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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.

Purpose: The authors examine whether community-dwelling older adults at high fall risk have lower backward walking speed reserve (WSR) than their healthy counterparts. Method: Twenty-one healthy older adults and 20 older adults at high fall risk performed five trials of forward walking at a self-selected and maximal pace. In addition, all participants walked backward at a self-selected pace, and 15 participants from each group walked backward at a maximal pace. WSR was calculated as the difference between maximal and self-selected walking speed. Comparisons between groups were made using a one-tailed independent samples t-test or Mann–Whitney U-test with an α value of 0.025. Results: Older adults at high fall risk were significantly slower during self-selected forward walking (11.7%; p = 0.006), maximal forward walking (15.5%; p = 0.001), self-selected backward walking (25.3%; p = 0.002), and maximal backward walking (23.8%; p = 0.006). Older adults at high fall risk showed a lesser forward WSR (25.4%; p = 0.03) and backward WSR (23.7%; p = 0.03). Conclusions: Backward WSR is not useful for discriminating between healthy older adults and older adults at high fall risk. The results imply that forward or backward walking speed rather than WSR might be a useful measure.

Introduction Recently backward/retro walking has been increasingly used in medicine. Kinetic and kinematic analysis during backward walking showed advantages over traditional ambulation making it ideal for those who struggle with knee pain. Retro walking is well known for reducing the strain on the knees and it is one of the few natural ways to strengthen the quadriceps of the thigh. Walking backwards leads to a more significant load on the cardiovascular and respiratory systems. This load builds a more substantial increase in both the aerobic and anaerobic capabilities than just walking forward with similar parameters of physical activity. Material and methods A systematic search of studies published during the period up to February 2020 was conducted using bibliographic databases in English, including Medline, PubMed, Scopus, Web of Science and in Russian, including eLIBRARY, CyberLeninka to summarize the available information on the possibilities of retro walking in treatment and rehabilitation of patients with knee pathology. Search terms included 'backward/retro walking/running', 'knee joint'. Results and discussion Several studies have been performed to explore the effectiveness of backward walking for knee osteoarthritis. There is a strong evidence that backward walking can be a useful adjunct to conventional physiotherapy to improve pain, knee function and strength of the quadriceps muscles. There is a limited number of papers describing effects of backward walking for patellofemoral pain syndrome and anterior cruciate ligament injury. Conclusions Although there is little data overall reporting effects of backward walking, and more studies are needed to further explore this topic this version of walking has been shown to provide great beneficial effects in knee joint rehabilitation.

Backward walking offers a unique challenge to balance and ambulation. This study investigated the characteristics of spatiotemporal gait factors and ankle kinematics during backward walking in people with chronic ankle instability. Sixteen subjects with chronic ankle instability and 16 able-bodied controls walked on a treadmill at their self-selected speed under backward and forward walking conditions. Gait speed, cadence, double limb support percentage, stride time variability, and three-dimensional ankle kinematics were compared between groups and conditions. During backward walking, both groups had significantly slower gait speed, lower cadence, and greater stride time variability. In addition, under backward walking condition, subjects in both groups demonstrated significant sagittal and frontal kinematic alternations, such as greater dorsiflexion and inversion following initial contact (0–27.7%, 0–25.0% of gait cycle respectively, p

How do descending inputs from the brain control leg motor circuits to change the way an animal walks? Conceptually, descending neurons are thought to function either as command-type neurons, in which a single type of descending neuron exerts a high-level control to elicit a coordinated change in motor output, or through a more distributed population coding mechanism, whereby a group of neurons, each with local effects, act in combination to elicit a global motor response. The Drosophila Moonwalker Descending Neurons (MDNs), which alter leg motor circuit dynamics so that the fly walks backwards, exemplify the command-type mechanism. Here, we identify several dozen MDN target neurons within the leg motor circuits, and show that two of them mediate distinct and highly-specific changes in leg muscle activity during backward walking: LIN156 neurons provide the hindleg power stroke during stance phase; LIN128 neurons lift the legs at the end of stance to initiate swing. Through these two effector neurons, MDN directly controls both the stance and swing phases of the backward stepping cycle. MDN exerts these changes only upon the hindlegs; the fore-and midlegs follow passively through ground contact. These findings suggest that command-type descending neurons can also operate through the distributed control of local motor circuits.

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.

Summary Objectives To validate accelerometer counts against oxygen uptake in 9 to 11 years old children performing a number of highly variable physical activities and to determine accelerometer cut-off points for sedentary behavior, light, moderate, and vigorous physical activities. Equipment and methods Eight boys and 6 girls aged 9 to 11 years old (height: 1.40 ± 0.06 m, body mass: 33.5 ± 5.1 kg, BMI: 16.9 ± 2.0 kg/m2, body fat: 17.0 ± 4.8%, estimated VO2max: 50.85 ± 4.8 ml.kg−1.min−1) volunteered to participate in this study. They performed eight activities of different intensity namely watching TV, arts-crafts, slow and brisk forward walking, slow backward walking, forward running, aerobics and step-ups while VO2 and counts were determined using indirect calorimetry and accelerometer, respectively. Results A highly significant correlation was found between accelerometer counts and VO2 (r = 0.86, P

Objective Forward walking speed (FWS) is known to be an important predictor of mobility, falls, and falls-related efficacy poststroke. However, backward walking speed (BWS) is emerging as an assessment tool to reveal mobility deficits in people poststroke that may not be apparent with FWS alone. Since backward walking is more challenging than forward walking, falls efficacy may play a role in the relationship between one’s preferred FWS and BWS. We tested the hypothesis that people with lower falls efficacy would have a stronger positive relationship between FWS and BWS than those with higher falls efficacy. Methods Forty-five individuals (12.9 ± 5.6 months poststroke) participated in this observational study. We assessed FWS with the 10-meter walk test and BWS with the 3-meter backward walk test. The modified Falls-Efficacy Scale (mFES) quantified falls efficacy. A moderated regression analysis examined the hypothesis. Results FWS was positively associated with BWS (R2 = 0.26). The addition of the interaction term FWS × mFES explained 7.6% additional variance in BWS. As hypothesized, analysis of the interaction revealed that people with lower falls efficacy (mFES ≤ 6.6) had a significantly positive relationship between their preferred FWS and BWS, whereas people with higher falls efficacy (mFES > 6.6) had no relationship between their walking speed in the 2 directions. Conclusions FWS is positively related to BWS poststroke, but this relationship is influenced by one’s perceived falls efficacy. Our results suggest that BWS can be predicted from FWS in people with lower falls efficacy, but as falls efficacy increases, BWS becomes a separate and unassociated construct from FWS. Impact This study provides unique evidence that the degree of falls efficacy significantly influences the relationship between FWS and BWS poststroke. Physical therapists should examine both FWS and BWS in people with higher falls efficacy, but further investigation is warranted for those with lower falls efficacy.

aydogan arslan, saniye/0000-0001-5470-9849; abit kocaman, ayse/0000-0002-6694-3015 WOS:000601309800040 PubMed: 33197801 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.

Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. Methods. All measures were collected in a single session. A 2×2×2 mixed model ANOVA was used to compare differences in forward and backward walking in single- and dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. Results. Eighteen individuals with relapsing-remitting MS and 14 age- and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task (p=0.015) and dual-task (p=0.014) conditions. Persons with MS demonstrated significant differences between single- and dual-task forward and backward walking velocities (p=0.023; p=0.004), whereas this difference was only apparent in the backward walking condition for healthy controls (p=0.004). In persons with MS, there were significant differences in double support time between single- and dual-task conditions in both backward (p<0.001) and forward (p=0.001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length (r=−0.490; p=0.046) and slower velocity (r=−0.483; p=0.050). Conclusion. Differences in MS and age- and sex-matched healthy controls are more pronounced during backward compared to forward walking under single- and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.

The 3-m backward walk test (3MBWT) is used to evaluate neuromuscular control, proprioception, protective reflexes, fall risk, and balance. The aim of the present study was to determine the test-retest reliability of the 3MBWT in patients with primary total knee arthroplasty (TKA). Twenty-eight patients with primary TKA, operated by the same surgeon, were included in this study. Patients performed trials for 3MBWT twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The 3MBWT showed an excellent test-retest reliability in this study. Intraclass correlation coefficient (ICC) for 3MBWT was 0.97. The standard error of measurement and smallest real difference at the 95% confidence level for 3MBWT were 1.06 and 2.94, respectively. The 3MBWT has an excellent test-retest reliability in patients with primary TKA. It is an effective and reliable tool for measuring dynamic balance and participant falls. As a clinical test, the 3MBWT is easy to score, requires little space, has no cost, needs no special equipment, and can be applied in a short time as part of the routine medical examination. © 2020 World Journal of Traditional Chinese Medicine | Published by Wolters Kluwer - Medknow.

Background/Aims: Little is known regarding the activation of knee and hip muscles during backward walking in patellofemoral pain syndrome. This study examineD the effects of backward walking and forward walking on the activation of knee extensors, hip abductors, and adductors in patients with patellofemoral pain syndrome. Methods: A total of 20 females with patellofemoral pain syndrome and 20 age-matched typically healthy female controls participated in this study. Surface electromyography from vastus medialis obliquus, vastus lateralis, gluteus medius, and adductor longus muscles were collected during forward walking and backward walking. Findings: The patellofemoral pain syndrome group had a significantly higher normalised root mean square of the vastus medialis obliquus, vastus lateralis and gluteus medius muscles (P=0.001), without significant difference in adductor longus muscle activity during backward walking versus forward walking (P=0.098). During forward walking, the patellofemoral pain syndrome group showed significantly higher activation of adductor longus muscle (P=0.001) and significantly lower activation of the gluteus medius muscle (P=0.002) compared to the healthy group. During backward walking there was a significant increase in the vastus medialis obliquus and adductor longus muscle activity of the patellofemoral pain syndrome group compared to the control group (P=0.003, 0.001) respectively. Conclusions: Clinicians should consider backward walking training to increase the muscle strength of knee extensors and hip abductors when developing rehabilitation programmes for patients with patellofemoral pain syndrome.

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.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.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, p0.001) 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, p0.001) and symptom duration in the second step (χ2 = 0.59, F (2, 33) = 11.46; p0.001) 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).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.

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.

In recent years backward walking is increasingly used in sports and medicine. During sports training backward walking can be used as one of the methods of fitness. Backward walking increases the cardiovascular and respiratory loads and aerobic and anaerobic capacities of the organism. Backward walking is associated with less overload of knee joints. It is also one of the few natural ways of strengthening the quadriceps. Backward walking training has found its application in rehabilitation programs for different categories of neurological patients with the aim of restoring sustainable body position and gait. Backward walking is used to elaborate the correct pattern of gait in children with cerebral palsy, in persons with hemiplegia after stroke, in patients suffering from Parkinson’s disease and multiple sclerosis, in spinal cord injured patients. There is an information about the application of backward walking exercises in diabetic foot syndrome in order to reduce a plantar pressure and in physical rehabilitation of postoperative patients. Tests with backward walking are used for diagnostic purposes - to assess the severity of impaired coordination and motor skills in post-stroke patients and in Parkinson's disease, to identify the minimal walking impairment in persons with multiple sclerosis and for probability of falling prediction in elderly individuals and patients with dizziness.

Backward locomotion (backward walking and running) is increasingly used in sports and medicine. Kinetic and kinematic analysis of backward walking showed its advantages over the usual method of movement that can be successfully used in the athletic training and for treatment and rehabilitation after various diseases. During sports training backward walking/running can be used as one of the methods of fitness to improve physical endurance. Backward walking leads to a more cardiovascular and respiratory load and a more significant aerobic and anaerobic capacity of the organism compared with forward walking at similar parameters of physical activity. Backward walking is associated with less overload on knee joints, it is also one of the few natural ways of strengthening the quadriceps. Backward walking is used to elaborate the correct pattern of gait in children with cerebral palsy, in persons with hemiplegia after stroke, in patients suffering from Parkinson’s disease and multiple sclerosis, in spinal cord injured patients. Regular backward walking trainings improve spatial-temporal parameters of walking and balance, increase muscle strength of the lower limbs in these diseases. There is an information about the application of backward walking exercises in diabetic foot syndrome in order to reduce a plantar pressure and in physical rehabilitation of postoperative patients. Tests with backward walking are used for diagnostic purposes - to assess the severity of impaired coordination and motor skills in post-stroke patients and in Parkinson’s disease, to identify the minimal walking impairment in persons with multiple sclerosis and for probability of falling prediction in elderly individuals and patients with dizziness.

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 &lt, 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.

Purpose: Forward Walking (FW) and Backward Walking (BW) on different gradients of the treadmill is a common exercise for lower extremity rehabilitation. However, limited studies are found about the three-dimensional analysis of lower extremity and status of the knee joint during FW and BW on different gradients. Therefore, this study aimed to investigate the lower extremity joints kinematics during FW and BW on incline and decline surfaces. Methods: The current research has a quasi-experimental design. Sixteen healthy males with the mean (SD) age of 22.4(2.5) years, volunteered to participate in this study. The subjects’ FW and BW with their preferred speed on a treadmill at four gradients (-7.5%, 0%, +5% and +10%), were analyzed by using motion capture system. All data were analyzed using paired sample t test (P

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.

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., Graphical Abstract Graphical Abstract

Purpose: To determine the test–retest reliability, concurrent validity and minimal detectable change of the 3-m backward walking test (3MBWT) in patients with Total Hip Arthroplasty (THA). Methods: A total of 29 patients after unilateral primary THA were enrolled in the study. All evaluations were carried out by the same physiotherapist. The test-retest reliability of the 3MBWT was assessed at an hour interval and analyzed by the Intraclass correlation coefficient (ICC). In the concurrent validity analysis, the Spearman correlation coefficient between 3MBWT and Harris Hip Score (HHS) was calculated. In addition, the standard error of measurement (SEM95) and Minimal Detectable Change (MDC95) values were also calculated. Results: The mean age of the patients was 75.6 ± 10.0 years. The mean time of the second test was 2.41 s better than the first assessment. The ICC score of 3MBWT was 0.983. Test-retest reliability was excellent. SEM95 and MDC95 values were 1.56 and 4.33, respectively. Both test and retest evaluations of the 3MBWT were correlated with the HHS (p < 0.01). The degree of correlations was moderate. Conclusion: The 3MBWT is a valid and reliable test in patients with primary unilateral THA. The MDC value of 3MBWT provides essential information to clinicians about patients’ clinical progression. © 2020 International Society for Knowledge for Surgeons on Arthroscopy and Arthroplasty, None.

We show that epidural spinal cord stimulation can elicit stable bidirectional locomotion of decerebrate cats on a split-belt treadmill. The stepping pattern of one limb was similar to unidirectional forward walking and, the other—was similar to unidirectional backward walking. This confirms that spinal and brainstem circuitry are sufficient to control such complex and extraordinary motor tasks driven by somatosensory input. Interlimb coordination during forward and backward walking was preserved in 2 out of 4 animals during ‘extreme’ conditions when one of the treadmill belts was stopped. Bidirectional locomotion worsened but was still possible after temporary spinalization by cooling the spinal cord on a low thoracic level. These present evidence for the great degree of the automatism for this stepping mode defined by the spinal neuronal networks.

Introduction: Stroke is one of the leading cause of long term disabilities. The most commonly affected activity is walking. Though conventional therapy is producing beneficial effects in the gait of stroke patients, Backward walking is proposed to be effective in improving the gait of stroke patients. Aim: To examine the effectiveness of backward walking training on gait performance of stroke patients. Materials and Methods: The study design was an experimental study. Thirty hemiplegic patients were selected by convenient sampling technique and divided into two groups. Subjects in both groups received 40 minutes of conventional training one session per day for two weeks. Subjects in the experimental group received additional backward training for 30 minutes. Gait performance was measured using Wisconsin gait scale. Gait parameters, cadence and walking speed were also measured before and after treatment. Statistical analysis was done using independent ‘t’ test and paired ‘t’ test for between the groups and within the groups respectively. Results: After four weeks of training period, subjects in the experimental group showed much improvement than those in control group for gait performance (score: 17.42±1.53 versus 22.47±1.52) (p

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: 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

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 mobility in the home and community. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes assessment of backward walking (BW) 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 healthy older adults. 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

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.

Backward walking has a positive effect on gait ability. Action observational training is an effective treatment method for stroke neurological disorders. This randomised comparator-controlled pilot study aimed to evaluate the feasibility of backward walking observational training on the gait ability of chronic stroke patients. Fourteen chronic stroke participants were randomly allocated to the experimental group (backward walking observation; n = 7) and control group (landscape observation; n = 7). Both groups performed conventional therapy 5 days/week; then the backward walking observation and landscape observation + backward walking training groups performed the observational training 3 days/week for 4 weeks. The primary outcome was measured dynamic gait index, 10-m walking test, and timed up and go test time. Both groups showed significant increases in dynamic gait index, 10-m walking test, and timed up and go test time. The experimental group showed more significant improvements in dynamic gait index (P = 0.04, η = 0.336), 10-m walking test (P = 0.04, η = 0.306), and timed up and go test time (P = 0.03, η = 0.334) than the control group. This pilot study demonstrated that conventional therapy with backward walking observational training improves gait ability. Our findings suggest that observing an action may have a positive effect on chronic stroke patients.Trial Registration Clinical Trials: KCT0003098.

[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.

The “walking backward” mode was achieved within a single model of cat hind-limb locomotion with the balance maintenance only due to a change in the controlling actions (in addition to the “forward walking” mode). The skeletal part of the model contains the spine, pelvis, and two limbs consisting of the thigh, shin, and foot. The hip joint and spine mount in the thoracic region have three degrees of freedom; the knee and ankle joints have one degree of freedom. The pelvis is rigidly connected to the spine. Control is performed by model muscles (flexors and extensors of the thigh, shin, and foot). The muscle activation is performed by the effects that are typical for motoneurons that control the muscles. The feet in the support phase touch the treadmill, which moves at a constant speed. The model qualitatively reproduces multiple characteristics of feline movements during forward and backward walking (supporting its validity).

Background: There is a direct relationship exists between hemiplegic walking speed and functional limitations, both in household and community ambulation. Walking after stroke is characterized by slow gait speed, poor endurance, and change in the quality and adaptability of walking patterns. Side stability, symmetrical weight-bearing, and backward motor control ability are required to improve walking function. Objective: To investigate whether a combination of backward and side walking training is effective in improving walking speed and walking endurance in patients with poststroke hemiparesis. Study Design: An experimental randomized controlled study design. Methods: A total of 56 patients with poststroke hemiparesis fulfilling inclusion criteria were recruited for the study. Patients in the experimental group received 30 min of backward and side walking training of 15 min each. The patients in the control group received conventional occupational therapy for 30 min. Walking speed was assessed by walking endurance was evaluated by 10-m walk test (MWT) (and walking endurance was evaluated by 6MWT. Follow-up assessment was performed after 6 weeks of intervention. Results: In the within-group comparisons, both experimental and control groups showed significant differences postintervention (P

BACKGROUND Backward walking (BW) training is increasingly used in rehabilitation for stroke, but relevant evidence remains unclear. OBJECTIVE To determine the effect of BW training on patients with stroke. METHODS A keyword search was conducted in PubMed, EMBASE, CINAHL, and China National Knowledge Infrastructure database for articles published until November, 2019. Two investigators screened the articles and extract data from each included study. Meta-analysis was performed to estimate the effect of BW on stroke. In addition, the quality of evidence was evaluated by GRADE (grading of recommendations, assessment, development, and evaluation; version:3.6) approach. RESULTS A total of ten studies were included according to the inclusion and exclusion criteria in the review. All included studies described some positive influences of BW on stroke relative to the control group (forward walking or conventional treatment). Compared to control group, there is a statistically significant improvement for BW group in gait velocity (mean difference [MD] = 6.87, 95%CI: [1.40, 12.33], P = .01, I = 3%), Berg balance score (MD =3.82, 95%CI: [2.12, 5.52], P < .0001, I = 0%), and walk test (MD =0.11, 95%CI: [0.02, 0.20], P = .02, I = 36%). CONCLUSIONS For patients with stroke, BW training, as an adjunct an adjunct to conventional treatment, can improve Berg balance score (moderate evidence), walk test performance (very low evidence), gait velocity (very low evidence). More large-scale and high-quality studies are warranted.

Walking can be challenging for aging individuals and people with neurological disorders such as Parkinson disease (PD). Gait impairment characterized by reduced speed and higher variability destabilizes gait and increases the risk of falls. External auditory cueing provides an effective strategy to improve gait, as matching footfalls to rhythms typically increases gait speed and elicits larger steps, but the need to synchronize to an outside source often has a detrimental effect on gait variability. Internal cueing in the form of singing may provide an alternative to conventional gait therapy. In the present study, we compare the effects of internal and external cueing techniques on forward and backward walking for both people with PD and healthy controls. Results indicate that internal cueing was associated with improvements in gait velocity, cadence, and stride length in the backward direction, and reduced variability in both forward and backward walking. In comparison, external cueing was associated with minimal improvement in gait characteristics and a decline in gait stability. People with gait impairment due to aging or neurological decline may benefit more from internal cueing techniques such as singing as compared to external cueing techniques.

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.

To investigate how early injuries to developing motor regions of the brain affect different forms of gait, we compared the spatiotemporal locomotor patterns during forward (FW) and backward (BW) walking in children with cerebral palsy (CP). Bilateral gait kinematics and EMG activity of 11 pairs of leg muscles were recorded in 14 children with CP (9 diplegic, 5 hemiplegic; 3.0–11.1 yr) and 14 typically developing (TD) children (3.3–11.8 yr). During BW, children with CP showed a significant increase of gait asymmetry in foot trajectory characteristics and limb intersegmental coordination. Furthermore, gait asymmetries, which were not evident during FW in diplegic children, became evident during BW. Factorization of the EMG signals revealed a comparable structure of the motor output during FW and BW in all groups of children, but we found differences in the basic temporal activation patterns. Overall, the results are consistent with the idea that both forms of gait share pattern generation control circuits providing similar (though reversed) kinematic patterns. However, BW requires different muscle activation timings associated with muscle modules, highlighting subtle gait asymmetries in diplegic children, and thus provides a more comprehensive assessment of gait pathology in children with CP. The findings suggest that spatiotemporal asymmetry assessments during BW might reflect an impaired state and/or descending control of the spinal locomotor circuitry and can be used for diagnostic purposes and as complementary markers of gait recovery.NEW & NOTEWORTHY Early injuries to developing motor regions of the brain affect both forward progression and other forms of gait. In particular, backward walking highlights prominent gait asymmetries in children with hemiplegia and diplegia from cerebral palsy and can give a more comprehensive assessment of gait pathology. The observed spatiotemporal asymmetry assessments may reflect both impaired supraspinal control and impaired state of the spinal circuitry.

The purpose of this study was to examine the effect of backward walking training on the balance capability(Functional Gait Assessment; FGA, Timed Up & Go Test; TUG) and gait performance(10 meter Walking Test; 10 mWT) of stroke patients. Eighteen with stroke patients were randomly allocated to an experimental and contral group of nine patients each. both groups received general neurorehabilitative physical therapy for 45 minutes per day 5 times per week during 4 weeks. The experimental group also performed additional backward walking training for 20 minutes per day 3 times per week during 4 weeks. There were signicantly increase by backward walking training in outcome of the balance capability from the FGA was increase from 17.67±1.00 scores to 19.22±1.00 scores(p