OBJECTIVE: This study aimed to compare the efficacy of game-based visual feedback-guided dynamic balance training with conventional training in patients with hemiplegia. DESIGN: Single-blind, pilot randomized controlled trial. PATIENTS: Fifty-three patients with hemiplegia exhibiting balance dysfunction at ≥ 1 month were enrolled. METHODS: The experimental group (n = 25) trained with the Physio Space™ system that uses a 3-axis balancing platform and touchscreen monitor to provide visual feedback during 9 game modules at varying challenge levels for 20 min per day, 5 days per week, for 3 weeks. The control group (n = 28) received traditional training for the same duration. To evaluate the efficacy of the training, a 2-way repeated-measures analysis of variance (ANOVA) was used. The study protocol was registered on the Chinese Clinical Trial Registry (ChiCTR2300067275, https://www.chictr.org.cn). RESULTS: Eighteen participants in each group completed the training programme, with no baseline between-group differences. The post-training assessment revealed significant improvements (Berg Balance Scale, Functional Reaching Test, Timed "Up-and-Go" Test scores and 10-metre fast walking speed) in outcome measures in the full sample. After training, no between-group differences were observed in the tests. CONCLUSION: Our results indicate that game-based visual feedback with dynamic balance training has effects comparable to those of conventional balance training in patients with hemiplegia.