Backward Gait Research Articles

A backward cycling programme for people with Parkinson's disease: a feasibility and preliminary results study.

To assess the feasibility of backward cycling for people with Parkinson's disease. Secondary objectives were to assess changes in gait and balance following a 6-week program. A single-group prospective pre-test, post-test study with 1-month follow-up. Twenty-six people with Parkinson's disease (mean age: 69 (7.74) years, gender: 83% males, time since diagnosis: 6 (4.44) years). Participants pedaled backward on a stationary bicycle for 30 minutes at moderate intensity twice a week for 6 weeks. Feasibility was assessed by acceptability, suitability, and burden. Data collected at pre- and post-intervention with 1-month follow-up included backward stepping response variables, forward/backward gait variables, Mini-Balance Evaluation Systems Test (MBT), and 6 Minute Walk Test. There was a high retention rate (95.8%) and adherence rate (100%) with one adverse event and minimal burden. Significant improvements were seen in step count and excursion distance during backward stepping responses, forward and backward gait velocity, forward step length, and the Mini-BESTest. Backward cycling was a feasible intervention for people with Parkinson's disease, demonstrating low burden with high retention and adherence rates, and it is a safe exercise with the potential for benefits in gait and balance variables.

Effectiveness of backward gait training on body composition, cardiopulmonary fitness, inflammation, and metabolic marker in adults: A systematic review and meta-analysis.

Walking is a fundamental physical activity with significant health implications. Backward gait training (BGT) has emerged as a novel approach with potential benefits, yet its effects in comparison to traditional forward gait training (FGT) remain uncertain. This systematic review and meta-analysis aimed to evaluate the effects of BGT on body composition, cardiopulmonary fitness, and inflammatory and metabolic markers in adults. A comprehensive search across electronic databases was conducted following the Preferred Publishing Items for Systematic Reviews and Meta-Analyses guidelines. Randomized clinical trials (RCTs) comparing BGT with FGT in adults were included. Methodological quality was assessed using the Cochrane risk-of-bias tool. The certainty of evidence was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation approach. The analysis included a total of 379 male participants across the studies. The meta-analysis demonstrated significant changes in body composition and inflammatory marker outcomes, which included waist-to-height ratio (standardized mean difference [SMD]-1.18, 95% confidence interval [CI]-1.89-0.48, I2 = 83%, P < 0.01), body mass index (SMD-0.55, 95% CI-0.77-0.32, I2= 0%, P < 0.01), and C-reactive protein (SMD-0.98, 95% CI-1.28-0.70, I2= 0%, P < 0.01). In addition, the qualitative review revealed potential enhancements in cardiopulmonary fitness and metabolic markers following BGT. While the results suggest potential benefits of BGT on body composition and inflammatory markers, the evidence remains limited and heterogeneous. Further robust research with diverse populations, longer intervention periods, and comprehensive outcome assessments is essential to elucidate the true impact of BGT and its utility for promoting overall health and well-being in adults.

Does backward gait require more proprioception and balance in older adults after total knee arthroplasty?

ObjectivesSome basic and instrumental daily living activities include backward gait. There is a need to clarify which parameters should be focused more on to improve backward gait in older individuals. This research investigated the proprioception, and balance in forward-backward gait of older individuals with total knee arthroplasty (TKA). MethodsA prospective cross-sectional research was conducted with 105 older adults with TKA. Individuals' forward and backward gait performance was assessed with the Timed Up & Go Test (TUG) and 3 Meter Walk Back Test (3MBWT), respectively. Proprioception was measured with a mobile application-based inclinometer. Berg Balance Scale (BBS) and Activity Specific Balance Confidence Scale (ABC) were used to assess balance and balance confidence levels, respectively. A single clinician evaluated the individuals. ResultsTUG was weakly and positively correlated with the Right and Left Leg Proprioception Test (RLPT and LLPT) (r1 = 0.386, r2 = 0.391, p < 0.01). Also, the 3MBWT was weakly and positively correlated with RLPT and LLPT, respectively (r1 = 0.293, r2 = 0.251, p < 0.01). In addition, TUG was strongly and negatively correlated with BBS and ABC, respectively (r1 = −0,693, r2 = −0.722, p < 0.01). Besides, 3MBWT was strongly and negatively correlated with BBS and ABC (r1 = −0.642, r2 = −0.645, p < 0.01). ConclusionThe study revealed that forward and backward walking were similarly associated with balance and proprioception in older adults with TKA. Clinicians should focus more on balance ability than proprioception to improve backward walking performance in older individuals with THA.

Association Between Baseline Gait Parameters and Future Fall Risk in Patients With De Novo Parkinson's Disease: Forward Versus Backward Gait.

Falls are not uncommon even in patients with early stages of Parkinson's disease (PD). The aims of this study were to determine the relationships between gait parameters and falls and identify crucial gait parameters for predicting future falls in patients with de novo PD. We prospectively recruited patients with de novo PD, and evaluated their baseline demographics, global cognitive function on the Montreal Cognitive Assessment test, and parkinsonian motor symptoms including their subtypes. Both forward gait (FG) and backward gait (BG) were measured using the GAITRite system. The history of falls in consecutive patients with de novo PD was examined along with 1 year of follow-up data. Among the 76 patients with de novo PD finally included in the study, 16 (21.1%) were classified as fallers. Fallers had slower gait and shorter stride for FG and BG parameters than did non-fallers, while stride-time variability was greater in fallers but only for BG. Multivariable logistic regression analysis revealed that slow gait was an independent risk factor in BG. Among the patients with de novo PD, gait speed and stride length were more impaired for both FG and BG in fallers than in non-fallers. It was particularly notable that slow BG was significantly associated with future fall risk, indicating that BG speed is a potential biomarker for predicting future falls in patients with early-stage PD.

Replacing forward gait training with backward gait training for children with cerebral palsy: what physical therapists should know

In this editorial, Alaa Abou Khzam and Majde Sleem briefly discuss the findings of studies that have investigated the effects of backward gait training for children with cerebral palsy.

Investigation of Motor Activity, Movement Kinematics and Forward-Backwards Gait in Children with Cerebral Palsy.

Our aim in this study was to examine relationships between the motor activity ability, sensor-based kinematics and forward-backwards gait characteristics of children with cerebral palsy (CP). In this prospective cross-sectional study we studied 40 children with CP. We used the Pediatric Motor Activity Log Revised (PMAL-R) to assess motor activity, evaluated motion kinematics (acceleration and angular velocity) with a sensor-based application, applied the Edinburgh Visual Gait Score (EVGS) and the Timed Up and Go Test (TUG) to observe gait performance, and used the Three Meter Backward Walk Test (3MBWT) to assess backward gait. We found moderately positive significant correlations (r1 = 0.416, r2 = 0.418, p < 0.05) between the chilidren's minimum angular velocity on PMAL-R motor activity frequency (how often) and quality (how well) scores, respectively. We also found moderately negative significant correlations (r1 = -0.529, r2 = -0.521, p < 0.05) between PMAL-R frequency (how often) and quality (how well) scores with TUG, respectively. There were moderately high positive correlations (r1 = 0.415, r2 = 0.726, p < 0.05) between EVGS scores and 3MBWT and TUG scores, respectively. We concluded that angular velocity ability was moderately related to children's motor activity and showed that physical performance tests (TUG and 3MBWT) could monitor gait function and upper extremity motor activity level, including both forward and backward walking tasks, in children with CP.

Referent Values for Commonly Used Clinical Mobility Tests in Black and White Adults Aged 50-95 Years

ObjectiveTo estimate referent values for performance on clinical mobility tests conducted amongst racially diverse adults aged 50-95 years in the Southeast US. DesignThis is an observational study of community-dwelling older adults from diverse racial groups who participated in observational and rehabilitative studies conducted from 2011-2019. SettingRehabilitation clinics around the greater metropolitan Atlanta, Georgia, region. ParticipantsA total of 314 adults (N=314; 222 women). Individuals were predominantly Black (n=121) or White (n=164), with some participants from other racial groups (n=29). InterventionsClinical and demographic data were collected at individual visits for each participant. Main Outcome MeasuresFour Square Step Test (FSST), timed Up and Go (TUG) test, dual TUG test, 6-minute walk test (6MWT), 30-second chair stand, and gait speed were all used as assessments in each cohort. ResultsPerformance slowly declines with increasing age, with a sharp drop in the ninth decade for preferred forward, backward, and fast gait speed; backward gait cadence; 6MWT, TUG test, dual-task TUG-Cognitive, and the 360° turn test. Declines were also seen in the eighth and ninth decades in the FSST. Among White participants, there were significant overall differences across age groups except in the assessment variable, preferred gait cadence. For Black individuals, there were significant overall differences across age groups for backward gait speed, fast gait speed, TUG-Cognitive, dual task, 6MWT, FSST, and 30-second chair stand. ConclusionsThese data enrich current referent values for brief, commonly used clinical tests in a diverse, older Southeast US cohort. These data include representatives of the oldest old cohort. This study will support race- and age-specific fall prevention and mobility-enhancing therapeutic application among older patients in clinical practice.

Gender differences in the effect of a 0.11% breath alcohol concentration on forward and backward gait

Alcohol contributes to a large number of diseases and health conditions related to injuries. The aim of our study was to evaluate gender differences in forward and backward gait when sober and at a breath alcohol concentration (BrAC) of 0.11%. Fifty females and fifty males participated in our study. The gait analysis was performed twice, when sober and after drinking a given amount of vodka mixed with orange juice. Under both conditions, participants were asked to walk forward and then backward on a Zebris platform. Multivariate analysis and the Mann–Whitney U test were used to compare the differences between genders when walking forward and backward. The Wilcoxon Signed Ranks test was used to compare the differences between 0.00% BrAC and 0.11% BrAC. Spearman’s Rho was used to analyze the relationship between the AUDIT score, anthropometrical characteristics and the subjective score of drunkenness and gait parameters. The results show different strategies to improve stability during gait in women and men when intoxicated with alcohol. When intoxicated, males in forward gait increase their stability by increasing their foot rotation, while females increase their step width. A decrease in balance-related variables was observed in females when walking backward with a BrAC of 0.11%. Additionally, females tended to perform an increase in balance-related gait variables when subjectively feeling more drunk in both forward and backward gait. Different strategies to maintain stability during gait were observed in women and men. The results of our study show that alcohol intoxication has a greater impact on gait in females who tended to perform an increase in balance-related variables with an increase in their subjective score of drunkenness.

Association Between Gait and Dysautonomia in Patients With De Novo Parkinson's Disease: Forward Gait Versus Backward Gait.

Studies on gait and autonomic dysfunction have been insufficient so far, particularly de novo Parkinson's disease (PD). The aim of this study was to identify the association between gait dynamics and autonomic dysfunction in patients with de novo PD. A total 38 patients with de novo PD were retrospectively included in this study. Details of patients' dysautonomia were assessed using the Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT). For assessment of gait, a computerized gait analysis was performed using the GAITRite system for forward gait and backward gait. High SCOPA-AUT score (PD-HSAS) group and low SCOPA-AUT score (PD-LSAS) group were identified according to their SCOPA-AUT scores. Nineteen (50%) patients with high SCOPA-AUT scores above median value (12.5) were assigned into the PD-HSAS group and others were assigned to the PD-LSAS group. Compared with the PD-LSAS group, the PD-HSAS group exhibited slower gait, shorter stride, decreased cadence, increased double support phase, decreased swing phase, and increased variability in swing time. Total SCOPA-AUT score showed significantly positive correlations with gait variability and instability but a negative correlation with gait hypokinesia. In subdomain analysis, urinary dysautonomia was highly associated with impairment of gait dynamics. All significant results were found to be more remarkable in backward gait than in forward gait. Our findings suggest that alteration in gait dynamics, especially backward gait, is highly associated with autonomic dysfunction in patients with de novo PD.

How Accurate Are Virtual Assessments Of Function In Persons With Parkinson’s Disease?

The COVID-19 pandemic has been associated with a deterioration of symptoms for those with Parkinson’s Disease (PD), which may be worsened with social isolation, apathy, and anxiety1. The pandemic necessitated the transition to utilizing online delivery of health and recreational activities1. PURPOSE: To compare the reliability of virtual and in-person physical assessments of function commonly utilized in the PD population. METHODS: 11 persons with PD were assessed virtually using the 360° turn test, 5 times sit to stand (5XSTS), Timed Up and Go (TUG) test, forward gait speed and backwards gait speed. Participants were sent a measuring tape with various markings on it to determine standard distances for testing. All assessments were recorded on Zoom video platform. Reference data was collected through literature reviews of these tests done in-person for persons with PD. A one sample T-Test was run to compare the data from virtual assessments (V) to the reference data (R). RESULTS: 360° turn time was not significantly different from the reference time (A: 5.2 ± 1.5 s, R: 6 s p = 0.119)2. 5XSTS and TUG time were found to be significantly less than the reference times (5XSTS V: 13.6 ± 2.5 s, R: 20.3 s, p < 0.0013 ; TUG V: 11.9 ± 2.7 s, R: 14.8 s, p = 0.0054). Forward and backward gait speed were significantly slower than the reference speed (Forward V: 0.9 ± 0.3 m/s, R: 1.2 m/s, p = 0.008; Backward V: 0.5 ± 0.2 m/s, R: 0.7 m/s, p = 0.021)5. CONCLUSIONS: Various factors could have contributed to these results, including inherent variability associated with disease severity levels in persons with PD. Testing at home in a familiar environment has the potential to alter results. Every assessment except the 360° turn test required outside equipment, including either a chair or tape measure, which adds variability to the test depending on chair height and tautness of the tape measure. The reduced variability in the 360° turn test allowed for more standardization in environment and allowed for a more focused camera angle to look only at the participants feet. Sending equipment or markers to participants that identify standard heights for testing could potentially improve consistency of results. The differences in virtual execution of these tests should be noted when using them for patient care for those with PD.

System Comparison for Gait and Balance Monitoring Used for the Evaluation of a Home-Based Training.

There are currently no standard methods for evaluating gait and balance performance at home. Smartphones include acceleration sensors and may represent a promising and easily accessible tool for this purpose. We performed an interventional feasibility study and compared a smartphone-based approach with two standard gait analysis systems (force plate and motion capturing systems). Healthy adults (n = 25, 44.1 ± 18.4 years) completed two laboratory evaluations before and after a three-week gait and balance training at home. There was an excellent agreement between all systems for stride time and cadence during normal, tandem and backward gait, whereas correlations for gait velocity were lower. Balance variables of both standard systems were moderately intercorrelated across all stance tasks, but only few correlated with the corresponding smartphone measures. Significant differences over time were found for several force plate and mocap system-obtained gait variables of normal, backward and tandem gait. Changes in balance variables over time were more heterogeneous and not significant for any system. The smartphone seems to be a suitable method to measure cadence and stride time of different gait, but not balance, tasks in healthy adults. Additional optimizations in data evaluation and processing may further improve the agreement between the analysis systems.

Backward vs. Forward Gait Symmetry Analysis Based on Plantar Pressure Mapping

Symmetry is one of the factors analysed in normal and pathological gaits. Backward gait is an area of interest to scientists, in terms of its physiology and therapeutic possibilities. This study aimed to analyse the symmetry of the pressure parameters of backward gait in comparison to forward gait using different symmetry indices. Eighty-one healthy people aged between 19 and 84 years took part in the study. Foot pressure distribution was analysed during forward and backward gaits at self-selected speeds. Mean and maximum pressure values were calculated after dividing the foot into four or ten areas. Delta, Ratio Index, Robinson Index, Gait Asymmetry, and Symmetry Angle were calculated for each area, separately for both forward and backward gaits. Higher ratios of asymmetry were found during backward than during forward gait. Larger ratios of asymmetry were found within toes II–V, forefoot, metatarsals I, II, and III, medial and lateral heel areas. No significant correlation between symmetry indices and age or BMI was found. Results suggested that the lower symmetry of backward gait is caused by a higher number of corrective movements that allow for the maintenance of body balance and global symmetry of gait. This can be realised by increased cortical control of the backward gait, which was a new movement task for all participants.

Use of real-time multimodal sensory feedback home program improved backward stride and retention for people with Parkinson Disease: A pilot study

IntroductionParkinson disease (PD) impairs sensory integration, contributes to motor dysfunction, loss of gait automaticity, and increased fall risk. Employing multimodal sensory feedback (MMSF) has the potential to improve proprioceptive integration and gait safety while reducing exercise burden especially for backward gait. MethodsThis single-blinded, randomized controlled pilot study used a home program with or without real-time visual, proprioceptive, and auditory feedback with stepping exercises which progressed in speed and distance. Both groups completed a six-week intervention followed by 6 weeks without exercise to assess long-term retention. Six additional weeks of exercises were completed to assess recovery of potential losses after the washout session.Eleven people with PD exercised with real-time MMSF and 7 exercised without MMSF. Outcome measures included backward stride length, velocity, cadence, and double support time. The Dual Timed Up and Go measured automaticity. Self-perceived improvements in gait, activities of daily living, participation, and quality of life were registered by a questionnaire. ResultsAnalysis was by repeated measures ANOVA. Using MMSF significantly improved backward stride length at 12 and 18 weeks, p = .007, η2 = 0.239. Both groups improved in all outcome measures after the initial 6-week exercise program, supporting efficacy of stepping exercises. The MMSF + ex group's significant improvements after a 6-week washout supported automaticity development. Questionnaire items received higher agreement percentages from MMSF + ex participants. ConclusionUsing real-time MMSF in a home program for pwPD provided significant and lasting improvements in backward stride, and potentially decreased fall risk and exercise burden compared to the same program without MMSF.

Functional gait assessment in early and advanced Parkinson\u2019s disease

BackgroundPostural instability and balance problems in patients with Parkinson’s disease (PD) can seriously affect the quality of life and lead to falls with a subsequent increase in the morbidity and mortality. Early identification of gait dysfunction in early stages of PD establishes an effective therapy, prevention of the falls and reducing health care costs. This work aimed to detect gait disorders in patients with PD using the functional gait assessment (FGA) scale and to correlate it with the disease severity in Egyptian PD patients. This is a case–control study in which 40 patients with PD were recruited from the Involuntary Movement Clinic at Alexandria University El-Hadara Hspoital; 20 patients had early stages of PD (Hoehn Yahr stages 1 and 2) and 20 patients had advanced PD (Hoehn Yahr stages 3 and 4). Another 20 subjects were recruited as controls. All recruited subjects underwent gait assessment using FGA scale.ResultsGait analysis using FGA showed significant differences (P < 0.001) between the recruited PD patients and the control group. Upon comparing the early and advanced PD patients’ groups, certain items in the FGA (gait with pivot turn, step over obstacle, gait with eyes closed and backward gait) together with time consumed for 6-m walk with eyes open and close showed significant statistical differences between early and advanced PD patients. The patients’ duration of illness with PD was reversely correlated with the total FGA score.ConclusionThe FGA scale was strongly influenced by the duration of PD among the Egyptian patients and can potentially detect early stages of PD.

Comparison of forward and backward gait in males with and without intellectual disabilities.

Intellectual disabilities (ID) affect both cognitive and motor functions. The backward gait is a daily activity and its assessment is used for fall risk estimation and training in the general population. For proper use of backward gait as a rehabilitation tool and in fall prevention programmes for people with ID, it is necessary to determine the backward gait characteristics in the ID population. The aim of this study was to compare the differences between forward and backward gait in persons with nonsyndromic mild and moderate ID, persons with Down syndrome (DS) and a control group of healthy adults. Fifty males divided into four groups (mild ID: n=15, moderate ID: n=19, DS: n=6, controls: n=10) participated in this study. All participants were asked to walk both forward and backward, barefooted and at their natural velocity on a Zebris FDM platform. The Kruskal-Wallis H test was used to compare differences between the analysed groups in forward and backward gait. The Mann-Whitney U test was used to compare the differences between forward and backward gait within each group. The velocity was significantly slower in moderate ID and DS compared to controls in forward and backward gait. When comparing forward and backward gait within each group, the gait velocity decreased in backward gait compared with forward gait by 21.80% in controls, by 33.89% in mild ID, by 34.45% in moderate ID, and by 40.32% in DS. In both moderate ID and DS, the mean backward velocity was slower than 2.16km/h, the velocity used to identify elderly fallers in the general population. Gait velocity was especially affected in DS and moderate ID compared with controls. In both mentioned groups, the backward gait velocity suggests an increased risk of falling. Future studies are necessary to examine the possibility of improving balance control and leg muscle strength by backward walking training in the ID population.

Effects of Backward Gait Training on Ground Reaction Forces in Patients with Medial Knee Osteoarthritis

Introduction: The aim of this study was to investigate the effects of backward gait training protocol on ground reaction forces in Patients with medial knee Osteoarthritis. Methods: This quasi-experimental study was performed with a pretest-posttest design in two groups of healthy and unhealthy and the experimental group (participants with medial knee osteoarthritis). The participants were 21 healthy and 42 unhealthy men with knee osteoarthritis who were divided into two experimental and control groups according to the Kellgren and Lawrence radiologic scale and the visual analogue scale. The experimental group performed backward gait training for six weeks. Two Kistler force plates (1000Hz) were used to measure parameters by Vicon Nexus 1.8.5, Polygon 4.1.2 software. For statistical analysis One-Way ANOVA test was used through SPSS, version 20 (p≤0.05). Results: Before training, there was a significant difference between the groups of the patients and healthy participants for the first peak of vertical (Fz1) and vertical valley (valley), braking force (AP1), propulsive force (AP2) of ground reaction forces (P&lt;0.05). The training protocol had a significant effect on increasing propulsive force (PPre=0.021, Ppost=0.068) and braking force (PPre=0.022, Ppost=0.077) in the experimental group compared to the healthy group; and there was no significant difference between the groups after training compared to pre-exercise (baseline). Exercise did not affect on the components of vertical force. Conclusion: Loss of braking-pushing forces and first peak of vertical ground reaction force (Fz1) could reflect limb pain or poor performance. Backward gait training protocol had a significant effect on braking-pushing forces.

Effects of Backward Gait Training of Body Weight Support Treadmill Combined FES on Balance and Gait Ability of Traumatic Brain Injury Patients: Case Study

Purpose: This study aimed to examine the effects of backward gait training of body weight support treadmill combined with functional electric Stimulation (FES) on balance and gait ability in chronic stroke patients. Methods: Five traumatic brain injury (TBI) participants were participated in the study. Each participant received backward gait training of body weight support treadmill program combined with FES. An evaluation was performed before the training was commenced and again 8 weeks after the training was initiated. We measured balance ability, center of pressure (COP), limited of stability (LOS), berg balance scale (BBS), gait ability (Optogait) and 10-Meter walking test (10WT). Results: In balance and gait ability, participants showed a significant difference between pre- and postintervention (p<.05). Conclusion: The backward gait training of body weight support treadmill combined with FES resulted in significant improvements in balance and gait ability.

Cross-Sectional Analysis of Backward, Forward, and Dual Task Gait Kinematics in People With Parkinson Disease With and Without Freezing of Gait.

People with Parkinson disease demonstrate increased gait variability, but the primary variability sources are poorly understood. People with Parkinson disease and freezing of gait (freezers) have greater gait impairments than people with Parkinson disease without freezing of gait (nonfreezers), which may relate to cerebellar dysfunction. Thirteen freezers and 31 nonfreezers completed backward, forward, and forward with dual task gait trials. Sagittal joint angle waveforms were extracted for the hip, knee, and ankle using 3D motion capture. Decomposition indices were calculated for the 3 joint combinations. Principal component analysis extracted variance sources from the joint waveforms. Freezers had significantly greater decomposition between hip-ankle (F1,42 = 5.1, P = .03) and hip-knee (F1,42 = 5.3, P = .03) movements. The principal component analysis did not differentiate freezers and nonfreezers; however, primary variance sources differed between conditions. Primary variance during forward and forward with dual task gait came from joint angle magnitude and peak angle timing. Backward gait showed primary variance from joint angle magnitude and range of motion. The results show that freezers decompose movement more than nonfreezers, implicating cerebellar involvement in freezing of gait. Primary variance differs between gait conditions, and tailoring gait interventions to address variability sources may improve intervention efficacy.

Abstract 46: A New Rehabilitation Strategy to Improve Gait Speed and Balance Self-Efficacy Following Stroke

Introduction: Impaired balance and decreased balance confidence contribute to slow gait speed and increased fall risk post-stroke. Standard balance exercises and gait training do not adequately address these impairments. Backward Walking Training (BWT), incorporating the unique postural and lower extremity motor control demands of walking backward, may reduce these gait impairments. This study compared the effects of BWT to Forward Walking Training (FWT) on forward and backward gait speed, dynamic balance and balance confidence. Methods: Thirty adults with first time stroke (18 male; 15 right hemisphere lesion; mean time post-stroke 12.7±6.6 months; mean age 58.8±10.1 yrs; mean Lower Extremity Fugl-Meyer Motor Score 22.7±1.4) were randomized to receive eighteen exercise sessions (3x/week for 6 weeks) of BWT (n=15) or FWT (n=15) consisting of 20 minutes training on a treadmill with Body Weight Support followed by 20 minutes overground. Gait was facilitated by a physical therapist-led team. Speed, limb loading and bout duration were progressed across sessions. The Ten Meter Walk Test (10MWT), Activities-Specific Balance Confidence (ABC) Scale, 3-meter Backward Walk Test (3MBWT), Functional Gait Assessment (FGA) and spatial-temporal gait characteristics were assessed pre- and post-intervention. Results: Pre- to post-intervention increases in the 3MBWT (BWT: 0.23±0.4 to 0.32±0.06 m/s ; FWT 0.21±0.4 to 0.23±0.04 m/s: ), ABC (BWT: 55.2±5.2% to 61.8±7.1% ; FWT: 52.9±6.5% to 53.5±6.2%: ), 10MWT (BWT: 0.42±0.07 to 0.51±0.08 m/s ; FWT: 0.44±0.08 to 0.47±0.07 m/s ) and backward paretic step length (BWT: 0.19±0.04 to 0.34±0.03 cm ; FWT: 0.21±0.03 to 0.20±0.04 cm were greater for the BWT than the FWT group. These gains were all statistically significant (p &lt; 0.01). Group differences in FGA did not reach statistical significance. Conclusions: The greater increase in backward paretic step length, backward walking speed and balance confidence observed in the BWT group are all known contributors to reduced fall risk. BWT may be an important addition to the rehabilitation plan for individuals post-stroke. A longitudinal examination of fall incidence following BWT is the next important step in determining the overall utility of this novel rehabilitation approach.

Effects of backward gait training protocol on knee adduction moment and impulse during walking in patients with medial knee osteoarthritis

Effects of backward gait training protocol on knee adduction moment and impulse during walking in patients with medial knee osteoarthritis