Impact of Vestibular Rehabilitation and Dual-Task Training on Balance and Gait in Survivors of Stroke: A Systematic Review and Meta-Analysis.

Falls remain one of the more stubborn problems after stroke, and standard rehabilitation guidelines rarely address the inner ear based balance system directly, even though dizziness and balance problems are common in survivors. This review pooled results from randomized controlled trials testing vestibular rehabilitation therapy, which targets the balance organs and their connections to eye and body movement, and dual task training, which practices walking or balancing while doing another mental or physical task at the same time, in people who were months to years past their stroke. Across the pooled studies, vestibular rehabilitation showed a large improvement in balance, and this effect was strongest when the training was specifically balance focused rather than general exercise.

Dual task training showed a more modest but still meaningful improvement in gait compared with practicing tasks one at a time. The evidence is encouraging in direction, but the studies were quite different from one another in design and intensity, and the researchers describe this variability as a real limitation on how confidently the findings can be generalized.

If you or someone you know is recovering from a stroke months or years ago and still struggling with balance or unsteady walking, this review looked at whether specific types of therapy can help. Researchers combined results from several small clinical trials that tested vestibular rehabilitation, which is training aimed at the inner ear balance system, and dual task training, which means practicing walking while also doing something else, like counting or carrying an object, instead of practicing movements one at a time. Across these trials, people who did vestibular rehabilitation, especially programs focused specifically on balance, showed notably better balance than those who did not.

People who did dual task training showed some improvement in their walking compared with those who practiced tasks separately, though this improvement was more modest. It is worth understanding that this comes from a relatively small pool of research, only about ten to eleven trials involving just over five hundred people in total, and the studies varied quite a bit in how they were designed and delivered. That variation means the results, while promising, should be read as an early signal rather than a settled conclusion.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis pooled eleven randomized controlled trials for the systematic review (509 participants) and ten trials for the meta-analysis (413 participants) examining vestibular rehabilitation therapy and dual task training in late subacute and chronic stroke survivors, averaging 36 months post-stroke. Vestibular rehabilitation showed a large pooled effect on balance (standardized mean difference 0.64, 95% CI 0.44 to 0.85, p less than 0.00001), with an even larger effect isolated to balance-specific training subgroups (standardized mean difference 1.07, 95% CI 0.70 to 1.45, p equals 0.002).

Dual task training showed a moderate pooled effect on gait (standardized mean difference 0.46, 95% CI 0.18 to 0.74, p equals 0.001), outperforming single-task training comparisons. The authors explicitly note substantial heterogeneity across included studies, which limits confidence in the precision of these pooled estimates and suggests caution generalizing across the varied protocols, dosing, and outcome measures used. No adverse event data were reported in the abstract, so no safety conclusions can be drawn.

The review authors frame these findings as supporting probable rather than definitive benefit, and they identify optimal session frequency, duration, and program length as unresolved questions requiring further trials before firmer conclusions can be drawn.