Lumbar Spinal Manipulation in Stroke

The aim of the study is to investigate the effects of lumbar spinal manipulation on balance and fall risk of the patients with chronic stroke.

Inclusion Criteria: * Having chronic stroke, * A Mini-Mental State Examination score of 24 or higher, * Ability to stand independently for 20 seconds or more, * Being between 18 and 75 years of age, * Ability to walk independently for 10 meters, using assistive devices or orthoses if necessary, * Daily blood pressure not exceeding 140/90 mmHg (or controlled with antihypertensive medication) Exclusion Criteria: * Presence of severe cardiac, pulmonary, hepatic, or renal dysfunction, * Presence of severe bone or joint disease, particularly affecting the spine, * Presence of risk factors for osteoporosis, especially involving the spine, * Orthopedic conditions limiting spinal rotation, * History of cancer or diabetic neuropathy, * Presence of vestibular disorders, * Presence of lower extremity ulceration or amputation, * Alcohol consumption within the last 24 hours, * Hemodynamic instability, * Diagnosis of posterior circulation stroke involving the basilar artery and cerebellum, * Presence of neurological diseases such as multiple sclerosis or Parkinson's disease, * History of acute lower extremity injury within the last 6 weeks, * History of lower extremity surgery