Gait and Balance Rehabilitation Post-Stroke in Low-Resource Settings

Stroke-related impairments of gait and balance are major contributors to long-term disability, limiting mobility, independence, and quality of life. In low-resource settings, these challenges are compounded by inadequate infrastructure, scarcity of rehabilitation professionals, socioeconomic barriers, and limited access to assistive technologies. This chapter provides a comprehensive overview of gait and balance rehabilitation post-stroke, drawing on current evidence while emphasizing context-specific solutions for resource-constrained environments. It begins with the neurophysiological basis of gait and balance impairments and their functional and psychosocial consequences. Evidence-based rehabilitation strategies, including task-specific and repetitive practice, circuit class therapy, treadmill training, virtual reality, functional electrical stimulation, and strength training, are reviewed, with an emphasis on their adaptability using low-cost materials and community facilities. Practical approaches for assessment, goal setting, dosage, safety, and integration of evidence into daily rehabilitation are discussed, highlighting the creative use of household resources, caregiver support, and group-based interventions. The chapter also examines barriers to effective rehabilitation, including limited service availability, cultural perceptions of stroke, financial constraints, and environmental hazards. To address these gaps, it outlines capacity-building priorities such as tele-rehabilitation, task-shifting to community health workers, training programmes, and the development of national rehabilitation guidelines. Policy and health system implications are underscored, advocating for rehabilitation to be recognized as a public health priority with sustained funding and universal health coverage. Future directions call for scalable, low-cost, and culturally relevant interventions, strengthened community-based rehabilitation, and innovative digital technologies to improve accessibility and adherence. By combining evidence-based practice, local adaptation, and system-level support, gait and balance rehabilitation can significantly enhance functional recovery and reintegration of stroke survivors in low-resource contexts.