Effectiveness of the Otago exercise programme in reducing fall risk in stroke survivors: A case study

Background: Stroke is one of the leading causes of long-term disability worldwide. Depending on the affected region of the brain, a stroke can cause a wide range of functional deficits, with motor impairments being among the most prominent. Evaluating balance and gait abnormalities is crucial as post-stroke survivors often experience significant impairments, leading to a high risk of falls and compromised independence. The Otago exercise programme (OEP) focuses on 3 key components: muscle strengthening, balance training, and walking. Therefore, this study aimed to investigate the effectiveness of the OEP in reducing fall risk among stroke survivors.
Case: A 68-year-old male with a history of right-sided ischemic stroke presented to the clinic with complaints of persistent imbalance, frequent near-falls, and difficulty initiating walking, especially on uneven surfaces. He also reported unsteadiness during routine activities such as standing and walking. On neurological examination, he exhibited mild spasticity in the left upper and lower limbs, moderate motor impairment in the left lower limb (Fugl-Meyer score: 23/34), and mild dysmetria on coordination testing. Balance assessment revealed difficulty in standing with eyes closed and a narrow base of support, inability to maintain tandem stance with eyes closed, reduced time on single-leg stance (especially on the left), and impaired heel and toe walking. The Tinetti Performance-Oriented Mobility Assessment score was 14/28, and the Dynamic Gait Index score was 13/24, both indicating a high fall risk. The patient underwent eight weeks of rehabilitation, which included 45-minute physiotherapy sessions for three days per week. The OEP included five strengthening exercises, 12 balance exercises, and a walking programme. Outcome measures were recorded on day 1, at the end of week 4, and at the end of week 8. The outcome measures were evaluated using the 30-Second Chair Stand Test (CST), Four-Stage Balance Test (FSBT), Timed Up and Go test (TUG), and Dynamic Gait Index (DGI). Post-intervention after 8 weeks, FSBT, 30-second CST, TUG test and DGI scores were improved by 8 points (pre-3 seconds, post-11 seconds), 7 points (pre-15seconds, post-8seconds), 7 points (pre-17seconds, post-10seconds) and 6 points (pre-13/24, post-19/24), respectively. The patient could perform standing with eyes closed and a narrow base of support, turning around and standing on one foot, and walking on toes and heels after eight weeks.
Conclusions: This case study concludes that the Otago exercise programme can be beneficial and safe for stroke survivors in reducing fall risk and improving balance and gait.