This study compares two types of coordinative locomotor training - the sprinter coordination synergy and the skater coordination synergy - to improve balance and coordination in people with chronic stroke (more than six months after stroke). Twenty two participants will be randomly assigned to receive either sprinter-based or skater-based training for 30 minutes per session, three times per week, for four weeks. Balance will be measured using the Berg Balance Scale and Functional Reach Test. Coordination and functional mobility will be measured using the Timed Up and Go test. This study aims to determine which coordination synergy produces greater improvements, which may help physiotherapists choose more effective treatments for stroke survivors in Pakistan.

Background: Chronic stroke survivors often experience persistent deficits in balance and coordination due to damage to motor control pathways in the brain. These deficits limit independence, increase fall risk, and reduce quality of life. Coordinative Locomotor Training (CLT) is a rehabilitation approach that integrates Proprioceptive Neuromuscular Facilitation (PNF) patterns with whole-body movement sequences. The sprinter coordination synergy mimics a runner's movement: on one side, the upper extremity moves into flexion, adduction, and external rotation while the ipsilateral lower extremity moves into extension, adduction, and internal rotation. The skater coordination synergy mimics a speed skater: on one side, the upper extremity moves into flexion, abduction, and external rotation while the lower extremity moves into extension, adduction, and external rotation. Both patterns activate the whole body with one leg functioning in a closed chain position.

Objectives: To compare the effects of sprinter coordination synergy versus skater coordination synergy on: (1) static and dynamic balance measured by Berg Balance Scale (BBS) and Functional Reach Test (FRT); (2) coordination and functional mobility measured by Timed Up and Go (TUG) test. Secondary objectives include determining which technique shows significantly greater improvement and providing evidence-based recommendations for physiotherapy practice in Pakistan.

Study Design: Randomized, parallel-group, double-blind clinical trial.

Setting: Outpatient rehabilitation department, Aziz Fatima Hospital and In Motion Clinic, Faisalabad, Punjab, Pakistan.

Sample Size: Twenty-two participants (11 per group). Sample size calculated based on effect sizes from previous similar studies (Kim, Lee and Jung, 2015), with 20% allowance for attrition (n=4).

Eligibility Criteria: Adults aged 30-60 years with a physician-diagnosed ischemic or hemorrhagic stroke occurring at least six months prior. Participants must be able to stand or walk independently for at least 10 meters (with or without assistive device) and follow verbal instructions. Exclusion criteria include visual or hearing deficits, vestibular dysfunction, orthopedic disorders affecting movement, other neurological disorders, or any contraindication to exercise.

Intervention Protocol: Both groups receive 30-minute sessions, three times per week, for four weeks (total 12 sessions). Group A (n=11) performs CLT using the sprinter coordination synergy . Group B (n=11) performs CLT using the skater coordination synergy. Both interventions are delivered by a trained physiotherapist using standardized PNF techniques. Participants perform the patterns in four postures: supine, sitting, standing, and walking with support as tolerated. Each pattern is performed for 30-60 seconds per posture, repeated 5-10 times with rest periods as needed.

Outcome Measures: Assessments occur at baseline (pre-intervention, week 0) and after the final intervention session (week 4). Primary outcomes: Berg Balance Scale (14 items, scored 0-56, higher scores indicate better balance) and Functional Reach Test (distance in centimeters, greater distance indicates better dynamic balance), Timed Up and Go test (seconds to stand from chair, walk 3 meters, turn, return, and sit; shorter times indicate better functional mobility and coordination).

Statistical Analysis: Intention-to-treat analysis will be used. Normality of data will be assessed by Shapiro-Wilk test. Within-group comparisons will use paired t-test for normally distributed data or Wilcoxon signed-rank test for non-normal data. Between-group comparisons will use independent t-test or Mann-Whitney U test. Significance level set at p ≤ 0.05. Results will be presented in graphical and tabular form using SPSS version (latest available).

Expected Outcomes: Both sprinter and skater coordination synergy are expected to improve balance and coordination. This study will identify whether one coordination synergy produces superior results, providing evidence for targeted rehabilitation programs for chronic stroke patients in Pakistan.

Inclusion Criteria:

• Physician-diagnosed ischemic or hemorrhagic stroke
• Age between 30 and 60 years, inclusive
• Both male and female participants
• Time since stroke onset: 6 months or more (chronic stage)
• Able to stand or walk independently for at least 10 meters (with or without assistive device)
• Able to follow verbal instructions (Mini-Mental State Examination score ≥ 24 or equivalent clinical judgment)
• Able to provide informed consent

Exclusion Criteria:

• Visual impairment that interferes with movement coordination
• Hearing deficit that prevents following instructions
• Vestibular dysfunction affecting balance
• Orthopedic disorders (fracture, joint deformity, severe arthritis, joint replacement) limiting movement
• Other neurological disorders besides stroke (Parkinson's disease, multiple sclerosis, peripheral neuropathy)
• Contraindication to exercise as advised by physician
• Participation in another interventional rehabilitation study concurrently

Participants, Outcomes Assessor