Balance and fall prevention post-stroke

1. Case. A 70-year-old man, 5 months post-stroke. Two falls in the past month, both indoors, both turning. Berg 41/56. FGA 14/30. He uses a cane outdoors only.

2. CPG section. AHA/ASA 2016 recommends balance training and fall prevention as part of comprehensive stroke rehabilitation (Class I). Core Set CPG (Moore 2018) recommends the Berg Balance Scale (strong, Level I) for static and dynamic standing balance and the FGA (moderate, Level I) for walking balance, plus the Activities-specific Balance Confidence Scale (strong, Level I) for confidence.

3. Reasoning walkthrough. Two falls in one month while turning is a recurring-fall pattern. Combined Berg 41/FGA 14 signals elevated fall risk. Berg ≤45 in older adults predicts higher fall probability (Shumway-Cook A et al. *Phys Ther*. 1997;77:812–819). For the FGA in mixed older-adult populations, scores below 22/30 are associated with falls history (Wrisley DM, Kumar NA. *Phys Ther*. 2010;90:761–773); stroke-specific work supports a cutoff of ≥20/30 to distinguish stroke from healthy adults (Wu et al., *BMC Neurol*. 2025). Training plan: turning practice, dual-task gait, dynamic standing with anticipatory and reactive components. The Locomotor CPG's strong recommendation against isolated static balance training (without VR) applies — embed balance in stepping and turning tasks.

4. Outcome measure. Berg + FGA, plus ABC for balance confidence. Berg MDC acute stroke 7 (Stevenson 2001); chronic stroke 4.66–6.7 (Hiengkaew V et al., *Arch Phys Med Rehabil*. 2012; Liaw LJ et al., *Disabil Rehabil*. 2008). FGA stroke MDC = 4 points (Lin JH et al., *Stroke*. 2010; per Core Set pocket guide).