and have more difficulty with spatial awareness (Bonan et al., 2004) 

If you had a cerebellar stroke: 

• You may lean forward and feel unsteady in multiple directions 

• Your brain has trouble coordinating all the balance information 

• You might feel like you're constantly in motion even when still 

• Training should include backward weight shifts and heel-to-toe activities 

The Integration Challenge is Universal 

Regardless of stroke type, all survivors face some degree of central integration difficulty. This means your brain needs to relearn how to: 

• Trust the information it's receiving 

• Combine signals from different senses effectively 

• Distinguish between fundamental instability and false alarm signals 

• Respond appropriately to balance challenges 

Your healthcare team can help you understand which type of stroke you experienced and how it affects your balance integration. 

Progressive Training Program 

Phase 1: Building Confidence (Weeks 1-2) 

Goal: Establish safe movement patterns with maximum support 

Exercise 1: Wall-Supported Weight Shifting 

1. Stand with your back against a wall, feet shoulder-width apart 

1. Place your hands on the wall for support 

1. Slowly shift weight to your stronger side, then gradually toward your affected side 

1. Pay attention to how the movement feels – this helps retrain your brain's perception 

1. Hold for 3-5 seconds on each side, focusing on what your body is telling you 

1. Repeat 10 times, 2-3 times daily 

1. Caregiver should stand nearby for additional support 

Note: You may feel more unstable than you actually are. This is your brain's integration system being overly cautious. With practice, your perception will become more accurate. 

Exercise 2: Seated Balance Reaches 

1. Sit on the edge of a stable chair, feet flat on floor 

1. Have your caregiver hold a small object (like a cup) slightly to your affected side 

1. Slowly reach toward the object, allowing your weight to shift 

1. Focus on how the movement feels versus how unstable you think you are 

1. Return to center 

1. Repeat 10 times, rest, then repeat 

Integration Focus: This exercise helps your brain learn to trust movement toward your affected side while maintaining actual stability. 

Phase 2: Gentle Challenges (Weeks 3-4) 

Goal: Introduce mild instability with continued support 

Exercise 3: Resistance Band Side Steps 

1. Place a light resistance band around your ankles 

1. Stand facing a wall or counter for hand support 

1. Take small steps sideways toward your affected side 

1. The resistance will help activate muscles while providing sensory feedback to your brain 

1. Notice how the band helps your brain understand where your leg is moving 

1. Take 8-10 steps in each direction 

1. This exercise helps retrain your brain to accept weight on your affected side while improving integration of movement information 

Exercise 4: Heel-to-Toe Walking with Support 

1. Stand next to a wall or railing 

1. Place one foot directly in front of the other (heel touching toe) 

1. Walk slowly along the wall support 

1. If you had a cerebellar stroke, this helps with forward-backward control 

1. Practice for 10-20 steps, several times daily 

Phase 3: Progressive Independence (Weeks 5-6) 

Goal: Reduce support while maintaining safety 

Exercise 5: Standing Balance Challenges 

1. Stand near (but not touching) a wall or counter 

1. Gradually reduce hand support while maintaining position 

1. Practice weight shifts without holding on 

1. Have your caregiver positioned for immediate assistance 

1. Build up to 30-60 seconds of independent standing 

Exercise 6: Multi-Directional Stepping 

1. Stand with support available but not used 

1. Take deliberate steps in multiple directions: 

• Forward and backward 

• Side to side (especially toward affected side) 

• Diagonal movements 

1. Focus on controlled movements rather than speed 

1. This mimics real-world walking demands 

Advanced Techniques for Continued Progress 

Sensory Challenge Training 

As you progress, you can safely challenge your balance system by modifying sensory input: 

Visual Challenges: 

• Practice balance exercises with eyes closed (only with support) 

• Use dim lighting for some exercises 

• Focus on distant objects while moving 

Research indicates that training with reduced visual feedback can enhance the brain's capacity to integrate other sensory information for balance control (Kim & Jang, 2021). 

Surface Challenges: 

• Stand on different textures (carpet, tile) with support 

• Use a thin foam pad under your feet for increased challenge 

Resistance Band Progressions 

Resistance bands provide excellent feedback for balance training: 

Lateral Band Walks: 

1. Band around knees or ankles 

1. Side-stepping with emphasis on affected side 

1. Helps strengthen hip muscles crucial for balance (In et al., 2017) 

Ankle Strengthening: 

1. Band around affected foot 

1. Practice lifting foot toward body (dorsiflexion) 

1. Improves foot clearance during walking 

Working with Your Healthcare Team 

Questions to Ask Your Physical Therapist 

• "What type of stroke did I have, and how does it affect my balance?" 

• "How is my brain's ability to process balance information affected?" 

• "Which specific movements should I focus on?" 

• "How can I tell if my perception of instability matches my actual stability?" 

• "What does 'normal' balance integration look like for someone with my type of stroke?" 

• "How can I progress safely at home?" 

• "What warning signs should stop my exercises?" 

• "How often should I practice these exercises?" 

• "How will I know if my central integration is improving?" 

Red Flags: When to Stop and Seek Help 

Stop exercising immediately and contact your healthcare team if you experience: 

• Sudden dizziness or lightheadedness 

• Chest pain or shortness of breath 

• Sudden weakness or numbness 

• Severe headache 

• Any fall or near-fall during exercises 

• Persistent pain that doesn't resolve with rest 

Creating Your Support System 

For Caregivers: How to Help Safely 

During Exercises: 

• Stay within arm's reach during all balance activities 

• Learn proper techniques for assisting without taking over 

• Encourage attempts but prioritize safety 

• Be patient – balance recovery takes time 

• Celebrate small improvements 

Environmental Safety: 

• Remove tripping hazards from exercise areas 

• Ensure adequate lighting 

• Keep emergency contacts readily available 

• Have a phone nearby during exercise sessions 

Building Confidence 

Balance recovery is as much about rebuilding confidence as it is about physical improvement. The central integration challenge means that your perception of balance may lag behind your actual balance abilities. 

For Stroke Survivors: 

• Start with exercises that feel manageable 

• Progress slowly – there's no rush 

• Remember that feeling unstable doesn't always mean you ARE unstable 

• Focus on the quality of movement over quantity 

• Pay attention to the difference between how you think and what's happening 

• Some days your brain's integration will work better than others – this is normal 

• Celebrate every small victory 

Understanding the Perception Gap: Many stroke survivors experience a gap between their actual stability and how stable they feel. This happens because: 

• Your brain's integration system is still healing 

• Old balance patterns think "wrong" even when they're safe 

• Your brain may be overly cautious as a protective mechanism 

• Retraining integration takes time and repeated practice 

For Families: 

• Encourage without dismissing their concerns. 

• Understand that their fear may be based on how their brain is processing information, not just physical ability. 

• Learn about stroke recovery to better understand the challenges of integration. 

• Be patient with the pace of progress – brain retraining takes longer than muscle strengthening. 

• Help maintain a positive, hopeful environment. 

• Recognize that some complaints of "feeling off" are real neurological effects, not anxiety. 

Understanding the Timeline 

What to Expect 

Weeks 1-4: Focus on safety and fundamental movement patterns 

• May feel slow or frustrating 

• Your brain is relearning how to process balance information 

• Building foundation for future progress 

• Emphasis on proper technique 

• Normal to feel more unstable than you actually are 

Weeks 4-12: Gradual improvement in confidence and ability 

• Movements may feel more natural 

• Your perception of balance may start matching your actual stability better 

• Increased independence in some activities 

• Better awareness of balance challenges 

• Integration improvements may come in sudden improvements rather than gradual 

3-6 Months: More significant functional improvements 

• Better balance during daily activities 

• Improved central integration – your brain processes balance information more accurately 

• Increased confidence in various environments 

• Potential return to some previously enjoyed activities 

• Research shows that improvements in weight-shifting capacity can continue for months after stroke (de Haart et al., 2005) 

6+ Months: Continued refinement and adaptation 

• Integration of balance skills into daily life 

• Your brain's processing becomes more automatic and reliable 

• Possible return to community activities 

• Ongoing maintenance and improvement 

Important Note about Central Integration Recovery: Unlike muscle strength, which often improves gradually, central integration can improve in sudden leaps. You may experience several weeks of little change, followed by a period where everything suddenly feels much more normal. This is because your brain is building new networks, and they often "come online" all at once. 

Remember, recovery timelines vary significantly among individuals. Some people see improvements quickly, while others progress more gradually. Both patterns are standard, and central integration recovery doesn't always follow a predictable timeline. 

Adapting Exercises for Different Abilities 

For Those with Significant Weakness 

If you have a substantial weakness on your affected side: 

• Start all exercises in a sitting position 

• Use maximum support during standing exercises 

• Focus on weight awareness rather than weight-bearing 

• Progress very gradually with professional guidance 

For Those with Mild Impairments 

If your stroke effects are relatively mild: 

• You may progress through phases more quickly 

• Can incorporate more challenging balance tasks sooner 

• Should still maintain safety precautions 

• May benefit from community-based balance programs 

For Those with Visual or Cognitive Changes 

If stroke affected your vision or thinking: 

• May need modified instruction methods 

• Visual feedback training might be especially important 

• Exercises may need to be broken into smaller steps 

• Extra emphasis on safety and environmental awareness 

Integrating Balance Training into Daily Life 

Making Exercise a Habit 

Set Realistic Goals: 

• Start with 10-15 minutes daily 

• Focus on consistency over intensity 

• Link exercises to existing routines (after meals, before TV) 

Track Your Progress: 

• Keep a simple exercise log 

• Note improvements in confidence or ability 

• Share progress with your healthcare team 

Stay Motivated: 

• Connect exercises to meaningful activities (playing with grandchildren, returning to gardening) 

• Find an exercise partner when possible 

• Remind yourself that every session contributes to recovery 

Real-World Application 

The goal of balance training is to improve your ability to handle everyday activities safely: 

Around the House: 

• Getting dressed while standing 

• Reaching for items in cabinets 

• Walking on different surfaces 

• Navigating stairs safely 

In the Community: 

• Walking on uneven sidewalks 

• Managing crowds or busy environments 

• Getting in and out of vehicles 

• Participating in social activities 

Technology and Tools 

Helpful Apps and Devices 

While not essential, some technology can support your balance training: 

Balance Training Apps: 

• Some smartphone apps provide visual feedback for balance 

• Virtual reality systems (when available) can create safe practice environments 

• Always use technology as a supplement to, not replacement for, professional guidance 

Wearable Devices: 

• Activity trackers can monitor your daily movement 

• Some devices can detect falls and alert caregivers 

• Balance-specific devices may be recommended by your therapy team 

Home Modifications 

Simple changes to your environment can support balance training and daily safety: 

Lighting: 

• Ensure adequate lighting in all areas 

• Consider motion-activated lights for nighttime safety 

• Remove glare from reflective surfaces 

Surfaces: 

• Use non-slip mats in bathrooms 

• Secure loose rugs or remove them entirely 

• Ensure clear pathways throughout your home 

Support Systems: 

• Install grab bars in bathrooms 

• Consider railings on both sides of stairs 

• Arrange furniture to provide support paths when needed 

Emotional Aspects of Balance Recovery 

Dealing with Fear of Falling 

Fear of falling is common and understandable after stroke. However, excessive fear can actually increase fall risk by causing you to move in overly cautious ways that aren't natural or stable. 

Understanding the Fear-Integration Connection: 

Much of the fear after stroke comes from the central integration problem. Your brain may be sending "danger" signals even when you're actually stable. This creates a challenging cycle: 

• Your brain perceives danger when there isn't any 

• You avoid certain movements or positions 

• Your brain never gets the chance to relearn that these movements are safe 

• The fear and misperception continue 

Strategies for Managing Fear: 

• Start with exercises that feel safe and build confidence gradually 

• Learn to distinguish between "feeling unstable" and "being unstable" 

• Practice relaxation techniques to manage anxiety 

• Focus on what you CAN do rather than limitations 

• Understand that your perception may be overly cautious as your brain heals 

• Work with a counselor if fear significantly impacts your daily life 

• Remember that controlled practice helps retrain your brain's threat detection system 

Building Mental Resilience 

Balance recovery requires patience and persistence: 

Expect Setbacks: 

• Some days will be more challenging than others 

• Fatigue, stress, or illness can temporarily affect balance 

• Setbacks don't mean you're losing progress 

Celebrate Progress: 

• Acknowledge improvements, even small ones 

• Share successes with family and healthcare team 

• Remember that recovery is often measured in months and years, not days 

Special Considerations 

If You Use Assistive Devices 

If you use a cane, walker, or other assistive device: 

• Balance training should complement, not replace, proper device use 

• Some exercises may be modified to incorporate your device 

• Never abandon prescribed assistive devices without consulting your therapy team 

• Focus on improving balance within the context of safe device use 

Returning to Physical Activities 

As your balance improves, you may want to return to previous physical activities: 

Safe Progression: 

• Discuss activity goals with your healthcare team 

• Consider modified versions of previous activities initially 

• Join stroke-specific exercise programs when available 

• Always prioritize safety over performance 

Long-Term Maintenance 

Balance training isn't just for early recovery – it's a lifelong practice: 

Ongoing Exercise: 

• Continue regular balance challenges to maintain improvements 

• Adapt exercises as your abilities change 

• Stay connected with healthcare providers for periodic assessment 

• Consider joining community-based maintenance programs 

Studies show that comprehensive balance training interventions can significantly increase limits of stability and reduce fall incidence when properly maintained over time (Chen et al., 2024). 

Resources and Support 

Finding Professional Help 

Physical Therapists: Specialize in movement and balance recovery Occupational Therapists: Focus on daily living skills and home safety Speech Therapists: May help if stroke affected communication during training Exercise Physiologists: Can design ongoing fitness programs 

Support Organizations 

American Stroke Association: Provides educational resources and local support groups Local Stroke Support Groups: Connect with other survivors and families Community Recreation Centers: May offer stroke-specific exercise programs Online Communities: Provide support and information sharing opportunities 

Educational Resources 

Books and Publications: Many excellent resources exist for stroke recovery Websites: Reputable medical websites provide ongoing education Workshops: Many communities offer stroke education programs Healthcare Provider Resources: Your team can recommend specific materials 

Moving Forward with Confidence 

Recovery after stroke is a journey, not a destination. Every person's path is different, and progress may come in unexpected ways. The key is to stay engaged in your recovery, work safely with proper support, and maintain hope for continued improvement. 

Remember that the brain's ability to adapt and recover continues for years after stroke. Many stroke survivors report continued improvements even months or years into their recovery journey. By staying active, challenging yourself safely, and working with your healthcare team, you're giving yourself the best possible chance for meaningful recovery. 

Your Next Steps 

1. Discuss this information with your healthcare team 

1. Start with the safest, most basic exercises 

1. Progress gradually with proper supervision 

1. Stay consistent with your practice 

1. Celebrate every improvement, no matter how small 

Balance recovery after stroke is challenging, but with patience, proper guidance, and consistent effort, significant improvements are possible. You're not alone in this journey – your healthcare team, family, and fellow stroke survivors are all part of your support system. 

Trust in your body's ability to adapt and recover. Research demonstrates that the brain's neuroplasticity allows for continued improvement even months or years after stroke (Seo et al., 2019). With time, practice, and the right approach, you can regain confidence in your balance and return to many of the activities that bring meaning to your life. 

 

References 

Bonan, I. V., Colle, F. M., Guichard, J. P., Vicaut, E., Eisenfisz, M., Tran Ba Huy, P., & Yelnik, A. P. (2004). Reliance on visual information after stroke. Part I: Balance on complex postures. Archives of Physical Medicine and Rehabilitation, 85(2), 268-273. 

Bonan, I. V., Leblong, E., Leplaideur, S., Laviolle, B., Tassel Ponche, S., & Yelnik, A. P. (2012). Sensory reweighting in controls and stroke patients. Clinical Neurophysiology, 123(10), 2020-2025. 

Chen, K., Zhu, S., Tang, Y., Lan, F., & Liu, Z. (2024). Advances in balance training to prevent falls in stroke patients: a scoping review. Frontiers in Neurology, 15, 1167954. 

de Haart, M., Geurts, A. C., Dault, M. C., Nienhuis, B., & Duysens, J. (2005). Restoration of weight-shifting capacity in patients with postacute stroke: a rehabilitation cohort study. Archives of Physical Medicine and Rehabilitation, 86(4), 755-762. 

Hwang, W. J., Kim, J. H., Jeon, S. H., & Chung, Y. (2018). Assessment of weight shift direction in chronic stroke patients. Journal of Physical Therapy Science, 30(8), 1099-1103. 

In, T., Jin, Y., Jung, K., & Cho, H. Y. (2017). Treadmill training with Thera-Band improves motor function, gait and balance in stroke patients. NeuroRehabilitation, 40(1), 109-114. 

Inoue, S., Otaka, Y., Kumagai, M., Sugasawa, M., Mori, N., & Kondo, K. (2022). Effects of balance exercise assist robot training for patients with hemiparetic stroke: a randomized controlled trial. Journal of NeuroEngineering and Rehabilitation, 19(1), 12. 

Kannan, L., Vora, J., Varas-Diaz, G., Bhatt, T., & Hughes, S. (2021). Does exercise-based conventional training improve reactive balance control among people with chronic stroke? Brain Sciences, 11(1), 2. 

Khan, F., & Chevidikunnan, M. F. (2021). Prevalence of balance impairment and factors associated with balance among patients with stroke. A cross sectional retrospective case control study. Healthcare, 9(3), 320. 

Kim, K. H., & Jang, S. H. (2021). Impact of sensory integration training on balance among stroke patients. Journal of Physical Therapy Science, 29(2), 264-269. 

Lee, H. J., & Choi, W. (2021). Multi-sensorimotor training improves proprioception and balance in subacute stroke patients: A randomized controlled pilot trial. Frontiers in Neurology, 10, 157. 

Liao, W. C., Lai, C. L., Hsu, P. S., Chen, K. C., & Wang, C. H. (2018). Different weight shift trainings can improve the balance performance of patients with a chronic stroke: a randomized controlled trial. Medicine, 97(49), e13207. 

Mansfield, A., Schinkel-Ivy, A., Danells, C. J., Aqui, A., Aryan, R., Biasin, L., ... & Inness, E. L. (2017). Does perturbation training prevent falls after discharge from stroke rehabilitation? A prospective cohort study with historical control. Journal of Stroke and Cerebrovascular Diseases, 26(9), 2174-2180. 

Navarro-Orozco, D., & Sánchez-Manso, J. C. (2019). Neuroanatomy, Middle Cerebral Artery. In StatPearls. StatPearls Publishing. 

Park, B. S., Noh, J. H., Lee, J. H., Shin, H. I., & Lee, J. (2022). Effects of multi-directional step exercise with weight-shifting as an adjunct to conventional exercises on balance and gait in stroke patients. Scientific Reports, 12(1), 14186. 

Quijoux, F., Nicolaï, A., Chairi, I., Bargiotas, I., Ricard, D., Yelnik, A., ... & Bertin-Hugault, F. (2021). A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open-access code. Physiological Reports, 9(22), e15067. 

Roelofs, J. M. B., van Heugten, K., de Kam, D., Weerdesteyn, V., & Geurts, A. C. H. (2018). Relationships between affected-leg motor impairment, postural asymmetry, and impaired body sway control after unilateral supratentorial stroke. Neurorehabilitation and Neural Repair, 32(11), 953-960. 

Seo, K. C., Park, S. H., & Park, K. (2019). Effects of proprioception training with exercise imagery on balance ability of stroke patients. Journal of Physical Therapy Science, 27(1), 1-4.