Search

Purpose: The presence of spinal arches is crucial for maintaining good body posture, reducing pressure on joints, and preventing deformities caused by misalignment. Engaging in exercises that focus on correcting body alignment, such as walking backward, can enhance posture and various related factors., Method: A group of 46 female students suffering from forward head posture was selected (age: 22.89 ± 2.31 years, height: 1.63 ± 0.05 m, weight: 60.01 ± 5.41 kg, body mass index: 22.38 ± 1.28 kg/m2) and randomly divided into two groups. The intervention group participated in three exercise sessions per week for four weeks, while the control group did not receive any intervention during the study. Changes in the craniovertebral angle, proprioception, resistance, and foot pressure were measured using photogrammetry, head-neck angle examination with a laser pointer, a balance measuring device, and a foot scanner., Findings: The results of this study showed that the training program had a significant effect on the craniovertebral angle (P = 0.001), neck proprioception (P = 0.001), balance (P = 0.001), and sole pressure (P = 0.001). Likewise, the results of the group comparison revealed significant differences in various variables, such as the craniovertebral angle (P = 0.001), neck proprioception (P = 0.001), balance (P = 0.001), and plantar pressure (P ≥ 0.05)., Conclusion: This study demonstrated that walking backward enhanced the craniovertebral angle, proprioception, balance, and alterations in the plantar center of pressure. Therefore, this exercise is recommended as a complementary therapeutic approach for individuals with forward head posture., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Despite growing applications of backward walking (BW) in assessing and rehabilitating neuromuscular conditions, its effects on gait in chronic ankle instability (CAI) remain unclear. Moreover, linking patient-reported and clinically generated measures is imperative for understanding CAI., Hypotheses: Patients with CAI will exhibit worse and compensatory spatio-temporal and kinetic gait parameters during BW, and patient-reported outcomes (PROs) will be correlated significantly with gait parameters., Study Design: Case-control study., Level of Evidence: Level 4., Methods: A total of 46 volunteers participated (23 per group). Patients filled out scales for pain, functions, and fear-avoidance beliefs before testing. All participants walked 6 times each in both forward and backward conditions, and gait was recorded using the Win-Track system. A 2-way mixed analysis of variance was performed to compare gait parameters. The relationship between PRO and gait outcomes was assessed through the Pearson product correlation coefficient., Results: The CAI group demonstrated prolonged support and swing phases, increased walk-off angle, and plantar pressure area, but decreased step length and plantar pressure versus controls ( P < 0.05). The CAI group had a smaller right walk-off angle during BW than FW; the control group showed the opposite ( P < 0.05). The left single stance duration was greater in the CAI group, while the right was not ( P < 0.05). PRO correlated significantly with gait parameters, particularly spatial parameters ( P < 0.05)., Conclusion: The CAI group exhibited worse gait parameters during BW. The CAI group exhibited a characteristic compensatory gait pattern. Linking the self-reported scores provides a better representation of gait changes in CAI., Clinical Relevance: These results suggest that BW may be an effective strategy for identifying and evaluating CAI. It may be feasible to apply BW to the rehabilitation of CAI., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Background and Purpose: Walking and balance impairments after stroke are a global health concern, causing significant morbidity and mortality. However, effective strategies for achieving meaningful recovery in the chronic stages are limited. Backward locomotor treadmill training (BLTT) is a novel walking rehabilitation protocol that is safe, feasible, and likely beneficial in stroke survivors; however, its efficacy has not been tested. This single-center, randomized, assessor-blind clinical trial aims to test the preliminary efficacy of BLTT compared to forward locomotor treadmill training (FLTT) on walking speed, symmetry, and postural stability., Methods: Forty stroke survivors [BLTT (N=19), FLTT (N=21); mean age= 56.3 ± 8.6 years; 53% Female; 30% Non-Hispanic Black] with mild-moderate walking impairment were enrolled. Participants underwent nine 30-minute BLTT or FLTT sessions over three weeks. The primary outcome was the mean change in the 10-meter walk test (10 MWT) at 24 hours post-training (24 hr POST). Secondary outcome measures were changes in spatiotemporal walking symmetry and postural stability during quiet standing at 24 hr POST. Retention was explored at Days 30- and 90 POST., Results: We report clinically meaningful (≥ 0.16 m/s) improvements in overground walking speed at 24 hr POST, with retention up to Day 90 POST with BLTT and FLTT. However, contrary to our working hypothesis, no between-group differences in walking speed were observed. Nonetheless, we found that BLTT resulted in offline improvements in spatial symmetry and retention of subcomponents of the modified clinical test of sensory interaction on balance (mCTSIB), including the testing of proprio-vestibular integration up to Day 30 POST., Conclusion: Among chronic stroke patients with mild-moderate walking impairment, BLTT and FLTT both resulted in long-lasting and clinically meaningful improvement in walking speed. However, preliminary findings suggest that BLTT may better comprehensively target walking asymmetry and sensory systems processing and integration., Competing Interests: DISCLOSURES OOA reports grant support from the American Academy of Neurology Institute Career Development Award and National Institutes of Health under grant 121HD11576. CD reports no conflict of interest. AG reports no conflict of interest. PB reports support from the National Institutes of Health under grant R01HD093694. HJS reports no conflict of interest. EW reports no conflict of interest. AB reports no conflict of interest. KD reports no conflict of interest. PK reports no conflict of interest. BMK reports no conflict of interest.

Balance impairment and accidental falls are a pervasive challenge faced by persons with multiple sclerosis (PwMS), significantly impacting their quality of life. While exercise has proven to be an effective intervention for improving mobility and functioning in PwMS, current exercise approaches predominantly emphasize forward walking (FW) and balance training, with variable improvements in balance and fall rates. Backward walking (BW) has emerged as a promising intervention modality for enhancing mobility and strength outcomes; however, significant gaps remain. Specifically, there is limited knowledge about the efficacy of BW interventions on outcomes such as static, anticipatory, and reactive balance, balance confidence, falls, and cognition. This randomized controlled trial aims to determine the feasibility, acceptability, and impact of 8-weeks of backward walking training (TRAIN-BW) as compared to forward walking training (TRAIN-FW). Ninety individuals with MS with self-reported walking dysfunction or ≥ 2 falls in the past 6 months will be randomized in blocks, stratified by sex and disease severity to either the TRAIN-BW or TRAIN-FW intervention groups. Adherence and retention rates will be used to determine feasibility and the Client Satisfaction Questionnaire will be used to assess acceptability. The primary outcomes will be static, anticipatory, and reactive balance. Secondary outcomes include walking velocity, balance confidence, concern about falling, cognition, physical activity, and fall rates measured prospectively for 6 months after post-testing. Additionally, the extent to which cognitive functioning influences response to intervention will be examined. Backward walking training may be an innovative intervention to address balance impairments and falls in persons with MS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aims/Background Backward walking is gaining traction in rehabilitation therapy, showing promise as an intervention for stroke patients with walking difficulties. However, the brain activity patterns (neurophysiological mechanisms) underlying backward walking in these patients remain unclear. This study investigated the neurophysiological mechanism in stroke patients within 1 year of their stroke. Methods Twenty-four subjects walked forward and backward for 5 min on an 8-m track while their electroencephalographic signals were collected. The power values of each frequency band were compared during forward and backward walking, and the delta to alpha power ratio (DAR) was calculated. Results The results showed a significant increase in α-band activity within the frontal cortex during backward walking ( p < 0.05). This increase correlated positively with scores on the Fugl-Meyer lower extremity motor function assessment scale. Similarly, α-band activity showed significant enhancement within the right parietal cortex during backward walking ( p < 0.05). There were no significant differences between forward and backward walking states in δ, θ, and β wavebands across the entire brain region ( p > 0.05). Additionally, the DAR was significantly lower during backward walking than during forward walking ( p < 0.05). Conclusion This study suggests that backward walking may more effectively activate neural activity in the prefrontal and right posterior parietal cortices. This finding supports the potential of backward walking to enhance motor execution and walking function in stroke patients, thereby supporting its application as a rehabilitation method.

Background: Badminton, a dynamic sport, demands players to display exceptional physical attributes such as agility, core stability, and reaction time. Backward walking training on a treadmill has garnered attention for its potential to enhance physical attributes and optimize performance in athletes while minimizing the risk of injuries., Objective: By investigating the efficacy of this novel approach, we aim to provide valuable insights to optimize training regimens and contribute to the advancement of sports science in badminton., Methodology: Sixty-four participants were randomized into a control group (n = 32) and an experimental group (n = 32). The control group received routine exercise training, while the experimental group received routine exercise training along with additional backward walking training on the treadmill. Pre- and post-intervention measurements were taken for core stability using the Plank test, balance using the Star Excursion Balance test, reaction time using the 6-point footwork test, and agility using the Illinois Agility test., Results: The results showed that the experimental group demonstrated significant improvements in core stability (p < 0.001), balance (p < 0.001), reaction time (p < 0.05), and agility (p < 0.001) compared to the control group. The backward walking training proved to be effective in enhancing these physical attributes in badminton players., Conclusion: Incorporating backward walking exercises into the training regimen of badminton players may contribute to their overall performance., (© 2024. The Author(s).)

Equine physiotherapy commonly includes basic exercises such as walking backward (BW) and voluntary lifting of single limbs (SLL), but trunk movements during these have not been studied. In order to compare the trunk kinematics during BW and SLL with forward walking (FW), nine horses were measured in FW, BW and during SLL triggered by tactile cue. Kinematics were obtained from skin markers captured by ten high-speed video cameras. Trunk angles were calculated in sagittal and horizontal planes from withers, dorsal to spinous processes of the 16th thoracic vertebra (T16), 2nd and 4th sacral vertebrae (S2, S4), WT16S2 and T16S2S4 respectively. From the hooves, maximum hoof height during swing phase and horizontal distance between hoof and median body plane during swing and stance phases were determined. Dorsoventral range of motion (ROM) and maximum flexion of WT16S2 was significantly larger in BW than in FW, while laterolateral ROM was significantly smaller during hindlimb swing phase in BW and SLL than in FW. In contrast, dorsoventral ROM of T16S2S4 was significantly smaller during stance and swing phases of hindlimbs in BW compared to FW, and throughout the movement. During forelimb swing phase, T16S2S4 ROM was significantly larger in BW than SLL. Hindhoof height in SLL was significantly higher than in FW. Distance between median body plane and hooves was significantly larger in BW than in FW, and significantly larger in BW than in SLL for hindlimb swing phase. In BW, increased lumbosacral stabilisation and the larger area of support created by fore- and hindlimbs may represent a strategy to enhance body stabilisation, as BW entails some insecurity., Competing Interests: Declaration of Competing Interest None of the authors has any financial or personal relationships that could inappropriately influence or bias the content of the paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To examine the effects of navigation controls and field-of-view modes on cybersickness severity and gait dynamics after cessation of exposure to a virtual environment (VE)., Background: The applications of virtual reality are increasing in various fields; however, whether changes in interaction techniques and visual contents could mitigate the potential gait disturbance following VE exposure remains unclear., Method: Thirty healthy adults wore a head-mounted display to complete six sessions of 12-min run-and-gun tasks using different navigation controls (gamepad, head, natural) and field-of-view modes (full, restricted). Forward and backward walking tasks were performed before and after VE exposure. The degrees of cybersickness and presence were evaluated using questionnaires, along with the in-session task performance. Spatiotemporal gait measures and their variabilities were calculated for each walking task., Results: The participants experienced less cybersickness with the head and natural controls than with the gamepad. Natural control, based on matching body movements, was associated with the highest degree of presence and best performance. VE navigation using the gamepad showed reduced cadences and increased stride times during postexposure forward-walking tasks. When the VE was presented via the restricted field-of-view mode, increased gait variabilities were observed from backward-walking tasks after VE exposure., Conclusion: Body movement-based navigation controls may alleviate cybersickness. We observed gait adaptation during both ambulation tasks, which was influenced by the navigation control method and field-of-view mode., Application: This study provides the first evidence for gait adaptation during balance-demanding tasks after VE exposure, which is valuable for designing guidelines for virtual reality interactions.

Background: People with multiple sclerosis (MS) experience mobility impairments that elevate fall risk, increasing the need to identify clinical measures that accurately predict falls. Backward walking (BW) better differentiates fallers from nonfallers in MS. However, no studies have reported the measurement properties of the backward walking Timed 25-Foot Walk (B-T25-FW) and BW metrics, like BW velocity. Additionally, it is unknown whether BW can predict future falls in MS or its link to activity levels. This study assessed the reliability and responsiveness of B-T25-FW and BW metrics, including BW velocity. It also examined whether BW could predict falls at 3 and 6 months and its association with activity levels., Methods: During 2 separate visits, 23 people with MS completed the forward walking Timed 25-Foot Walk (F-T25-FW) and B-T25-FW, as well as forward walking and BW assessments in which spatiotemporal measures were recorded. Test-retest reliability was determined with intraclass correlation coefficients, and minimum detectable changes were calculated. Correlation analyses explored the relationship between BW velocity, B-T25-FW, prospective falls, and activity levels., Results: B-T25-FW and BW velocity exhibited excellent test-retest reliability. Large effect sizes to interpret clinically meaningful change in the B-T25-FW and BW velocity were also found. Both metrics demonstrated modest negative correlations with falls at 3 and 6 months and correlated strongly with very active minutes at 3- and 6-months post study., Conclusions: The B-T25-FW and BW velocity are effective and reliable in clinical use for evaluating functional mobility in people with MS, are sensitive enough to detect subtle changes, and may be a meaningful marker for tracking disease progression and treatment efficacy., Competing Interests: CONFLICT OF INTEREST: The authors report no conflicts of interest., (© 2024 Consortium of Multiple Sclerosis Centers.)

Background: Decreased 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., Methods: 23 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., Results: A 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., Conclusion: The 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., Competing Interests: Declaration of competing interest No author has any financial or personal relationship that would inappropriately bias or influence their work., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Backward walking is an indispensable component of activities of daily living. The backward walk test has been used to assess balance, mobility, and fall risk in different populations. This systematic review aimed to identify and synthesize measurement properties of the backward walk test in people with balance and mobility deficits., Methods: Three bibliographic databases, PubMed, Embase, and Scopus, were searched on June 18th, 2023. Cross-sectional or cohort studies assessing the measurement properties (reliability, validity, responsiveness) of the backward walk test were included. The COSMIN risk of bias checklist was used for methodological quality assessment. Study selection, data extraction, and quality assessment were completed by two reviewers independently and in duplicate., Results: A total of 786 records were identified from three databases. Fourteen studies published from 2019 to 2023 with a total of 853 participants were included. Two studies were rated inadequate in quality assessment, all other studies demonstrated adequate to very good quality. The participants population included patients with cerebral palsy, stroke, multiple sclerosis, Parkinson's disease, fibromyalgia, hip and knee arthroplasty, dementia, and community-dwelling older adults. Good interrater and intrarater reliability, and moderate to good concurrent validity of the backward walk test were demonstrated., Significance: The review demonstrates that the backward walk test appears to be a valid and reliable tool in different patient populations. The 3-meter backward walk time and 3-meter backward walk speed can be used as outcome measures in clinical practice to assess balance and mobility and track progress throughout the course of physical rehabilitation. Future studies with a prospective cohort design are required to provide information regarding the predictive validity of the backward walk test for fall risk assessment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background and Purpose: The purpose of this study was to investigate the 3-meter backward walk test (3MBWT) in individuals with Parkinson Disease (PD) to determine the following: (1) concurrent validity with other gait velocity measures and (2) interrater and intrarater reliability of in-person and video assessment., Methods: A convenience sample of 25 people with PD participated. Forward gait velocity was measured using a computerized walkway (Zeno Walkway System), the 10-meter walk test (10MWT), and 4-meter walk test (4MWT). Backward gait velocity was measured using the 3MBWT. Concurrent validity was assessed using Pearson's correlations. Reliability was assessed using intra-class correlation coefficients (ICC (2,1) )., Results: All relationships between the 3MBWT and gait outcome measures were significant. The 3MBWT demonstrated strong correlations with the 4MWT dual task ( r  = .795, p =<.001) and moderate correlations with 4MWT comfortable walking speed ( r  = .658, p  < .001), 4MWT fast walking speed ( r  = .601, p =.002), 10MWT comfortable walking speed ( r  = .512, p  = .009), and 10MWT dual task ( r  = .535, p  = .006). A low yet significant correlation was noted with the 10MWT fast walking speed ( r  = .398, p  = .049). Association between the 3MBWT and the Zeno Walkway System revealed moderate correlations. All reliability tests were significant at p  < .001. Interrater reliability ICC (2,1) values were very high for 3MBWT (ICC (2,1)  = 0.93, [0.83-0.91]). Intrarater reliability was also very high (ICC (2,1)  = 0.96 [0.90-0.98])., Conclusion: The 3MBWT demonstrates validity and reliability as a tool for assessing gait speed in the posterior direction in people with PD.

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.

Backward walking training presents a great challenge to the physical and neural systems, which may result in an improvement in gait performance. Transcranial direct current electrical stimulation (tDCS), which can non-invasively enhance cortical activity, has been reported to strengthen corticomotor plasticity. We investigated whether excitatory tDCS over the primary motor cortex (M1) or the dorsolateral prefrontal cortex (DLPFC) enhances the effects of backward walking training in healthy participants. Thirty-six healthy participants (16 men and 20 women, mean age 21.3 ± 1.4 years) participated in this study. The participants were randomly assigned to one of the three tDCS groups (M1, DLPFC, and sham). They performed 5 min of backward walking training during 15 min of tDCS. We evaluated dual-task forward and backward walking performance before and after training. Both tDCS groups increased walking speed in the backward condition, but the DLPFC group increased the dual-task backward walking speed more than the M1 group. The M1 group showed decreased gait variability in dual-task backward walking, whereas the DLPFC group showed increased gait variability. Backward walking training combined with M1 stimulation may increase the backward walking speed by reducing gait variability. Backward walking training combined with DLPFC stimulation may prioritize walking speed over gait stability. Our results indicate that backward walking training combined with tDCS may be extended to other rehabilitation methods to improve gait performance., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Backward walking (BW) is an important gait adaptation and BW speed may be an important indicator of walking function and fall risk. However, the measurement characteristics of a standardized assessment of BW post-stroke have not been fully established., Objectives: To determine intra- and interrater reliability, concurrent validity and minimal detectable change (MDC) scores for the 3-Meter Backward Walk Test (3MBWT) post-stroke., Methods: Thirty-four individuals with subacute and 29 individuals with chronic stroke participated. Two trials of comfortable BW was measured over a total distance of 5-meters, while speed was calculated during the middle 3-meters of the walking distance. Intra and interrater reliability were determined by comparing the two trials from one rater and simultaneous assessment of two raters, respectively. Two additional trials were performed and BW speed was calculated using 3MBWT and an instrumented walkway to determine concurrent validity. Intraclass correlation coefficients (ICC) estimated reliability and validity. The MDC was calculated from the standard error of measurement., Results: Excellent ICC values were obtained for the 3MBWT in the subacute (interrater: ICC 2,1  = 0.99; intrarater: ICC 2,1  = 0.96; validity: ICC 2,1  = 0.96) and chronic (interrater: ICC 2,1  = 0.99; intrarater: ICC 2,1  = 0.94; validity: ICC 2,1  = 0.97) groups. The MDC was 0.07 m/s (subacute) and 0.11 m/s (chronic)., Conclusions: Establishment of the 3MBWT as a reliable and valid measure in assessing BW speed is an important addition to the assessment toolbox for rehabilitation post-stroke.

Introduction: Many of the activities in daily living require different walking skills such as straight walking (SW), walking with turning (WwT), curved walking (CW) or backward walking (BW) in a dual-task condition. However, there is a lack of evidence regarding the dual task cost (DTC) during different types of walking. Therefore, this study was planned to compare the DTC during different types of walking in people with Parkinson's disease (PwPD) and healthy controls., Methods: Thirty-one PwPD and 31 healthy controls were included. Different types of walking were assessed using the 10-Meter Walk Test for SW, the Timed Up and Go Test for WwT, the Figure-of-Eight Walk Test for CW, and the Three-Meter Backward Walk Test for BW. Walking assessments were performed in a single-task and a dual-task condition., Results: The DTC on SW was the lowest in both groups. The DTC on WwT, BW, and CW were similar in healthy controls, whereas the order of the DTC on remaining walking types from lowest to highest was; WwT, BW, and CW in PwPD. Also, the DTC on WwT, BW, and CW were higher in PwPD than healthy controls. However, the DTC on SW was similar in PwPD and healthy controls., Conclusion: The DTC is different during SW, WwT, BW, and CW in PwPD. Therefore, walking type should be considered in studies investigating dual task walking in PwPD. Also, dual task exercises consisting of different types of walking should be included in rehabilitation programs of PwPD., (© 2023. The Author(s) under exclusive licence to Belgian Neurological Society.)

Objective: To examine the validity and reliability of 3-Meter Backwalk Test (3MBWT) in children with Cerebral Palsy (CP)., Methods: Study included 55 children with CP with the mean age of 12.34 ± 3.78 years, at Expanded and Revised Gross Motor Functional Classification System (GMFCS-E&R) I and II levels. Intraclass Correlation Coefficient (ICC) was used for the intra-rater and inter-rater reliability of 3MBWT according to the GMFCS-E&R levels. MDC estimates were calculated using baseline data. Convergent validity of 3MBWT was evaluated with its correlation between the Timed Up and Down Stairs Test (TUDS), Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), Pediatric Reach Test (PRT), Four Square Step Test (FSST)., Results: Intra-rater and inter-rater reliability of 3MBWT was determined excellent at GMFCS-E&R I (Intra-rater ICC = 0.981-0.987, inter-rater ICC = 0.982-0.993), and GMFCS-E&R II (ICC = 0.927-0.933, ICC = 0.954-0.968). Intra-rater MDC values for GMFCS-E&R I were 1.17-1.22 s (s); 1.40-1.42 s for GMFCS-E&R II. Inter-rater MDC values for GMFCS-E&R I were 1.00-1.28 s, and MDC values for GMFCS-E&R II were 1.08-1.22 s. There was strong correlation between 3MBWT and PBS, TUG, and FSST in GMFCS-E&R I, moderate correlation between 3MBWT and TUDS, strong correlation between BBS, moderate correlation between TUG, and strong correlation between FSST in GMFCS-E&R II (p < 0.05)., Conclusion: The 3MBWT was found to be valid and reliable in children with CP. According to the MDC results, small differences in CP children can be adequately detected with 3MBWT. The 3MBWT also may add some more information on to GMFCS (E&R) data for following the disease progression as well as rehabilitation responses., Trial Registration Number: NCT04653363., (© 2023. The Author(s) under exclusive licence to Belgian Neurological Society.)

Although extensive literature exists on forward and backward walking, a comprehensive assessment of gait parameters on a wide and homogenous population is missing. Thus, the purpose of this study is to analyse the differences between the two gait typologies on a relatively large sample. Twenty-four healthy young adults participated in this study. By means of a marker-based optoelectronic system and force platforms, differences between forward and backward walking were outlined in terms of kinematics and kinetics. Statistically, significant differences were observed in most of the spatial-temporal parameters, evidencing some adaptation mechanisms in backward walking. Differently from the ankle joint, the hip and knee range of motion was significantly reduced when switching from forward to backward walking. In terms of kinetics, hip and ankle moment patterns for forward and backward walking were approximately mirrored images of each other. Moreover, joint powers appeared drastically reduced during reversed gait. Specifically, valuable differences in terms of produced and absorbed joint powers between forward and backward walking were pointed out. The outcomes of this study could represent a useful reference data for future investigation evaluating the efficacy of backward walking as a rehabilitation tool for pathological subjects.

Background: Multiple sclerosis (MS) causes motor, cognitive, and sensory impairments that result in injurious falls. Current fall risk measures in MS (ie, forward walking [FW] speed and balance) are limited in their sensitivity. Backward walking (BW) velocity is a sensitive marker of fall risk and correlates with information processing speed (IPS) and visuospatial memory (VSM) in persons with MS. Backward walking is a complex motor task that requires increased cognitive demands, which are negatively affected by MS; however, whether cognitive function modifies the sensitivity of BW as a fall risk assessment in MS remains unknown. This study examines the influence of cognition on the relationship between BW and falls in persons with MS., Methods: Measures of BW, FW, IPS, VSM, and retrospective falls were collected. Hierarchical regression tested moderation and included an interaction term predicting number of falls. Covariates for all analyses included age and disease severity., Results: Thirty-eight persons with MS participated. Although BW, IPS, and covariates significantly predicted the number of falls ( R 2 = .016), there was no evidence of moderation. Backward walking, VSM, and covariates also significantly predicted number of falls ( P = .016), there was no evidence of moderation. Backward walking, VSM, and covariates also significantly predicted number of falls ( R 2 = 0.332, P = .008), but there was no evidence of moderation. The FW models generated comparable results., Conclusions: The relationship between BW velocity and falls was not conditional on IPS or VSM in this sample. Larger-scale studies examining additional cognitive domains commonly affected by MS and prospective falls are needed to characterize neurobiological processes relevant to BW and its clinical application in the assessment of fall risk., Competing Interests: FINANCIAL DISCLOSURES: Dr Fritz serves on the MS scientific advisory board for Helius Medical. The other authors declare no conflicts of interest., (© 2023 Consortium of Multiple Sclerosis Centers.)

Introduction: Parkinson's disease (PD) is a neurodegenerative disease characterized by motor symptoms and gait impairments. Among them, freezing of gait (FOG) is one of the most disabling manifestations. Backward walking (BW) is an activity of daily life that individuals with PD might find difficult and could cause falls. Recent studies have reported that gait impairments in PD were more pronounced in BW, particularly in people presenting FOG. However, to the best of our knowledge, no systematic review has synthetized the literature which compared BW performance in PD patients with and without FOG., Objective: The aim of this study was to evaluate the differences in BW performance between PD patients with FOG and PD patients without FOG., Methods: Two databases, PubMed and Web of Science, were systematically searched to identify studies comparing BW performance in PD patients with and without FOG. The National Institutes of Health (NIH) tool was used to assess the quality of the studies included., Results: Seven studies with 431 PD patients (179 PD with FOG and 252 PD without FOG) met the inclusion criteria and were included in this review. Among them, 5 studies reported walking speed, 3 studies step length, stride length and lower limb range of motion, 2 studies functional ambulation profile, toe clearance height, swing, and stance percent and 1 study reported the decomposition index and stepping coordination. Compared to PD patients without FOG, PD patients with FOG showed slower walking speed and reduced step length in 3 studies, shorter stride length, lower functional ambulation profile and decreased ankle range of motion in 2 studies, and smaller swing percent, higher stance percent, worse stepping coordination, greater decomposition between movements, and lower toe clearance height in one study., Conclusion: Despite the small number of included studies, the findings of this review suggested that PD patients with FOG have worse gait performance during the BW task than PD without FOG.

Forward walking (FW) is a common balance assessment tool. However, its sensitivity is limited by the ceiling effect. Reverse gait, such as backward walking (BW), has been reported to have more advantages than FW for balance assessment. Three factors related to postural instability (i.e., increased speeds, restricted arm swing, and reduced visual feedback) during BW were investigated to determine BW conditions that have the potential to predict falls. Three-dimensional analyses were used to analyze seven walking conditions. FW and BW at self-selected and fast speeds were analyzed to identify the effects of speed. Walking with normal arm swings, crossed arms, and abducted arms during BW was tested to determine the effects of arm position. BW with closed and open eyes was compared to investigate the effects of visual feedback. BW had a significantly shorter step length than FW at high speeds. When the arms were abducted, the stance phase (%) was significantly lower compared to when arms were crossed during BW. Moreover, BW with closed eyes revealed significantly higher mediolateral center of mass (COM) displacements than with open eyes. We observed that BW with fast speeds, a crossed arm position, and closed eyes has the potential to help assess fall risk because it requires higher balance ability through spatiotemporal and COM adjustment.

Background: The 3-meter backward walk test (3MBWT) evaluates neuromuscular control, proprioception, protective reflexes, fall risk, and balance. This study aimed to examine the reliability, validity, and minimal detectable change (MDC) of the 3MBWT in patients with Multiple Sclerosis (pwMS)., Methods: 40 pwMS (8 male, 32 female) were included in the study. The Intraclass Correlation Coefficient (ICC) was used for the reliability of the 3MBWT. MDC estimates were calculated using baseline data. The validity of the 3MBWT was evaluated by the correlation between The Timed Up and Go test (TUG), The 12-item Multiple Sclerosis Walking Scale (MSWS-12), The 2 Min Walk Test (2MWT), The Timed 25-Foot Walk Test (T25FW), and The Four Square Step Test (FSST) RESULTS: The intra-rater (ICC 0.944-0.945) and inter-rater (ICC 0.932-0.935) reliability of the 3MBWT was determined to be excellent. MDC values for intra-rater were 1.13-1.30 sec, and MDC values for inter-rater were 1.10-1.24 sec. The correlation with 3MBWT, TUG, MSWS-12, and 2MWT was found to be statistically significant., Conclusion: The 3MBWT was found to be valid and reliable in pwMS. It is a short and easily applied test in outpatient and inpatient clinics without any need for equipment. According to the MDC results, small differences in pwMS can be adequately detected with 3MBWT. Therefore, it may be a clinically suitable test for detecting subtle changes in synergistic motor functions related to prorioception in relapsing or remitting periods. It, also may add some more information on to EDSS data for following the disease progression as well as treatment responses., (Copyright © 2022. Published by Elsevier B.V.)

Background: One of the biggest problems for persons with Multiple Sclerosis (PwMS) is dizziness, poor posture, and balance problems that cause injury-causing falls. The aim of our study was to reveal the test-retest reliability and validity of the 3-Meter Backward Walk Test (3MBWT) in mildly disabled PwMS., Methods: This study included a total of 93 mildly disabled PwMS with mean EDSS of 1.89. 3MBWT, Functional Access Test (FRT), Dynamic Gait Index (DGI), Timed 25-Foot Walk (T25FW), and Timed-Up and Go (TUG) were applied to the patients. To measure test-retest reliability, a second evaluation was performed three days after the first evaluation., Results: Cronbach's alpha coefficient was found to be 0.998 (excellent). For intra-rater agreement, the ICC values in the individual test were 0.998. The SEM value was 0.18, the MDC value was found to be 0.50. A very strong correlation was revealed between the 3MBWT and FRT (r: -0.931, p: 0.001), TUG (r: 0.968, p: 0.001), T25FW (r: 0.879, p: 0.001), DGI (r: -0.871, p: 0.001) and falling history (r: 0.932, p: 0.001)., Conclusion: The 3MBWT was observed to be valid and reliable in mildly disabled PwMS. 3MBWT is an effective and reliable tool for measuring ability to walk backward in mildly disabled PwMS., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Introduction: Although there is growing literature supporting the implementation of backward walking as a potential rehabilitation tool, moving backwards may precipitate falls for persons with Parkinson's disease. We sought to better understand interlimb coordination during backward walking in comparison to forward walking in persons with Parkinson's disease and healthy controls., Methods: We assessed coordination using point estimate of relative phase at each participant's preferred walking speed., Results: Persons with Parkinson's disease demonstrated impaired interlimb coordination between the more affected arm and each leg compared to controls, which worsened during backward walking., Conclusion: For those with Parkinson's disease, inability to output smooth coordinated movement of the more affected shoulder may impair coordination during forward and, especially, backward walking. Our findings provide new information about backward walking that can allow clinicians to make safer, more effective therapeutic recommendations for persons with Parkinson's disease., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The purpose of this study was to investigate the spatiotemporal and kinematic parameters of backward walking (BW) and forward walking (FW) on sand. Randomly selected subjects (n = 28) were categorized into a sand group (SG, n = 14) and an overground group (OG, n = 14). SG was directed to perform both FW and BW on sand, while OG performed the same on the overground. Spatiotemporal and kinematic parameters were measured using the LegSys + device. The comparative findings of both the groups showed that the spatiotemporal parameters of SG varied significantly from those of OG in both FW and BW conditions (p < 0.05). The kinematic parameters varied significantly between the two groups only in the FW condition (p < 0.05). When compared within each group, spatiotemporal and kinematic parameters in the BW condition were significantly different from those in the FW condition. However, the percentages of stance, swing, and double support were not significantly different between FW and BW conditions (p > 0.05). This study suggests that sand walking is associated with a different gait pattern than overground walking, as evident from the analysis of the results of spatiotemporal and kinematic parameters in both FW and BW conditions. Therefore, sand walking can be used as a new approach to gait and balance training in clinical practice., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective : The present study aimed to assess proprioception of the knee to evaluate the effectiveness of backward walking for rehabilitation after anterior cruciate ligament (ACL) reconstruction. Methods : Patients (n = 52) who underwent ACL reconstruction in a single knee divided randomly into four experimental groups (A-D) and a control group, who all practiced a systematic rehabilitation exercise program. The patients in the experimental groups underwent backward walking using different treadmill angles: group A (0°), B (5°), C (10°) and D (15°). The whole training period comprised 4 weeks. Outcomes for the joint were assessed using the Angle Reproduction Test (ART) and Passive Motion Perception Test (PMPT). Results : Compared with the pre-training recorded parameters, significant differences were found in the ART and PMPT scores among all training groups and between the control group and the training groups. When the four training groups were compared with each other, there was no difference in the ART results between groups A and B, but significant differences were found between group A and groups C and D. Conclusion : Backward walking as a rehabilitation technique improved knee proprioception after ACL reconstruction. Increasing the angle of the treadmill during exercise improved the efficacy of rehabilitation.

Background: We studied the effects of motor tasks using backward walking training on balance and gait functions of children with cerebral palsy. This was a single-blinded, randomized controlled trial with a crossover design conducted at a single facility., Methods: Among 12 children with cerebral palsy, the forward (FWG) ( n = 6) and backward walking groups (BWG) ( n = 6) underwent training three times a week for 4 weeks, 40 min a day. After a 6-week break, the crossover training was conducted. Functional walking variables were measured. Time-Up-and-Go (TUG) test, Figure-8 Walk Test (FW8T), and Pediatric Balance Scale (PBS) were used for measuring balance., Results: Both groups showed significant improvement in walking speed, stride length, and step length. The BWG demonstrated significant improvement in walking speed ( p < 0.05) compared with the FWG. The TUG test, FW8T, and PBS showed significant improvement. After the 4-week intervention, both groups displayed a remarkable decrease in TUG duration and FW8T. Both groups also exhibited improvement in the PBS; more so in the BWG., Conclusions: Backward walking training with motor dual tasks could be a more effective interventional approach than forward walking training to improve balance and walking functions of children with spastic hemiplegia.

Objectives: The 3-m backward walk test (3MBWT) is used to evaluate neuromuscular control, proprioception, protective reflexes, fall risk and balance. The aim of our study was to reveal the test-retest reliability and validity of the 3MBWT in stroke patients., Materials and Methods: This study included a total of 41 stroke patients [age 59 (35-78) years]. 3MBWT, Berg Balance Scale (BBS), Timed Up and Go test (TUG) were applied to the patients. The second evaluation (retest) was carried out by the same physiotherapist two days following the first evaluation (test) in order to measure test-retest reliability., Results: Cronbach's alpha coefficient was found to be 0.974 (excellent). For intra-rater agreement, the ICC values in the individual test were 0.985. The SEM value was 1.11 sec, the MDC value was found to be 1.57 sec. A moderate correlation was revealed between the 3 m-backward walking speed and BBS (r: -0.691, p: 0.001) and TUG (r: 0.849, p: 0.001)., Conclusions: The 3MBWT was observed to be valid and reliable in stroke individuals. It is an effecive and reliable tool for measuring dynamic balance and falls in stroke., Competing Interests: Declaration of Competing Interest None, (Copyright © 2020 Elsevier Inc. All rights reserved.)

Studies have compared the differences and similarities between backward walking and forward walking, and demonstrated the potential of backward walking for gait rehabilitation. However, current evidence supporting the benefits of backward walking over forward walking remains inconclusive. Considering the proven association between gait and the cerebral cortex, we used electroencephalograms (EEG) to differentiate the effects of backward walking and forward walking on cortical activities, by comparing the sensorimotor rhythm (8-12 Hz, also called mu rhythm) of EEG signals. A systematic signal procedure was used to eliminate the motion artifacts induced by walking to safeguard EEG signal fidelity. Statistical test results of our experimental data demonstrated that walking motions significantly suppressed mu rhythm. Moreover, backward walking exhibited significantly larger upper mu rhythm (10-12 Hz) suppression effects than forward walking did. This finding implies that backward walking induces more sensorimotor cortex activity than forward walking does, and provides a basis to support the potential benefits of backward walking over forward walking. By monitoring the upper mu rhythm throughout the rehabilitation process, medical experts can adaptively adjust the intensity and duration of each walking training session to improve the efficacy of a walking ability recovery program.

Backward walking (BW) is being increasingly used in neurologic and orthopedic rehabilitation as well as in sports to promote balance control as it provides a unique challenge to the sensorimotor control system. The identification of initial foot contact (IC) and terminal foot contact (TC) events is crucial for gait analysis. Data of optical motion capture (OMC) kinematics and inertial motion units (IMUs) are commonly used to detect gait events during forward walking (FW). However, the agreement between such methods during BW has not been investigated. In this study, the OMC kinematics and inertial data of 10 healthy young adults were recorded during BW and FW on a treadmill at different speeds. Gait events were measured using both kinematics and inertial data and then evaluated for agreement. Excellent reliability (Interclass Correlation > 0.9) was achieved for the identification of both IC and TC. The absolute differences between methods during BW were 18.5 ± 18.3 and 20.4 ± 15.2 ms for IC and TC, respectively, compared to 9.1 ± 9.6 and 10.0 ± 14.9 for IC and TC, respectively, during FW. The high levels of agreement between methods indicate that both may be used for some applications of BW gait analysis.

Background: Individuals with multiple sclerosis experience deficits in mobility resulting in injurious falls. Fall detection has proved challenging; the majority of clinical measures rely on forward walking and balance measures, yet these measures have poor sensitivity and predictive value for differentiating between fallers and non-fallers. Backward walking better differentiates fallers from non-fallers in the elderly and other neurodegenerative diseases; therefore, the objective of this study was to examine both forward and backward walking to determine the strongest, unique contributor that differentiates fallers from non-fallers in persons with multiple sclerosis., Methods: In a single session, spatiotemporal measures of forward and backward walking and fall history were collected. For the subsequent six months, individuals recorded falls in a fall diary. Discriminant function analysis was used to determine what variables most strongly and uniquely differentiate multiple sclerosis fallers from non-fallers., Results: Thirty-eight individuals with multiple sclerosis participated. Forward and backward velocity, stride length, and double support time as well as age, disease severity, and symptom duration were included in the models. Together, the variables differentiated between fallers and non-fallers (Wilk's lambda χ2 (8, N = 36) = 0.497, p<0.001) and in rank order, backward walking velocity was the strongest unique predictor. Repeating the analysis with a stepwise approach yielded that backward walking velocity in the first step (χ2 (1, 34) = 0.68, F = 15.96, p<0.001) and symptom duration in the second step (χ2 = 0.59, F (2, 33) = 11.46; p<0.001) most strongly differentiated retrospective fallers and non-fallers. This stepwise model with backward walking velocity and symptom duration accurately classified 76.3% of cases. Addition of forward walking measures did not significantly improve the models, and indeed the accuracy of classification was reduced to 71.1%. Exploratory analysis showed that backward walking velocity was the best predictor of prospectively reported fallers and non-fallers (χ2 (1, 7) = 0.43, F = 9.20, p = 0.02)., Conclusion: Backward walking velocity exhibits the highest effect magnitude and specificity in differentiating fallers from non-fallers in individuals with MS and demonstrates potential as clinically feasible and efficient fall detection tool., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Walking impairment impacts nearly 66% of stroke survivors and is a rising cause of morbidity worldwide. Despite conventional post-stroke rehabilitative care, the majority of stroke survivors experience continued limitations in their walking speed, temporospatial dynamics and walking capacity. Hence, novel and comprehensive approaches are needed to improve the trajectory of walking recovery in stroke survivors. Herein, we test the safety, feasibility and preliminary efficacy of two approaches for post-stroke walking recovery: backward locomotor treadmill training and transcutaneous spinal direct current stimulation. In this double-blinded study, 30 chronic stroke survivors (>6 months post-stroke) with mild-severe residual walking impairment underwent six 30-min sessions (three sessions/week) of backward locomotor treadmill training, with concurrent anodal ( N  = 19) or sham transcutaneous spinal direct current stimulation ( N  = 11) over the thoracolumbar spine, in a 2:1 stratified randomized fashion. The primary outcomes were: per cent participant completion, safety and tolerability of these two approaches. In addition, we collected data on training-related changes in overground walking speed, cadence, stride length (baseline, daily, 24-h post-intervention, 2 weeks post-intervention) and walking capacity (baseline, 24-h post-intervention, 2 weeks post-intervention), as secondary exploratory aims testing the preliminary efficacy of these interventions. Eighty-seven per cent ( N  = 26) of randomized participants completed the study protocol. The majority of the study attrition involved participants with severe baseline walking impairment. There were no serious adverse events in either the backward locomotor treadmill training or transcutaneous spinal direct current stimulation approaches. Also, both groups experienced a clinically meaningful improvement in walking speed immediately post-intervention that persisted at the 2-week follow-up. However, in contrast to our working hypothesis, anodal-transcutaneous spinal direct current stimulation did not enhance the degree of improvement in walking speed and capacity, relative to backward locomotor treadmill training + sham, in our sample. Backward locomotor treadmill training and transcutaneous spinal direct current stimulation are safe and feasible approaches for walking recovery in chronic stroke survivors. Definitive efficacy studies are needed to validate our findings on backward locomotor treadmill training-related changes in walking performance. The results raise interesting questions about mechanisms of locomotor learning in stroke, and well-powered transcutaneous spinal direct current stimulation dosing studies are needed to understand better its potential role as a neuromodulatory adjunct for walking rehabilitation., (© The Author(s) (2020). Published by Oxford University Press on behalf of the Guarantors of Brain.)

Backward walking (BW) has been extensively used in athletic training and orthopedic rehabilitation as it may have value for enhancing balance. This study identified the differences in foot intersegment kinematics (forward walking (FW) vs. time-reversed BW) and plantar pressure parameters of 16 healthy habitually shod individuals walking FW and BW using flexible shoes (SH) and under barefoot conditions (BF). BW was found to have shorter stride length (SL) and higher stride frequency (SF) under BF conditions compared with SH, which indicates a better BW gait stability under BF conditions. Decreased HX/FF dorsiflexion at HO in BW induces less plantar aponeurosis tension which may inhibit the windlass mechanism compared to FW walking. Increased forefoot relative to hindfoot (FF/HF) pronation and sequentially hindfoot relative to tibia (HF/TB) eversion combined with medially distributed plantar pressure and a higher plantar contact area in the medial side in BW-BF maybe beneficial in maintaining balance. These results indicate that BW training may be more reliable under BF conditions compared to the SH conditions based on greater sensory information feedback from the plantar area resulting in better biomechanical behavior.

External cues, including touch, enable walking animals to flexibly maneuver around obstacles and extricate themselves from dead-ends (for reviews, see [1-3]). In a screen for neurons that enable Drosophila melanogaster to retreat when it encounters a dead-end, we identified a pair of ascending neurons, the TwoLumps Ascending (TLA) neurons. Silencing TLA activity impairs backward locomotion, whereas optogenetic activation triggers backward walking. TLA-induced reversal is mediated in part by the Moonwalker Descending Neurons (MDNs) [4], which receive excitatory input from the TLAs. Silencing the TLAs decreases the extent to which freely walking flies back up upon encountering a physical barrier in the dark, and TLAs show calcium responses to optogenetic activation of neurons expressing the mechanosensory channel NOMPC. We infer that TLAs convey feedforward mechanosensory stimuli to transiently activate MDNs in response to anterior body touch., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

This study aimed to investigate effects of walking direction and speed on gait complexity, symmetry and variability as indicators of neural control mechanisms, and if a period of backward walking has acute effects on forward walking. Twenty-two young adults attended 2 visits. In each visit participants walked forwards at preferred walking speed (PWS) for 3-minutes (pre) followed by 5-minutes walking each at 80%, 100% and 120% of PWS of either forward or backward walking then a further 3-minutes walking forward at PWS (post). The order of walking speed in each visit was randomised and walking direction of each visit was randomised. An inertial measurement unit was placed over L5 vertebra to record tri-axial accelerations. From the trunk accelerations multiscale entropy, harmonic ratio and stride time variability were calculated to measure complexity, symmetry and variability for each walk. Complexity increased with increasing walking speed for all axes in forward and backward walking, and backward walking was less complex than forward walking. Stride time variability was also greater in backward than forward walking. Anterio-posterior and medio-lateral complexity increased following forward and backward walking but there was no difference between forward and backward walking post effects. No effects were found for harmonic ratio. These results suggest during backward walking trunk motion is rigidly controlled but central pattern generators responsible for temporal gait patterns are less refined for backward walking. However, in both directions complexity increased as speed increased suggesting additional constraint of trunk motion, normally characterised by reduced complexity, is not applied as speed increases., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background : With limited inpatient rehabilitation (IR) length of stays for patients post-stroke, it is critical to maximize the effectiveness of interventions to address their balance and gait speed deficits. Backward walking (BW) is an emerging training approach; however, its application to patient populations consistent with those in IR is limited. Objectives : To describe the effects of an additional BW training program to standard IR care on balance, walking ability and fall-risk in a heterogenic caseload of adults <2 weeks post-stroke with a broad range of lesion locations and physical sequelae. Methods : Eight patients with first-time stroke (5 male; average age 66.5 ± 11.7 years; average stroke onset 7.6 ± 1.6 days; 6 right hemiparesis) participated in 10-daily sessions that included 20 min of over ground BW training for each session, in addition to standard IR. Standard outcome measures were used to assess balance, walking ability and fall-risk at admission and post-intervention. Results : All eight patients demonstrated improvements in all outcomes with a clinically meaningful increase in forward walking speed, as measured by 10MWT. Four participants exceeded fall-risk cut-off scores for all balance-related outcome measures. Conclusions : In a diverse patient population early after stroke, individuals successfully participated in an additional BW training program. Despite the patients' acuity and severe impairments in walking, significant gains in balance and walking function were noted. This program may be useful in improving outcomes with patient characteristics commonly seen in IR.

Background: Forward and backward walking are both impaired in Parkinson disease (PD). In this study, an exploratory factor analysis was performed to investigate the relationship between forward and backward walking in PD., Research Question: Given the difference in levodopa response between forward and backward walking, what is the additive value of testing backwards walking in a clinical setting., Methods: Sixty-two patients with PD (65.29 ± 7.17 yrs, UPDRS OFF = 29.68 ± 9.88, UPDRS ON = 16.40 ± 8.21) and eleven healthy age-matched controls (63.09 ± 8.09 yrs) were recruited. PD participants completed forward (F) and backward (B) walking tasks on a 6.1 m instrumented walkway (OFF and ON levodopa). Factor analysis was used to derive models for both walking tasks/medication states., Results: In both OFF and ON, four factors were identified: Variability (OFF: F = 30.0%, B = 17.8%, ON: F = 21.6%, B = 25.0%), Rhythm (OFF: F = 14.5%, B = 17.0%, ON: F = 17.4%, B = 19.0%), Asymmetry (OFF: F = 13.7%, B = 14.3%, ON: F = 16.1%, B = 15.2%), and Pace (OFF: F = 12.2%, B = 17.0%, ON: F = 13.9%, B = 8.7%). In the ON state, a fifth factor was identified: Posture (ON: F = 3.8%, B = 7.7%)., Significance: This study demonstrates the similarity in gait domain factors in both forward and backward walking. While domains of gait are similar in both walking tasks, levodopa response is reduced in backward walking. This could be a result of the increased complexity of backward walking. This study provides a normative dataset that can be used when assessing forward and backward walking in individuals with PD., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background : While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators. Objective : To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls. Methods : Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition). Results : The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p < .01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p < .05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p < .05). Conclusions : Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation.

Objectives: This study aims to examine the effect of backward walking (BW) and forward walking (FW) on the myoelectric activity ratio of the vastus medialis oblique (VMO)/vastus lateralis (VL) in females with patellofemoral pain syndrome (PFPS)., Patients and Methods: Between September 2016 and December 2016, a total of 40 female participants (mean age 20.9±1.9 years; range, 19 to 26 years) were included in the study. The participants were divided into two groups as those with unilateral PFPS (PFPS group, n=20) and healthy controls (Control group, n=20). Surface electromyography (EMG) from VMO and VL muscles were collected during FW and BW at a speed of 3 km/h using the Myomonitor® IV EMG system., Results: There was a significant increase in the EMG activities of the VMO and VL muscles during BW compared to FW in PFPS and healthy groups (p=0.001). During BW, the VMO activity of PFPS was significantly higher than the healthy controls (p=0.013) without any significant difference in the VL activity (p=0.916). During FW, there was no significant difference in the VMO and VL activities between the groups (p=0.348 and p=0.705), respectively. The VMO/VL ratio of the PFPS group during BW was significantly higher than the FW ratio (p=0.001) without any significant difference between BW and FW of the healthy group (p=0.841). During BW, the ratio of the PFPS group was significantly higher than compared to the healthy controls (p=0.016) without any significant difference between the groups during FW (p=0.100)., Conclusion: Our study results show that BW increases the VMO muscle activation and preserve the ideal VMO/VL ratio in PFPS patients. Therefore, clinicians should consider BW training when developing rehabilitation programs for females with PFPS., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Objective:: To investigate the effectiveness of backward walking in the treatment of people with gait impairments related to neurological and musculoskeletal disorders., Design:: Systematic review and meta-analysis of randomized and quasi-randomized control studies., Data Sources:: Searched from the date of inception to March 2018, and included PubMed, Scopus, Cochrane Library, PEDro, CINAHL, and the MEDLINE databases., Methods:: Investigating the effects of backward walking on pain, functional disability, muscle strength, gait parameters, balance, stability, and plantar pressure in people with gait impairments. The PEDro scale was used to assess the quality. Similar outcomes were pooled by calculating the standardized mean difference., Results:: Of the 21 studies (neurological 11 and musculoskeletal 10), 635 participants were included. The average PEDro score was 5.4/10. The meta-analysis demonstrated significant standardized mean difference values in favour of backward walking, with conventional physiotherapy treatment for two to four weeks to reduce pain (-0.87) and functional disability (-1.19) and to improve quadriceps strength (1.22) in patients suffering from knee osteoarthritis. The balance and stability in cases of juvenile rheumatoid arthritis, and gait parameters and muscle strength in anterior cruciate ligament injury improved significantly when backward walking was included as an exercise. There was no significant evidence in favour of backward walking in any of the other conditions., Conclusion:: The systematic review and meta-analysis suggests that backward walking with conventional physiotherapy treatment is effective and clinically worthwhile in patients with knee osteoarthritis. Insufficient evidence was available for the remaining gait impairment conditions and no conclusions could be drawn.

Background: Backward walking (BW) training is thought to impact balance performance through improving motor system proprioception and gait characteristic, but relevant evidence remains sparse and inconclusive., Objective: This study systematically reviewed and quantified the scientific evidence regarding the effectiveness of BW training on balance performance., Methods: Keyword and reference search on BW training interventions was conducted in six electronic databases (PubMed, Web of science, SPORTDiscus, CINAHL, Cochrane Library, and CNKI) for peer-reviewed articles published till November 2017. A standardized form was used to extract data from each selected article that met the pre-specified eligibility criteria. Meta-analysis was conducted to estimate the pooled effects of BW training on balance performance measures., Results: Eleven studies (nine randomized controlled trials and two pre-post studies) met the eligibility criteria and were included in the review. All studies reported some beneficial effects of BW training on balance performance. Compared to control, BW training was associated with a reduction in overall stability index score by 0.99 (95% CI = 0.37, 1.61; I 2  = 0.0%; fixed-effect model), medial-lateral stability index score by 0.95 (95% CI = 0.34, 1.57; I 2  = 0.0%; fixed-effect model), and anterior-posterior stability index score by 0.99 (95% CI = 0.37, 1.61; I 2  = 0.0%; fixed-effect model). Meanwhile, BW training was associated with an increase in open-eyes single leg standing duration by 0.91 s (95% CI = 0.29, 1.53; I 2  = 75.9%; random-effect model) in comparison to control., Conclusions: BW training could serve as a potentially useful tool to improve balance performance among those with a high risk of fall. However, current evidence remains preliminary due to the small cohort of studies and possible learning effect in pre-post studies. Future work with larger scale and randomized experimental design is warranted to evaluate the effectiveness of BW training on balance performance across diverse population and disease subgroups, and elucidate the underlying biomechanical and neurological pathways., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective:: To investigate the effects of backward gait training on balance, gross motor function, and gait parameters in children with cerebral palsy., Data Sources:: PubMed, Cochrane Library, Web of Science, Science Direct, Physiotherapy Evidence Database (PEDro), and Google Scholar were searched up to May 2018., Review Methods:: Randomized controlled trials were included if they involved any form of backward gait training for children with cerebral palsy. Two authors independently screened articles, extracted data and assessed the methodological quality using PEDro scale, with any confliction resolved by the third author. Modified Sackett Scale was used to determine the level of evidence for each outcome., Results:: Out of 1492 papers screened, 7 studies with 172 participants met the inclusion criteria. The duration of treatment ranged from 15 to 25 minutes, three times a week and for 6-12 weeks. The quality of studies ranged from good (two studies) to fair (four studies) and poor (one study), with a mean PEDro score of 4.7 out of 10. All included studies showed positive effects in the measured outcomes. The results showed level 1b evidence for balance when compared to no intervention, and for gross motor function, step length and walking speed when compared to same dose of forward gait training. The clinical heterogeneity of studies makes meta-analysis inappropriate., Conclusion:: In children with cerebral palsy, there is moderate evidence that backward gait training improves balance, gross motor function, step length and walking velocity. More high-quality studies are needed.

Background: Patients with spastic Cerebral Palsy are prone to equinus deformities, likely affected by short and inextensible plantarflexor muscles. Manual stretching is a popular treatment but its effectiveness concerning joint mobility, muscle-tendon morphometrics and walking function is debated. Eccentric exercise by backward-downhill treadmill training could be a therapeutic alternative for ambulatory patients improving gait and muscle function., Research Question: What are the effects of eccentric training by backward-downhill treadmill training and plantarflexor stretching concerning gait and muscle function in patients with spastic Cerebral Palsy?, Methods: 10 independent ambulators with spastic Cerebral Palsy (12 [SD 4] years old, 2 uni- and 8 bilaterally affected) participated in a randomized crossover-study. One group started with manual static stretching, the other one with backward-downhill treadmill training. Each treatment period lasted 9 weeks (3 sessions per week). Pre and post treatments, 3D gait was assessed during comfortable and during fastest possible walking. Ultrasonography and dynamometry were used to test plantarflexor strength, passive joint flexibility, as well as gastrocnemius morphometrics, stiffness and strain on muscle-tendon and joint level., Results: When comparing both treatments, backward-downhill treadmill training lead to larger single stance dorsiflexion at comfortable walking speed (+2.9°, P = 0.041) and faster maximally achievable walking velocities ( + 0.10 m/s, P = 0.017). Stretching reduced knee flexion in swing, particularly at faster walking velocities (-5.4°, P = 0.003). Strength, ankle joint flexibility, as well as stiffness on muscle-tendon and joint level were not altered, despite similar increases in passive muscle and fascicle strain with both treatments (P ≤ 0.023)., Significance: Backward-downhill treadmill training can be an effective gait treatment, probably improving coordination or reducing dynamic stretch sensitivity. More intense BDTT might be necessary to further alter muscle-tendon properties. Manual static plantarflexor stretching may not be optimal in Cerebral Palsy patients with high ambulatory status., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Backward walking training (BWT) is thought to affect gait biomechanics, but relevant evidence has been sparse and inconclusive., Objective: This study systematically reviewed and quantified the effectiveness of BWT on spatial-temporal gait characteristics (STGC)., Methods: A keyword and reference search of interventions on BWT was conducted in five bibliographic databases: PubMed, Web of Science, SPORTDiscus, CINAHL, and Cochrane Library for articles published until November, 2017. Two reviewers independently screened titles, abstracts, and full texts of all articles and jointly decided the final pool. A standardized form was used to extract data from each included article. Meta-analysis was conducted to estimate the pooled effect of BWT on STGC., Results: Eleven studies met the eligibility criteria and were included in the review. All studies reported some positive influences of BWT on STGC relative to forward walking training (FWT) and/or control. Compared to FWT, BWT was associated with an increase in forward gait speed by 0.69 (95% confidence interval [CI] = 0.12, 1.25) m/s and stride length by 0.51 (95% CI = 0.22, 0.80) cm. Compared to control, BWT was associated with an increase in forward gait speed by 1.00 (95% CI = 0.36, 1.64) m/s., Conclusions: BWT could improve participants' STGC and be potentially useful in neurological rehabilitation. However, current evidence remains preliminary. The effects found could merely be due to differences in training intensity between the FWT and BWT, and thus, may not reflect actual differences between training in different walking directions. Future studies are warranted to elucidate the pathways linking BWT to gait biomechanics., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The review summarizes existing information on coaching and potential treatment-and-prophylactic effect of backward walking in elderly. It provides information on the success of the backward walking to restore a stable body position and gait in persons with hemiplegia after stroke, suffering from Parkinson's disease and diabetic foot syndrome. It is noted that the tests with backward walking can be used for diagnostic purposes - to assess the severity of impaired coordination and motor skills and to predict the probability of falling in the elderly.

This study aimed to compare the ground reaction forces (GRF) and lower limb muscles correlation and activation time delay between Forward (FW) and Backward (BW) walking. Twenty-four male students participated in this research. Electromyogram activities of gluteus medius, biceps femoris, medial gastrocnemius, soleus and anterior tibialis muscles along with GRFs were measured. Each participant performed two FW and two BW trials bare foot. Statistical parametric mapping (SPM) analysis was performed over anterior-posterior and vertical GRFs time series. The paired t-test was used in SPM analysis. Cross-correlation analysis compared similarity in shape and time delay of EMG pattern. SPM analysis of GRFs showed that these two walking modes have asymmetrical kinetic behavior during most parts of stance phase. Based on cross-correlation analysis, the shape of EMG activation profiles differed, where a phase shift in the muscle activation pattern of approximately 60% occurred. This shift may indicate different control mechanisms, at the spinal level, underpin FW and BW walking modalities., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To compare the effects of backward walking training and forward walking training on spatiotemporal gait parameters, and gross motor function measures in children with cerebral palsy., Design: Randomized controlled clinical trial., Setting: Physical therapy clinics., Subjects: A total of 30 children with hemiparetic cerebral palsy of both sexes (10 to 14 years of age, classified as I or II by gross motor function classification system) participated in this study. They were randomly assigned into two equal groups., Interventions: Both groups received a conventional physical therapy program for 12 successive weeks (three sessions per week). The experimental group additionally received (25 min) backward walking training. The control group additionally received (25 min) forward walking training., Outcome Measures: Baseline, posttreatment, and follow-up assessment for spatiotemporal gait parameters and gross motor functions were evaluated by using three dimensional gait analysis system and gross motor function measures., Results: There was a significant improvement in step length, walking velocity, cadence, stance phase, and swing phase percentage and gross motor function measures (Dimensions D and E) of the experimental group (0.55 ±0.16, 0.53 ±0.19, 121.73 ±2.89, 54.73 ±1.67, 44.40 ±1.40, 90.20 ±6.44, 82.47 ±12.82), respectively, than the control group (0.39 ±0.13, 0.46 ±0.20, 125.80 ±2.96, 50.27 ±1.62, 49.47 ±1.55, 82.47 ±7.05, 80.47 ±12.61), respectively, ( p < 0.05). The significant improvement of all measured outcomes of the experimental group was maintained at 1 month follow-up assessment ( p < 0.05)., Conclusion: In addition to a conventional physical therapy program, backward walking training is more effective than forward walking training on spatiotemporal gait parameters, and gross motor function measures in children with hemiparetic cerebral palsy.

Walking direction is an important attribute of biological motion because it carries key information, such as the specific intention of the walker. Although it is known that spatial attention is guided by walking direction, it remains unclear whether this attentional shift is reflexive (i.e., constantly shifts to the walking direction) or not. A richer interpretation of this effect is that attention is guided to seek the information that is necessary to understand the motion. To investigate this issue, we examined how backward-walking biological motion orients attention because the intention of walking backward is usually to avoid something that walking forward would encounter. The results showed that attention was oriented to the walking-away direction of biological motion instead of the walking-toward direction (Experiment 1), and this effect was not due to the gaze direction of biological motion (Experiment 2). Our findings suggest that the attentional shift triggered by walking direction is not reflexive, thus providing support for the rich interpretation of these attentional effects.

[Purpose] To investigate the features of backward walking in stroke patients with hemiplegia by focusing on the joint movements and moments of the paretic side, walking speed, stride length, and cadence. [Subjects and Methods] Nine stroke patients performed forward walking and backward walking along a 5-m walkway. Walking speed and stride length were self-selected. Movements were measured using a three-dimensional motion analysis system and a force plate. One walking cycle of the paretic side was analyzed. [Results] Walking speed, stride length, and cadence were significantly lower in backward walking than in forward walking. Peak hip extension was significantly lower in backward walking and peak hip flexion moment, knee extension moment, and ankle dorsiflexion and plantar flexion moments were lower in backward walking. [Conclusion] Unlike forward walking, backward walking requires conscious hip joint extension. Conscious extension of the hip joint is hard for stroke patients with hemiplegia. Therefore, the range of hip joint movement declined in backward walking, and walking speed and stride length also declined. The peak ankle plantar flexion moment was significantly lower in backward walking than in forward walking, and it was hard to generate propulsion power in backward walking. These difficulties also affected the walking speed.

Backward walking (BW) is an inherent component of mobility and function in daily activities, particularly indoors, when it is more likely that a person is barefoot. No studies to date have compared the spatio-temporal characteristics of BW with and without shoes in elderly individuals. This study compared spatio-temporal measures of BW and forward walking (FW) among elderly individuals while barefoot or wearing shoes. Forty-seven elderly individuals (13 men and 34 women, 76.7±7.7years of age) were evaluated. Participants were requested to walk at a comfortable, self-selected pace across the GAITRite ® walkway for three trials under each of four conditions: walking forward (FW) and BW wearing their own comfortable low-heeled walking shoes and FW and BW walking without shoes. Gait speed, stride length and cadence were significantly reduced in BW versus FW, with an increase in double limb support (DLS), both with and without shoes. Barefoot BW resulted in significantly increased gait speed and cadence, and decreased DLS compared to BW with shoes. BW stride length was not affected by footwear. While barefoot FW was also associated with a significant increase in cadence and decrease in DLS time compared to walking with shoes, it decreased stride length and had no detrimental effect on gait speed. Assessment of the spatio-temporal parameters of walking barefoot and with shoes during FW and BW can contribute to our understanding of the ability of elderly individuals to adapt to changing walking conditions, and should be included in the assessment of functional mobility of elderly individuals., (Copyright © 2016 Elsevier B.V. All rights reserved.)