Home›Neurology› Square-stepping exercise may improve balance, gait, and cognition after stroke
Square-stepping exercise may improve balance, gait, and cognition after strokeSquare-stepping exercise may improve balance and thinking after stroke
Frontiers in MedicinePublished October 12, 2026DOI ↗Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain
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Key Takeaway
Interpret SSE evidence as exploratory: motor and cognitive gains are suggested but unquantified.
This scoping review synthesizes 7 studies on square-stepping exercise (SSE) in patients with stroke. SSE is a cognitive-motor training approach that involves stepping patterns on a gridded mat. The review's scope covers motor and cognitive outcomes, including balance, gait function, risk of falls, global cognitive function, executive function, and attention.
The authors report that SSE may improve balance and gait function, may reduce the risk of falls, and may improve global cognitive function, including executive function and attention. No effect sizes, absolute numbers, p-values, or confidence intervals were reported for any outcome. The comparator, primary outcome, follow-up duration, and setting were not reported.
Safety data were not reported: adverse events, serious adverse events, discontinuations, and tolerability were all absent from the reviewed evidence. Funding and conflicts of interest were also not reported.
The authors note that research remains at an exploratory stage. The review does not establish causality, and the certainty of the evidence was not reported. Practice relevance is framed cautiously: SSE may help improve motor and cognitive function in patients with stroke, but the current evidence base is insufficient to support firm clinical recommendations.
How this fits prior evidence
This scoping review extends prior coverage of rehabilitation approaches in stroke, including Gua Sha as an add-on to standard rehabilitation and robotic-assisted therapy for gait and upper-limb function. Like those findings, the SSE evidence points toward potential motor benefits but remains limited. The review also touches on cognitive outcomes, a domain less represented in prior coverage focused on functional recovery and biomarkers such as neurofilament light chain. No prior item addressed square-stepping exercise specifically, so this review addresses a gap in synthesized evidence for this intervention.
Living with the aftermath of a stroke often means facing daily challenges with movement and mental clarity. For many, the goal is simply to regain a sense of stability and stay safe while moving around at home. New research looks at how a specific exercise called square-stepping might help with these exact hurdles.
Researchers looked at several studies involving people who had suffered a stroke. They found that square-stepping exercise may improve balance and gait, which is the way a person walks. It may also help lower the risk of falling. Beyond physical movement, the exercise might help with cognitive functions, including things like attention and executive function, which helps the brain plan and complete tasks.
While these results are encouraging, it is important to remember that the research is still in an early, exploratory stage. Because the evidence is not yet extensive, these findings show potential rather than a guaranteed outcome. Talk to a doctor or physical therapist to see if this specific exercise is right for your recovery plan.
What this means for you:
Square-stepping exercise may improve balance, walking, and mental focus for people recovering from a stroke.
Common questions
What is square-stepping exercise and how does it help?
Square-stepping exercise is a specific movement routine. The research suggests it may help people who have had a stroke improve their balance and gait function. It may also help improve cognitive functions, such as attention and executive function, which are important for daily mental tasks.
Can this exercise help prevent falls after a stroke?
The findings indicate that square-stepping exercise may reduce the risk of falls for patients who have had a stroke. By improving balance and gait, it may help make movement safer. However, because the research is in an exploratory stage, you should consult a healthcare professional.
Does this exercise help with memory or thinking after a stroke?
Yes, the research suggests that square-stepping may improve global cognitive function. This includes specific areas like executive function and attention. These are the mental processes that help people focus and manage tasks after a stroke.
BackgroundSquare-stepping exercise (SSE) is a form of dual-task training that has been used in studies involving patients with stroke. This scoping review provides an overview of the intervention protocols and outcomes reported in studies examining the use of SSE among patients with stroke.MethodsPubMed, Embase, Web of Science, The Cochrane Library, CINAHL, CNKI, SinoMed, Wanfang Data, and the VIP Database were searched for studies published from 2006, when the first study on SSE was published, to April 30, 2026. A total of 459 records were identified, of which seven met the eligibility criteria and were included in the final analysis.ResultsA total of seven studies were included. The intervention types included face-to-face and hybrid interventions. The duration of a single session was generally 30 min, the frequency was mostly 3–5 times per week, and the intervention period ranged from 6 to 24 weeks. The outcome measures primarily covered two domains: motor function and cognitive function. The findings suggested that SSE may improve balance and gait function in patients with stroke and may reduce the risk of falls. In addition, SSE may improve global cognitive function, including executive function and attention.ConclusionSSE may help improve motor and cognitive function in patients with stroke, but related research remains at an exploratory stage. Future research should include large-scale, multicenter studies with long-term follow-up to further clarify its long-term effects and optimal intervention protocol, explore remotely delivered SSE interventions, and promote the standardized implementation and dissemination of SSE in stroke rehabilitation.
