Stroke is a leading cause of long-term disability globally, frequently resulting in impaired balance and gait velocity, which in turn compromise functional mobility and increase fall risk (Langhorne et al., 2011). These motor deficits greatly impact the individual’s ability to perform daily activities independently, affecting their quality of life and social participation (Jørgensen et al., 1995). Among post-stroke individuals, impaired balance is one of the most significant predictors of falls and reduced community ambulation (Mao et al., 2002).

Conventional physiotherapy has been shown to improve balance and gait after stroke; however, the high cost, need for specialized supervision, and long-term commitment often limit its accessibility, especially in low-resource or rural settings (Pollock et al., 2014). This underscores the importance of exploring scalable, task-specific, and cost-effective rehabilitation strategies that enhance recovery of balance and gait while promoting functional independence.

Square Stepping Exercise (SSE) is a structured, low-cost, and adaptable exercise program that involves performing specific foot patterns on a gridded mat. Originally developed by Shigematsu and Okura to improve balance and prevent falls in older adults, SSE has shown promise in enhancing coordination, lower limb strength, and cognitive-motor integration. However, despite its proven utility in geriatric populations, SSE is not well established in stroke rehabilitation. The cognitive demand of memorizing and executing step sequences adds a dual-task component that may be particularly beneficial for stroke patients, who often exhibit deficits in both motor and cognitive domains. Therefore, exploring the efficacy of SSE in stroke recovery may provide a novel, evidence-based approach to enhancing post-stroke rehabilitation outcomes.