Backward Walking Research Articles

Use of backward walking speed as an outcome measure in clinical populations: A systematic review

Use of backward walking speed as an outcome measure in clinical populations: A systematic review

Backwards walking speed reserve in persons with multiple sclerosis

BackgroundDecreased gait speed is common in persons with Multiple Sclerosis (PwMS) and has been associated with elevated fall risk. The walking speed reserve (WSR) indicates the ability to increase gait speed on demand and has previously been examined in PwMS. Backward walking is a sensitive measure of fall risk in PwMS; however, no studies have reported on the utility of backward walking speed reserve (BW-WSR) as a clinical assessment tool of functional mobility or fall risk in PwMS, nor have they associated this measure with cognition. Methods23 PwMS completed walking trials at their preferred walking speed (PWS) and maximal walking speed (MWS). Participants performed these walking trials in both the forward (FW) and backward direction (BW). The forward walking speed reserve (FW-WSR) was calculated as the difference between MWS and PWS in the forward direction, while the backward walking speed reserve (BW-WSR) was calculated as the difference between MWS and PWS in the back backward direction. Correlation analyses examined the relationship between the FW- and BW-WSR with clinical assessments of functional mobility (the timed up-and-go) as well as cognitive functioning (the Symbol Digit Modalities Test, the Brief Visuospatial Memory Test-Revised, the California Verbal Learning Test, and the Trail Making Test A and B). Correlations also examined the relationship between FW- and BW-WSR with prospective falls. ResultsA lower BW-WSR was associated with disease severity and poorer performance on clinical walking and balance assessment, as well as with decreased information processing speed and attentional performance. Interestingly, FW-WSR showed similar relations. Neither FW- or BW-WSR were associated with prospective risk in this small sample of PwMS. ConclusionThe BW-WSR did not offer a distinct advantage over other measures, such as the FW-WSR, PWS, or MWS, in the forward or backward direction. The selection of the most sensitive clinical measures of functional mobility and fall risk is crucial; our study holds valuable clinical implications for PwMS by providing novel insights into functional mobility assessments in PwMS.

Time-course of balance training-related changes on static and dynamic balance performance in healthy children

ObjectiveIn healthy children, there is evidence of improvements in static and dynamic balance performance following balance training. However, the time-course of balance training-related changes is unknown. Thus, we determined the effects of balance training after one, three, and six weeks of exercise on measures of static and dynamic balance in healthy children (N = 44, 20 females, mean age: 9.6 ± 0.5 years, age range: 9–11 years).ResultsParticipants in the intervention group (2 × 25 min balance exercises per week) compared to those in the control group (2 × 25 min track and field exercises and soccer practice per week) significantly improved their static (i.e., by measuring stance time in the One-Legged Stance test) and dynamic (i.e., by counting step number in the 3-m Beam Walking Backward test) balance performance. Late effects (after 6 weeks) occurred most frequently followed by mid-term effects (after 3 weeks) and then early effects (after 1 week). These findings imply that balance training is effective to improve static and dynamic measures of balance in healthy children, whereby the effectiveness increases with increasing training period.Trial registrationCurrent Controlled Trials ISRCTN16518737 (retrospectively registered at 24th August, 2023).

On the Move: Correlation of Impaired Mobility with Spatial Navigation Ability in Persons with Multiple Sclerosis.

Spatial navigation ability is essential for independent living, and it relies on complex cognitive and motor processes that are vulnerable to decline in persons with multiple sclerosis (pwMS). The role of mobility in the physical act of navigation has been well documented; however, its association with cognitive processing that supports efficient navigation and recall of the environment is unknown. This study examined the relation between clinical mobility function and spatial navigation ability in pwMS. In a clinical sample of 43 individuals with relapsing-remitting MS (MPDDS = 2; age 25-67 years), we assessed spatial navigation ability in a virtual Morris water maze that allowed for active search by controlling a joystick while seated at a computer, and subsequent free recall of environment details. Individuals with worse mobility (measured by slower forward and backward walking) traveled less efficient virtual navigation routes to the goal location and recalled fewer accurate details of the environment. A stratified analysis by disability revealed moderate-strong correlations for those with a low level of disability, and effects were attenuated in individuals with a high level of disability. Given that the virtual navigation task was performed while seated, evidence of any correlation with mobility suggests differences in navigation ability that cannot be ascribed to general walking impairment, and instead suggests a role for mobility impairment to modify cognitive processing supporting navigation in pwMS.

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.

Lower leg muscle activation during the ebbets foot drills

Lateral ankle sprains (LAS) often lead to chronic ankle instability (CAI). The Ebbets foot drills were created to strengthen the lower leg muscles and reduce the risk of LAS. The current study aimed to explore the activation of the lower leg muscles during the Ebbets foot drills. Twenty-two (22) college students without LAS participated in the study. Surface electromyography (sEMG) of the tibialis anterior (TA), tibialis posterior (TP), and peroneus longus (PL) was collected during each of the Ebbets foot drills and a normal walking trial. The sEMG mean root mean square (RMS) was calculated for each walking and Ebbets foot drill trial duration. The mean RMS was higher during the Ebbets foot drills compared to normal walking for all muscles. The TA sEMG mean RMS was greater (4.0–68.3%, P = 0.001–0.023) during all the Ebbets foot drills than during the walking trial. The TP had greater mean RMS during the toe-in (50.4%, P < 0.001), toe-out (55.0%, P < 0.001), and backward walking (47.3%, P < 0.001) drills, than during the walking trial. The PL had greater mean RMS during all Ebbets foot drills (19.4–53.7%, P < 0.001) except for the heel walking and inversion drills. Ebbets foot drills higher muscle activity than regular walking, suggesting that the Ebbets foot drills could aid in the strengthening of the TA, TP, and PL muscles. These results build evidence on Ebbets’ theory and indicate that these drills may be used to rehabilitate LAS and CAI.

Investigating Biomechanical Postural Control Strategies in Healthy Aging Adults and Survivors of Stroke

As the aging populations, both nationwide and worldwide, rapidly increase, falls leading to unintentional injury and death subsequently increase. Thus, developing an understanding of biomechanical postural control strategies used to maintain balance in aging healthy adults, and those that have suffered stroke, are critical. Here, we were interested in how one’s body segments stabilize relative to one another, and in space, in order to maintain balance. To accomplish this goal, we studied 30 healthy individuals and 8 survivors of stroke between 60 and 85 years old, both before and after several weeks of sensory training. Motion capture data were acquired to assess participants’ body kinematics during walking: forward (easiest), forward-tandem, backward, and backward-tandem walking (most challenging). Deviations (via the observation of the absolute angle with deviations, or AADs) of the head, thorax, and lumbar areas relative to an earth vertical reference, as well as how one body segment stabilized in space or relative to the inferior body segment (via the observation of anchoring indices, or AIs), were explored. The results provide metrics (AADs and AIs) that can assess aging posture. Further, the results show an initial indication that, for aging individuals, training could lead to improved head and body stabilization in space.

Effect of Retro Walking on Pain in Patients with Knee Osteoarthritis (Randomized Control Trial)

Effect of Retro Walking on Pain in Patients with Knee Osteoarthritis (Randomized Control Trial)

The effect of deep brain stimulation on lower extremity dexterity in people with Parkinson’s disease

Purpose To examine the effect of deep brain stimulation (DBS) on lower extremity dexterity in people with Parkinson’s disease (PwPD) and to investigate the relationship between this effect and the effect of DBS on measures of different walking characteristics, and other features of Parkinson’s disease. Materials and methods Thirty-six PwPD were included. Assessment was performed twice with DBS “on” and DBS “off” state. Results The LEDT scores of both extremities, the Unified Parkinson Disease Rating Scale-motor section (UPDRS-III), the 10-Meter Walk Test (TMWT), the Timed Up and Go Test (TUG), the Figure-of-Eight Walk Test (FEWT), and the Three-Meter Backward Walk Test (TMBWT) scores were significantly better in “on” DBS condition than “off” DBS condition. The effect of DBS on lower extremity dexterity is related to age and levodopa equivalent daily dosage (LEDD). The effect of DBS on lower extremity dexterity and the effect of DBS on the bradykinesia, TUG, the FEWT, and the TMBWT were also related. Conclusions DBS has a positive effect on lower extremity dexterity. Clinical characteristics such as age and LEDD and the effect of DBS on bradykinesia, walking with turning, curved walking, and backward walking is related with the effect of DBS on lower extremity dexterity.

Back geometry and mobility function changes in cerebral palsy children after backward walking training: arandomized controlled trial

ABSTRACT Aim To compare the effects of backward (BW) and forward (FW) walking training on back geometry and mobility function in children with hemiparetic cerebral palsy (CP). Methods Fifty-five children with hemiparetic CP participated in this study. They were randomly assigned into two groups. For 12 weeks, both groups got a conventional physical therapy program three days/week. Groups A and B got a specifically developed FW walking training (25 minutes/session) and a specially designed BW walking training (25 minutes/session), respectively. Results The trunk imbalance, lateral deviation, pelvic tilting, pelvic torsion, surface motion, and dynamic gait index of group B improved significantly more than group A (p < .05). Both groups showed significant improvements in all measured variables (p < .05). Conclusion BW walking training might be considered as an effective therapy modality for improving back geometry and mobility function in hemiparetic CP children compared with FW walking training combined with a typical program.

IN VIVO ACUTE TOXICITY TEST OF ALOIN EXTRACT ON CHICKEN WHITE MENCITES (Mus musculus)

Aloin has many benefits potential as a medicine. However, it is necessary to carry out toxicity tests on experimental animals as a pre-screening test. Toxic effect parameters were seen from changes in body weight, tremors, convulsions, salivation, weakness, walking backward, walking on the stomach, death, and levels of SGOT and SGPT in experimental animals. This study aims to evaluate the in vivo acute aloin toxicity test results in mice (Mus Musculus) regarding potential toxic symptoms and animal death. A sample of 27 mice were separated into three groups for this investigation: the control group, the treatment group I at a dose of 2500 µg/kg BW, and the treatment group II at an amount of 5000 µg/kg BW, and 5 mice in the preliminary test. This study employed a laboratory experimental test method using a pre-post control group design study. Based on observations of experimental animals, it concluded neither the preliminary test nor the toxicity test revealed any toxic signs. Neither the initial test nor the toxicity test resulted in any observed animal fatalities. Before and after aloin administration, changes in body weight were significantly different. Treatment group II, treatment group I, and the control group's SGOT levels were classified from highest to lowest, with subsequent values of 22.4 U/L, 21.9 U/L, and 19.9 U/L. The highest value of 35.7 U/L, 32.1 U/L, and 26.2 U/L in the treatment groups II, I, and the control group was used to rank the SGPT levels. There were no toxic symptoms and no mortality in experimental animals, so it can be concluded that aloin did not cause harmful effects in mice, so it was categorized as a pseudo-lethal dose.

The Dubousset Functional Test: a reliable and valid test in early stage Parkinson’s disease patients

IntroductionDubousset Functional Test (DFT) is an assessment test evaluating the functional capacity and dynamic balance. The study aimed to examine the reliability, validity, and responsiveness of the DFT in early stage Parkinson’s disease (PD) patients.MethodsThis was a cross-sectional study. Thirty-three early stage PD patients were recruited. The DFT was performed along with the Timed Up and Go (TUG) test, dual-task TUG, Functional Reach Test (FRT), 3-m backward walk test (3MBWT), Tinetti Performance-Oriented Mobility Assessment (POMA), and Berg Balance Scale (BBS).ResultsThe test–retest reliability of the subcomponents of the DFT was excellent. The ICCs were as follows: 0.952, 0.955, 0.917, and 0.919, respectively. The correlation with subcomponents of DFT and TUG, dual-task TUG, FRT, 3MBWT, BBS, and POMA was found to be statistically significant (p < 0.05). The standard measurement errors of the subcomponents of the DFT were 1.45, 1.39, 1.70, and 1.57, respectively. The minimal clinically important difference (MCID) of the subcomponents was 2.05, 1.97, 2.41, and 2.22, respectively.ConclusionThe DFT is a reliable, valid, and easy-to-administer tool in assessing the balance and physical function of early stage PD patients.

Reliability and Validity of 3-Meter Backward Walk Test in Individuals with Balance Impairments: A Literature Review

Reliability and Validity of 3-Meter Backward Walk Test in Individuals with Balance Impairments: A Literature Review

Sex-related differences in young binge drinkers on the neurophysiological response to stress in virtual reality.

Stress is one of the main environmental factors involved in the onset of different psychopathologies. In youth, stressful life events can trigger inappropriate and health-damaging behaviors, such as binge drinking. This behavior, in turn, can lead to long-lasting changes in the neurophysiological response to stress and the development of psychological disorders late in life, e.g., alcohol use disorder. Our aim was to analyze the pattern of neurophysiological responses triggered with the exposition to a stressful virtual environment in young binge drinkers. AUDIT-3 (third question from the full AUDIT) was used to detect binge drinking (BD) in our young sample (age 18-25 years). According to the score, participants were divided into control (CO) and BD group. Next, a standardized virtual reality (VR) scenario (Richie's Plank) was used for triggering the stress response while measuring the following neurophysiological variables: brain electrical activity by electroencephalogram (EEG) and cortisol levels through saliva samples both measurements registered before and after the stressful situation. Besides, heart rate (HR) with a pulsometer and electrodermal response (EDA) through electrodes placed on fingers were analyzed before, during and after the VR task. Regarding the behavior assessed during the VR task, BD group spent significantly less amount of time walking forward the table and a tendency toward more time walking backwards. There was no statistically significant difference between the BD and the CO group regarding time looking down, but when we controlled the variable sex, the BD women group displayed higher amount of time looking down than the rest of the groups. Neurophysiological measurements revealed that there was not any statistically significant difference between groups in any of the EEG registered measures, EDA response and cortisol levels. Sex-related differences were found in HR response to VR scenario, in which BD women displayed the highest peak of response to the stressor. Also, the change in heartbeat was higher in BD women than men. Unveiling the neurophysiological alterations associated with BD can help us to prevent and detect early onset of alcohol use disorder. Also, from our data we conclude that participants' sex can modulate some stress responses, especially when unhealthy behaviors such as BD are present. Nevertheless, the moment of registration of the neurophysiological variables respect to the stressor seems to be a crucial variable.

Effectiveness of Rehabilitative Interventions Beginning within the First Month of Stroke Onset in Improving Lower Extremity-related Outcomes: A Systematic Review and Network Meta-Analysis

Reviews about early interventions, which are important in stroke rehabilitation due to significant neural plasticity, are relatively less. This study objective was to investigate the effectiveness of different interventions started within one-month post-stroke in improving lower extremity-related outcomes as compared to conventional rehabilitation and the corresponding effectiveness ranking. Cochrane Library, Ovid, PubMed, and Scopus were searched for articles dated up to 18 March 2022. Randomised controlled trials were included if they evaluated the effectiveness of two or more different non-drug, non-invasive, and non-surgical interventions which were started within one-month post-stroke on lower extremity-related outcomes. Network meta-analysis revealed that transcranial direct current stimulation, repetitive transcranial magnetic stimulation, mirror therapy, cycling, transcutaneous auricular vagus nerve stimulation, neuromuscular electrical stimulation (NMES), combination of robot and NMES, and thermal stimulation were significantly more effective in improving lower extremity motor function than conventional rehabilitation. In improving mobility, mirror therapy, cycling, and thermal stimulation were significantly more effective. In enhancing balance, physio ball, transcutaneous electrical nerve stimulation, cycling, thermal stimulation, and robot showed significantly higher effectiveness. Thermal stimulation scored the highest effectiveness ranking in improving lower extremity motor function and mobility whereas robot and backward walking achieved the highest effectiveness ranking in improving balance and gait speed respectively.

Effects of sports experience on children's gross motor coordination level.

Gross motor coordination (GMC) development could be influenced by age, gender, weight status, geographical area, living setting, home environment, socio-economic status, sports practice. To verify whether practicing sports and practicing different sports could influence children's GMC level. A total of 295 children aged 8-11 years were involved in the study and divided into 5 groups in relation to the sport they practiced: gymnastics group (n = 67; 51F, 16M), cycling group (n = 64; 15F, 49M), athletics group (n = 47; 22F, 25M), swimming group (n = 35; 20F, 15M), control group (n = 82; 42F, 40M). The four subtests of the Körperkoordinations Test für Kinder (KTK) assessed children's GMC level. The scores from each of the four subtests were summed into the KTK total raw score (RS) and then converted into a gender- and age-specific motor quotient (MQ). Children practicing sports showed significantly higher RS and MQ score than children of control group (203.14 ± 38.55 vs. 163.63 ± 43.50 and 98.56 ± 15.79 vs. 83.01 ± 16.71, respectively; p < 0.001). Children practicing gymnastics had a significantly higher RS and MQ than children of cycling, swimming, and control groups (p < 0.05), children of control group had a significantly lower RS and MQ than children of all other groups (p < 0.05). Children practicing gymnastics performed better walking backwards subtest than all other children's groups (p < 0.001). Children of control group performed worse jumping sideways subtest than children of gymnastics, athletics and swimming groups (p < 0.01). Children practicing gymnastics performed better moving sideways subtest than children of athletics, cycling and control groups (p < 0.01); children of control group performed worse than children of all other groups (p < 0.01). Children of control group performed worse hopping for height subtest than children of gymnastics, athletics and cycling groups (p < 0.05); children practicing gymnastics performed better than children of swimming and control groups (p < 0.05). The performance model and therefore the specialized training that each sport discipline required, could justified the differences in children's GMC level among sports groups. Thus, coaches should plan individualized interventions and choose activity contents to support children's GMC development.

BACKWARD WALKING SPEED: A NOVEL MOBILITY MEASURE FOR YOUNGER AND OLDER ADULTS

Abstract Mobility is fundamental to healthy aging. Forward walking speed (FWS) is a well-established measure of mobility, physical functioning, and fall risk but fewer studies have assessed backward walking speed (BWS). This study explored the relationship between FWS, BWS, and fall-related factors. Independently ambulatory, community-dwelling young adults (n=20; age: 22.9 years ±1.6) and older adults (n=19; age: 70.2 years ±6.2) completed forward and backward walking assessments on a 3.9 meter long instrumented pressure mat. Paper surveys assessed sociodemographic characteristics, fall history, and fear of falling using the Falls Efficacy Scale – International (FES). FWS, BWS, and directional difference percent change ((FWS-BWS/FWS)*100) were compared using independent sample t-tests, and simple linear regression was used to model the relationship between mobility measures and fear of falling. In the total sample (n=39), 23% of adults reported a fall in the previous 12 months. Compared to older adults, young adults exhibited significantly faster FWS (138.3 cm/sec ± 16.5 vs. 119.3 cm/sec ±23.4; p=0.006) and BWS (82.6 cm/sec ±18.2 vs. 63.8 cm/sec ±20.7; p=0.005). Males displayed a significantly lower mean directional difference percent change (39.4 ±11.4 vs. 47.4 ±11.1; p=0.034), than females. Among older adults, BWS was strongly and negatively correlated with FES scores (r=-0.58; p=0.009). BWS explained a greater proportion of variance in fear of falling compared to FWS (33.93% vs. 24.84%). BWS and directional difference in walking speed may be novel measures of physical functioning. Prospective studies should consider assessing BWS with future fall risk among older adults.

Walking backwards into the future of health professional practice

Health professional education needs to be designed so that future practitioners are well equipped for clinical and professional challenges. While the biomedical model has enabled major biological advances in all health professions, its inherent presuppositions have prevented progress in many of the more complex issues within healthcare, examples being health inequities, somatisation, chronic pain and student/clinician burnout. We suggest that students learn about the scientific origins and tacit assumptions of the biomedical model, such as reductionism, biological plausibility and clinical objectivity. Critical reflection, including interprofessional discussion, can enable students to explore its strengths and limitations. Although biomedicine will remain the dominant paradigm in both training and clinical practice, other “ways of seeing” may be helpful, including biopsychosocial and Indigenous models. Complexity sciences now provide additional understandings of human physiology and socio-cultural processes within healthcare and could also be taught explicitly as core curricula. Student-selected components may enable faculty to pilot educational initiatives in relation to specific professional challenges, which could then be further developed for all students. Critical reflection and teaching innovation are core values of the Australian and New Zealand Association of Health Professional Educators (ANZAHPE). “Walking backwards into the future” in healthcare education means identifying and critiquing our taken-for-granted assumptions, then providing future clinicians with broader frameworks and skills to respond more effectively to persistent challenges in healthcare.

Investigation of the validity and reliability of the 3-meter backward walk test in high functional level adults with lower limb amputation.

Backward walk training has an important place in the rehabilitation programs of lower extremity amputees. This study aimed to investigate the test-retest validity and reliability of the 3-meter backward walk test (3MBWT), minimal detectable change, and the cutoff time in high functional level adults with lower limb amputations (LLAs). Adults with LLA (n = 30) and healthy adults (n = 29) were included in the study. This is a randomized cross-sectional study. The Modified Fall Efficacy Score, Rivermead Mobility Index, and Timed Up and Go test with the 3MBWT were used to evaluate the concurrent validity of the test. The second evaluation (retest) was performed by the same physiotherapist 1 week following the first evaluation (test). The validity was assessed by correlating the 3MBWT times with the scores of other measures and by comparing the 3MBWT times between adults with LLA and healthy adults. Test-retest reliability of the 3MBWT was excellent. The intraclass correlation coefficient for the 3MBWT was 0.950. The standard error of measurement and minimal detectable change values were 0.38 and 0.53, respectively. A moderate correlation was found between the 3MBWT, Modified Fall Efficacy Score, Timed Up and Go test, and Rivermead Mobility Index ( p < 0.001). Significant differences in the 3MBWT times were found between adults with LLA and healthy controls ( p < 0.001). The cutoff time of 3.11 s discriminates healthy adults from high functional level adults with LLA. The 3MBWT was determined to be valid, reliable, and easy-to-apply tool in high functional level adults with LLA. This assessment is a useful and practical measurement for dynamic balance in high functional level adults with LLA.

Comparative Effects of Core Stability Exercises and Retro-walk on Balance and Coordination in Down Syndrome

Background: Individuals with Down syndrome (DS) often face motor deficits impacting balance and coordination. While core stability exercises are a recognized form of intervention, the potential benefits of Retro walking require further exploration. Objective: To evaluate and compare the effects of core stability exercises and Retro walking on balance and coordination in individuals with DS. Methods: This randomized clinical trial included 24 participants with a confirmed diagnosis of DS, aged 8-14 years, and with mild to moderate mental retardation. They were allocated into two groups: Group A, receiving core stability exercises, and Group B, undergoing Retro walking, both over an 8-week period. Inclusion criteria were the ability to stand and walk with a Pediatric Balance Scale (PBS) score of at least 14/56. Exclusion criteria encompassed any orthopedic, cardiac, or uncontrolled cardiovascular conditions. Assessments were conducted using the PBS and Foot Tapping Test, pre- and post-intervention. Data analysis was performed using SPSS version 25.0, employing paired and independent t-tests. Results: Post-intervention, Group A exhibited an increase in PBS scores from 15.83±2.406 to 32.17±2.209 (p &lt; .001), and Group B from 15.08±2.999 to 31.25±1.913 (p &lt; .001). Foot Tapping Test scores for the right side improved from 9.92±1.311 to 20.17±2.082 in Group A (p &lt; .002), and from 9.67±1.614 to 18.08±2.610 in Group B (p &lt; .003). Conclusion: Both core stability exercises and Retro walking significantly improved balance and coordination in children with DS. These modalities should be considered valuable additions to the therapeutic interventions for this population.