The application of square-stepping exercise in patients with stroke: a scoping review

Square-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.

PubMed, 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.

A 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.

SSE 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.