Table 1.

Rehabilitation programs after stroke for postural imbalance, proprioception, and dual-task training. Characteristics and outcomes of studies included in the systematic review, according to PICOS criteria for inclusion of studies.

Authors, yr	Study Design	Sample Size, y	Months after Stroke	Outcomes Measure	Rehabilitative Therapy	Duration Therapy	Exercise Description	Results after Therapy
Ada 2003 [25]	CLT	A: 13 p B: 14 p 66 ± 11 y	>6	Walking speed, distance, step length, step width, cadence, SA-SIP30	A: Cognitive task and walking program B: Home exercises	3 d/w, for 4 w	Cognitive task on treadmill and overground walking program for 30 min. Proprioceptive group walked around an outdoor circuit, such as curbs, slopes, stairs, and rough terrain, while performing a cognitive dual-task. The cognitive task consisted of matching the word “red” with the response “yes” or the word “blue” with the response “no”. For the control group: home exercise program, such as stretching and strengthening exercises of lower limbs and training for balance and coordination.	Effectiveness of treadmill and overground walking training. Gain of 18 cm/s in stroke patients
An 2014 [13]	CLT	A: 12 p B: 12 p C: 12 p	Chronic stroke	STI, WDI with open and closed eyes, TUG, FSST, 10 MWT	A: Motor DT gait training B: Cognitive DT gait training C: Motor and cognition DT gait training	3 d/w, for 8 w	Fifteen minutes of walking on the treadmill, with motor or cognitive tasks or both types of tasks (30′). The motor tasks included: “tossing up and catching a ball”, “rehanging loops on different hooks”, “doing up buttons after unbuttoning”, “holding a cup of water without spilling it”, and “receiving and returning a cup of water”. Dual cognitive tasks included: “discerning colours”, “mathematical subtraction”, “verbal analogical reasoning”, “spelling words backward” and “counting backward”.	Motor and cognitive DT training improved motor performance and balance and gait abilities
Baek 2021 [18]	CLT	A:17 p B: 17 p	Chronic stroke	Gait parameters (speed, stride, variability, and cadence), CRR, DTC, FES	A: Gait training on a treadmill and cognitive task exercises at the same time B: Separately, first gait training on a treadmill, then cognitive task exercises	2 d/w, For 6 w	Sixty minutes of treadmill training with a cognitive task: serial subtraction by three from two-digit numbers randomly selected	Dual-task gait treadmill training was more effective in improving gait ability in dual-task training and dual-task interference than single-task training involving gait and cognitive tasks separately in subjects with chronic stroke
Cho 2015 [21]	CLT	A: 11 p 60.0 y B: 11 p 58.6 y	Chronic stroke patients A: 273.9 d B: 263.9 d	Spatio-temporal gait parameters: speed, cadence, step and stride length	A: Virtual reality training with cognitive task B: Virtual reality treadmill training	5 d/w, for 4 w	The standard rehabilitation program consisted of physical and occupational therapies. Thirty minutes/session of treadmill and cognitive tasks (memory, arithmetic, and verbal tasks)	Effectiveness of virtual reality training with cognitive load L on walking function under the dual-task condition
Choi 2014 [37]	CLT	A: 19 p 49.1 11.9 B: 18 p 49.2 ± 7.05 y	18.2 ± 5.7	TUG, sway velocity	A: Cognitive–motor dual-task B: Single-task training	3 d/w, for 4 w	The dual cognitive–motor task group performed rehabilitation for 15 min with a random auditory cue while walking on a treadmill. The sound of a bell was the auditory cue indicating that the participants should move the circle ring from side to side. The single-task group walked on the treadmill. Conventional physical therapy included progressive resistance exercise and postural control, neurodevelopment and occupational training, Brunnstrom movements, and proprioceptive neuromuscular facilitation techniques.	Cognitive and motor dual-task training and auditory cues improved balance
Fishbein 2019 [19]	CLT	A: 11 p B: 11 p 65.2 ± 9 y	>12	10 MWT, TUG, FRT LRT-L/R, ABC, BBS	A: DT training B: Single-task treadmill walking	2 d/w, for 4 w	Mobilisation and flexibility exercises for 8 min and walking around for 3 min, treadmill for 3 min. Subsequently, the single-task group walked for 20 min, and the dual-task training group, while walking for 20 min, trained with 3 virtual games: hit the virtual ball, touch the virtual boxes, clean the virtual windows	Improvements in BBS, FRT, LRT-L/R, 10 MWT, ABC in A group; in gait variables. No changes in TUG.
Her 2011 [14]	RS	A: 12 p B: 13 p C: 13 p 64.8 ± 5.2 y	>12	BBS, FIM, centre of pressure	A: MDT B: CDT C: MCDT	3 d/w, for 6 w	Group A: Exercises comprising motor tasks for 30 min, such as exchanging a ball, receiving a ball with a basket, bouncing a ball on the floor, and holding a glass with water and exchanging a water glass while maintaining balance on an unstable balance pad. Group B: Exercises of cognitive tasks such as counting backwards, calculating two subtractions, calling the correct names of objects, and reciting words in reverse order while maintaining balance. Group C: Motor and cognitive exercises with postural control task.	To obtain improvement in balance and gait, both motor and cognitive DT were needed, not only motor or cognitive DT alone.
Hong 2020 [34]	CLT	A: 8 p 56.6 ± 8.7 y B: 9 p 66.2 ± 11.5 y	>6	TUG, BBS	A: CDT B: General task group	3 d/w for 4 w	Exercises with a cognitive task for 30 min. The program consisted of maintaining a standing posture while moving the lower extremity of the less-affected side toward the 3 flexion directions of the hip joint and then moving it back in place.	Cognitive task training is a more effective intervention method to improve balance and gait ability after stroke.
Iqbal 2020 [33]	CLT	A: 32 p 58.2 ± 7.13 y B: 32 p 58.8 ± 6.13 y	Chronic stroke	Step length, stride length, 10 MWT, TUG, cycle time, cadence	A: Motor dual-task training B: Conventional training	4 d/w for 4 w	Motor dual-task with exercises were conducted for 40 min. Slowly walking backward, sideways, and forward on a smooth surface while holding a 100 gm sandbag.	Conventional physical therapy and dual-task training effectively improved the gait ability of chronic stroke patients, who showed a significant improvement in all spatial and temporal gait variables.
Kannan 2019 [35]	CLT	A: 13 p B: 12 p 59.2 ± 6.3 y	>3	TUG, 6 MWT, ABC, BBS	A: High-intensity, tapered motor and cognitive rehabilitation B: Conventional balance rehabilitation	10 sessions, for 6 w	The cognitive tasks and proprioceptive exercises included four Wii Fit games played for 5 min. The control group performed balance training exercises for 90 min: 10 min of stretching, 15 min of functional stretching, 35 min of balance training, and 10–15 min of treadmill walking. The cognitive tasks included: training for semantic memory (i.e., recite as many types of animals as they could within the time limit provided), verbal fluency (i.e., participants recited words that began with the letter provided, such as “A”, while avoiding saying proper nouns), abstract memory (i.e., participants completed phrases according to the relationship of the cue in the sentence), and repetition of letters.	Effectiveness of cognitive and motor rehabilitation in improving balance control and cognition
Kim 2013 [26]	RS	A:14 p B: 15 p 56.4 ± 12.3 y	7 ± 2.4 m	Cadence, speed, step time, cycle time, step length, stride length	A: Conservative physical therapy B: Dual-motor task training	5 d/w, for 4 w	Neurological developmental treatment for 30 min. The motor dual-task training included passive and active resistance exercises and exercises for coordination, motor sensation, and balance. The proprioceptive neuromuscular facilitation lower limb patterns consisted of: flexion–adduction–external rotation knee flexion or extension–adduction–external rotation knee extension. Dual-task: rising from a chair from the sitting position while picking up plastic cups that lay in front of the feet, then slowly walking forward, sideways, and backward on a flat surface while holding a 100 g sandbag against the affected wrist and going up and down a ramp or stairs while transferring cups from tables of different heights located beside the ramp or stairs in consecutive order.	Improvement in temporal (cadence, speed, step time, and cycle time) and spatial parameters (step length and stride length) in a DT group
Kim 2014 [32]	RS	A: 10 p B: 10 p 68.5 ± 7.8 y	17.9 ± 13	Stroop test, TUG, 10 MWT, F8WT	A: Traditional rehabilitation program B: Traditional rehabilitation program + DT training	A: 5 d/w 1 w B: 3 d/w, 4 w	Motor dual-task training was conducted for 30 min and consisted of words written using inks of various colours, with the subjects having to state the colour of the ink and gait tasks, which included walking on a level surface, walking while changing gait speeds, walking with vertical or horizontal head turns, walking with pivot turns, stepping over or around obstacles, and walking up and downstairs.	Improvement in cognitive skills and gait after DT training
Kim 2016 [40]	RS	A: 10 p B: 10 p 68.5 ± 3.1 y	10.9 ± 1.1	BBS, 5-Times Sit-to-Stand Test, Functional Reach Test, TUG, 10 MWT, FGA	A: Neurodevelopmental treatment + aquatic dual-task training B: Neurodevelopmental treatment	5 d/w, for 6 w	Aquatic motor dual-task training for 30 min a day, including stability exercises, such as standing with eyes closed, stability exercise while playing catch with the therapist, walking 10 m at a comfortable speed, and walking 10 m at a comfortable speed while holding a 200 mL cup of water	Improvement in balance and gait after aquatic DT training
Kim 2018 [22]	CLT	A: 13 p 52.62 ± 9.84 y B: 13 p 56.15 ± 10.82 y	Chronic stroke	Speed, cadence, single support time, stride length, 10-MWT	A: Progressive treadmill cognitive dual-task gait training B: Conventional treadmill gait training	5 d/w, for 4 w	Thirty minutes of treadmill exercises with cognitive dual-task: speaking numbers task, arithmetic subtraction, memory task, and verbal fluency	Progressive treadmill cognitive dual-task gait training had a positive influence on the gait and clinical gait.
Lee 2015 [27]	RS	A: 18 p B: 18 p 28 p < 65 y 8 p > 65 y	11.5 ± 1.9	BBS, TUG, joint position sense	A: Motor imagery exercises for 5′ and proprioceptive rehabilitation for 25′ B: Proprioceptive rehabilitation for 30′	5 d/w, for 8 w	Motor image training and proprioceptive training for 30 min included exercises on a balance pad with 5 different tasks. The program included: standing with the support position of two feet and standing upright by moving both heels up and down. Stretching and eyes-closed exercises, balance board exercises shifting weight left and right and forward and backward to the maximum, and sitting and standing on a balance board	Improvements in K-BBS, TUG, weight-bearing ratio, and joint position sense error in group A > B
Meester 2019 [23]	CLT	A: 26 p 60.85 ± 14.86 y B: 24 p 62.25 ± 15.53 y	>6 months	SF-36, EuroQol-5D-5L, PASE, step activity.	A: Traditional treadmill B: Treadmill with dual-task	2 d/w, for 10 w	Thirty-minute treadmill program at an aerobic training intensity with dual-task: listening task or talking about planning daily activities	Walking with specific additional cognitive distraction (dual-task training) might increase activity more over 12 weeks.
Pang 2018 [28]	CLT	A: 25 p B: 28 p 61.2 ± 6.4 y	75.3 ± 64.9	ABC, Frenchay Activities Index, Stroke-specific Quality of Life Scale	A: DT balance/mobility training B: Single-task balance/mobility training	1 d/w, for 8 w	For 60 min a week, the motor dual-task program included walking combined with verbal fluency and with serial-3-subtractions and the timed up and go test combined with verbal fluency.	After DT rehabilitation, improvement in speed, reduction in falls, and no improvement in social participation and quality of life
Plummer 2021 [29]	CLT	A: 18 p B: 18 p	<3 years	Gait speed, cognitive task performance	A: Dual-task gait training B: Single-task gait training on cognitive–motor dual-task	3 d/w for 4 w	Cognitive task performance during walking included spontaneous speech, arithmetic word, backward spelling, working memory, random number, calculating time, backward numbers, and naming opposites. The exercises lasted 60 min.	Both single- and dual-task gait training improved single- and dual-task gait speed but did not change the amount of relative interference.
Saleh 2019 [36]	CLT	A: 25 p B: 25 p 49.7 ± 1.8 y	9.02 ± 1.8	Stability index, speed, step length, time of support on limb	A: Motor DT in water B: Motor DT on land	3 d/w, for 6 w	The dual-motor task training included exercises performed during walking: holding a ball, holding a 200 mL cup of water and standing on a balance board, walking forward, walking sideways and walking backward in each condition, and transferring coins from one pocket to another. The exercises lasted 45 min.	Improvement in anteroposterior and mediolateral stability index, speed, step length, and time of support on the affected limb after water exercises
Subramaniam 2014 [30]	RS	8 p 51.75 y	6.1 ± 4	BBS, TUG, IMI Reaction time, speed, maximum excursion, directional control	Virtual reality balance training in DT	110′/d, for 5 d consecutive	Cognitive motor dual-task training for balance in virtual reality consisted of 110 min of balance board games: table tilt, tightrope, soccer, and balance bubble, played while performing cognitive tasks, such as memory tasks, word list generation, letter–number sequencing, and question–answer and memory recall games.	Improvement in balance after DT rehabilitation
Timmermans 2016 [20]	CLT	A: 20 p B: 20 p	>3 m	10 MWT, TUG, FAC, BBS, ABC	A: Treadmill-based C-Mill therapy B: Overground Falls program	2 d/w, for 5 w	A group performed cognitive–motor dual-task training: the C-Mill treadmill training program, which consisted of 1.5 h each session, twice a w for 5 w. It included practising avoidance of visual obstacles, practising accurate positioning of the foot on a step-to-step basis, walking forwards in a regular or irregular sequence of visual stepping objectives, exercises to practise acceleration and deceleration while maintaining position, and playing a functional and interactive adaptability walking game. The FALLS program consisted of an overground therapy program to reduce the number of falls by practising walking adaptability. It included exercises to practise obstacle avoidance, exercises to practise foot placement while walking over uneven terrain, and tandem walking and slalom. These exercises were also performed under visual constraints.	Improvement after C-Mill therapy with respect to FALLS program
Timmermans 2021 [24]	CLT	A: 16 p 52 ± 13 y B: 17 p 59 ± 10 y	>3 months	Speed, 10 MWT	A: Treadmill-based C-Mill therapy B: Overground Falls program	2 d/w, for 5 w	Ninety minutes/session. A group performed cognitive–motor dual-task training: the C-Mill treadmill training program. The FALLS program for the other group consisted of exercises for walking adaptability.	Greater improvement in context-specific walking speed in C-Mill group
Yang 2007 [31]	CLT	A: 12 p B: 13 p 59.3 ± 11.8 y	64.5 ± 63.1	Speed, cadence, stride time, stride length, temporal symmetry index	A: Ball exercise program B: No rehabilitation training	3 d/w for 4 w	Motor dual-task program: 30 min of gait training while manipulating 1 or 2 balls with diameters of 45, 55, 85, and 95 cm and a basketball. The training program included walking while holding 1 or 2 balls in both hands, walking to adapt to the rhythm of bouncing 1 ball with 1 hand or both hands, walking while holding 1 ball in 1 hand and simultaneously kicking another ball from basketball into a net, and walking while bouncing a ball with both hands. Three motor tasks of simple walking included walking with buttoning task and walking with the task of carrying a cup on a tray.	Walking ability was significantly improved after training. Gain of ba29.74 cm/s.

Patients post stroke: p; group A: A; group B: B; group C: C; years old: y; female: f; male: m; years: y; days: d; hours: h; months: m; minutes: min; weeks: w; clinical trial: CLT; observational study: OS; dual-task: DT; task-specific motor relearning program: MRP; electromyography: EMG; retrospective study: RT; Motor Assessment Scale: MAS; the Sødring Motor Evaluation Scale: SMES; Nottingham Health Profile: NHP; stability test index: STI; weight distribution index: WDI; timed up and go test: TUG; four square step test: FSST; 10 m walk test: 10MWT; 6 min walking test: 6 MWT; Berg Balance Scale: BBS; Activity-specific Balance Confidence: ABC; Functional Ambulation Category: FAC; Functional Reach Test: FRT; Lateral Reach Test Left/Right: LRT-L/R; One-Leg Stand Test: OLST; Intrinsic Motivation Inventory: IMI; Functional Gait Assessment: FGA; Figure-of-8 Walk Test: F8WT; Subjective Index of Physical and Social Outcome: SIPSO; stroke-adapted 30-item version of the Sickness Impact Profile: SA-SIP30; Medical Research Council scale: MRC; Fugl-Meyer Upper Extremity scale: F-M UE; Functional Independence Measure scale: FIM; correct response rate: CRR; dual-task cost: DTC; Fall Efficacy Scale: FES; Rivermead Mobility Index: RMI; Range of Motion: ROM; Physical Activity Scale for Elderly: PASE.