Hemiplegia rehabilitation is a long and demanding process, but with the right approach and patience, it is possible to regain lost functions and improve quality of life. Balance plays a critical role in helping stroke survivors regain independence. This randomized controlled study aims to compare the effects of balance exercises and video-based exergame training, in addition to conventional physiotherapy, on lower extremity functionality, balance, gait, daily living activities, quality of life, and fear of falling in patients with hemiplegia following stroke.

A minimum of 30 eligible participants will be randomly assigned to two groups:

Group 1 (Balance Exercise Group): Conventional physiotherapy plus balance exercises.

Group 2 (Exergame Group): Conventional physiotherapy plus video-based exergame sessions using the Nintendo Switch Ring Fit Adventure.

Both interventions will be conducted twice a week for four weeks under the supervision of a physiotherapist. Assessments will be performed before and after the intervention using standardized scales.

Hemiplegia rehabilitation is not only a process of regaining lost motor functions but also a journey toward restoring independence and self-confidence. Balance improvement is one of the key components of this process, as it directly influences gait, mobility, and daily life participation. With technological advancements, exergame-based interventions have emerged as engaging and motivating tools that can complement traditional rehabilitation programs.

This study aims to compare the effectiveness of balance exercise training and exergame-based exercise programs when added to conventional physiotherapy in stroke patients with hemiplegia. Participants who meet the inclusion criteria and provide informed consent will be randomly allocated into two groups (n ≥ 15 per group).

Group 1 (Balance Exercise Group): Participants will perform balance exercises twice a week for four weeks, in addition to their conventional physiotherapy program, under the supervision of a physiotherapist.

Group 2 (Exergame Group): Participants will perform exergame sessions using Nintendo Switch Ring Fit Adventure twice a week for four weeks, alongside the same conventional physiotherapy program.

Outcome measures:

Lower extremity motor function: Fugl-Meyer Assessment for Lower Extremity Balance: Berg Balance Scale Functional mobility and gait: Functional Reach Test, Timed Up and Go Test, 10-Meter Walk Test Activities of daily living: Modified Barthel Index Quality of life: Stroke Impact Scale Fear of falling: Falls Efficacy Scale-International Assessments will be conducted at baseline and after the four-week intervention. Data analysis will be performed using the Statistical Package for Social Sciences (SPSS). Continuous variables will be expressed as mean ± standard deviation, and categorical variables as frequency and percentage. Depending on the normality of data distribution, appropriate parametric or non-parametric tests will be applied, with the level of significance set at p ≤ 0.05.

Inclusion Criteria:

• Aged between 25 and 70 years.
• Have experienced either hemorrhagic or ischemic stroke.
• At least six months have passed since the stroke event.
• Have a Modified Rankin Scale score of 2 or 3.
• Able to stand independently.
• Able to walk at least 10 meters independently or with an assistive device.
• Able to sit and stand up independently.
• Have a Brunnstrom stage of at least 4 in both upper and lower extremities.
• Have a Brunnstrom stage of at least 3 in the hand.
• Have a Mini-Mental State Examination score greater than 24.
• Willing to voluntarily participate in the study.

Exclusion Criteria:

• History of more than one stroke.
• Participation in another exercise or rehabilitation program.
• Body Mass Index greater than 29.9.
• Cognitive, visual, or auditory impairments that interfere with -communication.
• Presence of other neurological disorders such as multiple sclerosis, Parkinson's disease, or spinal cord injury.
• Vestibular system disorders affecting balance (e.g., vertigo, CANVAS syndrome).
• Severe contractures, joint complications affecting movement, recent fractures, arthritis, or use of medications that may impair physical function.