Lumbar Spinal Manipulation in 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