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The objective was to examine the effects of backward walking training for improving walking speed and balance in children with cerebral palsy. A systematic review of randomized trials was conducted. Trials had to include children with cerebral palsy, with a Gross Motor Function Classification System, between I and III, that delivered backward walking training as a solo intervention or in combination with forward walking training. The outcomes of interest were walking speed and balance. The methodological quality of included trials was assessed by the PEDro scale, and the quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation. Eight papers, involving 156 participants, were included. Using random-effects meta-analysis, we estimated that backward walking training improved walking speed by 0.10 m/s [95% confidence interval (CI) 0.05-0.16] and by 2 points on the Pediatric Balance Scale (0-56) (95% CI 1.5-2.2) more than forward walking training. We also estimated that the addition of backward walking training increased walking speed by 0.20 m/s (95% CI 0.07-0.34) and reduced the angular excursion of the center of gravity by 0.5 degrees (95% CI -0.7 to -0.3). The quality of the evidence was classified as low to moderate. In conclusion, overall, backward walking training appears to be as effective or slightly superior to forward walking training for improving walking speed in children with CP. The addition of backward walking training statistically significantly and clinically important enhanced benefits on walking speed., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Identifying the determinants of walking confidence can be crucial in therapeutic terms. On these bases, interventions to improve these factors could improve, in turn, walking confidence. Objective is to explore the relationship between motor impairments and activity limitation measures and walking confidence in people with chronic stroke. Walking confidence was assessed using the modified Gait Efficacy Scale. The independent variables were: strength of the hip flexors and knee flexors/extensors (measured with a dynamometer), lower limb coordination (assessed by the Lower Extremity Motor Coordination Test), dynamic balance (assessed by the Four-Square Step Test), walking speed (from the 10-m Walk Test), aerobic capacity (from the 6-Minute Walk Test), and self-perceived locomotion ability (assessed by the ABILOCO). Pearson correlation was used to explore the relationships between the variables, and multiple linear regression to identify the independent explainers of walking confidence after stroke. Ninety chronic stroke individuals (35 men), with a mean age of 68 (SD 13) years were assessed. All independent variables were significantly correlated with walking confidence. Regarding the regression analysis, these measures explained 44% ( F = 9.21; P < 0.001) of the variance in walking confidence; however, only walking speed, strength of the hip flexor muscles, aerobic capacity, and perceived locomotion ability showed significance. All motor impairment and activity limitation measures correlated with walking confidence. However, the regression analysis highlighted that only walking speed, aerobic capacity, the strength of the hip flexor muscles, and perceived locomotion were independent explainers of walking confidence after stroke., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

The purpose of the present study was to examine the main characteristics of clinical trials in physiotherapy aimed at improving walking speed after stroke, as well as the correlation between trials' methodological quality and journals' Impact Factor. Searches were conducted on Physiotherapy Evidence Database for all randomized controlled trials aiming at improving walking speed after stroke. Data extracted from the studies were: continent, language, methodological quality, year of publication, number of normalized citations, open access, sample size, measurements of walking speed, interventions, comparators, and prior registration. Data extracted from the journals were: 2018 Impact Factor, open access, endorsement of CONSORT recommendations, predatory classification, PubMed indexing, and Journal Citation Reports category. The main outcomes were journals' Impact Factor, open access, CONSORT recommendations endorsement by the journal, and methodological quality. Spearman correlation coefficients were calculated to explore the relationships between trials' methodological quality and journals' Impact Factor. Two hundred twenty-seven trials were published in 62 journals. The number of trials has increased over the last years. Most of these trials had citations, moderate methodological quality, were published in English, in open access journals, which endorse the CONSORT recommendations, and had Impact Factor ≥2.0. The results indicated a positive, but weak correlation between methodological quality and journals' Impact Factor. Thus, trials in physiotherapy aimed at improving walking speed after stroke have increased over the last years. Overall, trials had moderate methodological quality and were published in journal with moderate-to-high Impact Factor. Best trials were not necessarily published in journals with high Impact Factor.

Background: The identification of the predictors of locomotion ability could help professionals select variables to be considered during clinical evaluations and interventions., Objective: To investigate which impairment measures would best predict locomotion ability in people with chronic stroke., Methods: Individuals (n=115) with a chronic stroke were assessed. Predictors were characteristics of the participants (i.e. age, sex, and time since stroke), motor impairments (i.e. muscle tonus, strength, and motor coordination), and activity limitation (i.e. walking speed). The outcome of interest was the ABILOCO scores, a self-reported questionnaire for the assessment of locomotion ability, designed specifically for individuals who have suffered a stroke., Results: Age, sex, and time since stroke did not significantly correlate with the ABILOCO scores (-0.07<ρ<0.05; 0.48

Background: The ABILOCO is a self-reported questionnaire, specific for individuals with stroke, for the assessment of ability of locomotion. The ABILOCO has been investigated using the Rasch model and has shown satisfactory measurement properties. However, its test-retest reliability has not been investigated., Objective: To investigate the test-retest reliability, that is, agreement, systematic and random variability of the ABILOCO Questionnaire in individuals with chronic stroke., Design: A test-retest reliability study., Setting: Research laboratory., Participants: Thirty-one individuals (21 men and 10 women; mean age, 60 years), who had poststroke hemiparesis., Intervention: Not applicable., Main Outcome Measurement: The ABILOCO was applied twice, on two occasions, 5 to 7 days apart. Test-retest reliability was investigated, as follows: agreement by the calculation of intraclass correlation coefficients (ICCs); systematic variability by the change in the mean; random variability by the standard error of measurement (SEM) and smallest real difference (SRD)., Results: Two outliers were identified in the sample. The ICC values for the whole sample were 0.76 (CI 95% 0.56 to 0.88), whereas the SEM (SEM%) and SRD (SRD%) were 0.55 (21%) and 1.52 (58%), respectively., Conclusion: The ABILOCO showed to be reliable to be applied within clinical and research contexts for the assessment of changes in locomotion ability of a group of individuals with chronic stroke. However, it appears to be less suitable to detect changes at individual levels., Level of Evidence: III., (© 2018 American Academy of Physical Medicine and Rehabilitation.)

Objective: To explore the relationship between walking measurements (i.e., walking speed, walking performance and walking confidence), and participation in ambulatory people with chronic stroke. Materials and Methods: Participation was measured using the mobility domain of Brazilian version of the Stroke Impact Scale 3.0. Walking measures were walking speed, assessed by 10‐m Walk Test, walking performance, assessed by ABILOCO, walking confidence, assessed by mGES. Pearson correlation coefficients were used to explore the relationships between the walking measures and social participation, and step‐wise multiple linear regression analysis was used to identify which walking measures would explain participation after stroke. Results: Ninety‐five chronic stroke individuals (38 men), with a mean age of 67 (SD 13) years were assessed. Significant positive correlations, of high magnitude, were found between participation and all walking measures (r ≥.53; p <.001). Regarding the regression analysis, walking confidence alone explained 44% (F = 72.4; p <.001) of the variance in participation. When perceived locomotion ability was included in the model, the explained variance increased to 48% (F = 42.8; p <.001). Conclusion: All walking measures were correlated with social participation after stroke, but only perceived locomotion ability and walking confidence explained the variance in participation. Clinicians should be encouraged to evaluate real‐life performance and personal factors that may limit community participation after stroke. [ABSTRACT FROM AUTHOR]

To examine whether using a cane would improve spatiotemporal parameters of walking, i.e., speed, stride length, cadence, and symmetry after stroke. Searches were conducted in eight databases. The experimental condition was walking with a cane. Four outcomes were of interest: walking speed, stride length, cadence, and symmetry. Twelve studies were included. Results from nine studies suggested that individuals with stroke walked 0.01 m/s (SD 0.06) slower with a single-point cane, compared with no cane. Two studies suggested a reduction in cadence (MD-5 steps/min, SD2) and an increase in stride length (MD 0.08 m, SD 0.01). Three studies suggested that individuals walked 0.06 m/s (SD 0.07) slower with a four-point cane, compared with no cane. Four studies suggested that individuals walked 0.06 m/s (SD 0.04) faster with a single- point cane compared with a four-point cane. Results regarding other outcomes were inconclusive. Results showed no worthwhile improvements in spatiotemporal parameters of walking with a single-point cane and a slight reduction with a four-point cane, compared with no cane. Individuals walked slightly faster with a single-point cane compared with a four-point cane, but the evidence is insufficient to support this superiority. A single-point cane may not improve spatiotemporal parameters of walking after stroke. Walking with a four-point cane may slightly decrease spatiotemporal parameters of walking. Canes may be prescribed without the fear of negatively impairing walking kinematics. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationships between selected measures of motor impairments and activities involving the lower-limbs in ambulatory people with chronic stroke. Design: Motor impairment measures included maximal isometric strength and motor coordination. Activity measures included walking speed, stair ascent/descent cadences, and the time to perform the Timed Up and Go (TUG) test. Results: Ninety individuals were included. The correlations between all motor impairment and activity measures were significant (0.18 < r < 0.52, p < 0.05). Motor coordination and strength of the knee flexor muscles explained 30% (F = 20.3; p < 0.001) of the variance in walking speed, 32% (F = 19.1; p < 0.001) of stair ascent, and 31% (F = 16.8; p < 0.001) of stair descent cadence. Regarding the TUG, only motor coordination reached significance and explained 13% (F = 13.4; p < 0.001) of the variance. Conclusion: Measures of strength and motor coordination of the paretic lower limb were significantly correlated with all activity measures. However, despite the fact that knee flexor strength explained some variance in walking speed and stair ascent/descent cadences, motor coordination was the only measure that explained the variances in all three selected activity measures. These findings are innovative for neurological rehabilitation, since this is the first study to demonstrate that deficits in motor coordination of the paretic lower limb best explained limitations in performing different lower-limb activities. [ABSTRACT FROM AUTHOR]

Background: Backward walking training has gained popularity as an alternate type of training for improving walking and cardiorespiratory fitness.1 Aim: To examine the effects of backward walking training in comparison with forward walking training for improving walking after stroke. Methods: A systematic review of randomized trials was performed. Searches were conducted on AMED, Cochrane Library, EMBASE, LILACS, MEDLINE, Scielo and PEDro databases. Participants were ambulatory adults after stroke. The experimental intervention was backward walking training. Outcome data related to walking speed, cadence and stride length were combined in meta-analyses. The quality of trials was assessed by the PEDro scores, and the quality of evidence was determined according to the GRADE system. Results: Six trials (PEDro score 6), involving 156 participants, were included. The mean age of participants ranged from 50 to 69 years old. Moderate-quality evidence suggested that backward walking training is as effective or better than forward walking training for improving walking speed (MD 0.16 m/s, 95% CI 0.06 to 0.27). Effects on cadence (MD 3 steps/min, 95% CI -2 to 6) and stride length (MD 0.03 m, 95% CI -0.02 to 0.09) were very similar between interventions. Conclusion: This review provided evidence that the effect of backward walking training is similar to or better than the effect of forward walking training for improving walking speed after stroke. [ABSTRACT FROM AUTHOR]