Effects of Combined Otago Exercises and Perturbation-Based Training versus Mirror-Based Cawthorne-Cooksey Exercises on Balance and Anticipatory Control in Post-Stroke Patients: A Randomized Clinical Trial

Background: Stroke is a leading cause of long-term disability and is often associated with impaired anticipatory postural control, poor balance, gait instability, and increased fall risk. These impairments reduce functional independence and quality of life in stroke survivors. Various rehabilitation approaches, including Otago exercises, perturbation-based training, Cawthorne-Cooksey exercises, and mirror therapy, are commonly used to improve balance and postural stability. Objective: To evaluate and compare the effectiveness of combined Otago exercise and perturbation-based training with mirror-based Cawthorne-Cooksey exercises on balance and anticipatory postural control in stroke patients. Methodology: A randomised clinical trial was conducted on 34 stroke survivors, with seventeen participants receiving combined Otago exercise and perturbation-based training, while others underwent mirror-based Cawthorne-Cooksey exercises. Participants were eligible if they had a first-ever ischemic or hemorrhagic stroke occurring at least three months before enrollment, were between 40 and 75 years of age, could stand and ambulate independently or with an assistive device, and had sufficient cognitive and communication abilities to follow instructions and medical clearance for participation in exercise-based rehabilitation. Patients with Parkinson’s disease, having severe cognitive impairment, uncontrolled cardiovascular or severe musculoskeletal disorders, severe spasticity, contractures, or impaired motor control, and inability to stand independently for at least 30 seconds or walk 10 meters, even with support, were excluded. Outcome measures included the Berg Balance Scale and Mini-Balance Evaluation Systems Test, which were assessed at baseline and post-intervention. Results: The findings demonstrated significantly greater improvement in the experimental group. The mean Berg Balance score improved to 43.41±3.72 compared to 40.00±3.42 in the control group (p=0.009). Similarly, Mini-BESTest scores were significantly higher in the experimental group (22.05±1.81) than in the control group (20.11±1.72; p=0.003). Conclusion: Combined Otago exercise and perturbation-based training was more effective than mirror-based Cawthorne-Cooksey exercises in improving balance and anticipatory postural control among post-stroke patients.