Effectiveness of backward walking training on balance performance: A systematic review and meta-analysis

Measurement properties of the backward walk test in people with balance and mobility deficits: A systematic review

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.

Differences in motor imagery abilities in active and sedentary individuals: new insights from backward-walking imagination

Evidence has shown that imagining a complex action, like backward-walking, helps improve the execution of the gesture. Despite this, studies in sport psychology have provided heterogeneous results on the use of motor imagery (MI) to improve performance. We aimed to fill this gap by analyzing how sport experience influences backward-walking MI processes in a sample of young women (n = 41, mean age = 21 ± 2.2) divided into Active and Sedentary. All participants were allocated to two randomized mental chronometric tasks, in which they had first to imagine and then execute forward-walking (FW) and backward-walking (BW). The Isochrony Efficiency measured the difference between imagination and execution times in both conditions (FW and BW). Moreover, we analyzed the ability to vividly imagine FW and BW within various perspectives in both groups through the Vividness of Movement Imagery Questionnaire (VMIQ-2). Findings showed that active individuals performed better in the BW imagery task when compared to sedentary ones (F1,39 = 4.98; p = 0.03*), while there were no differences between groups in the FW imagery task (F1,39 = .10; p = 0.75). Further, VMIQ-2 had evidenced that the ability to imagine backward is influenced by perspective used. Specifically, the use of internal visual imagery (IVI) led to worse Isochrony Efficiency (t32,25 = 2.16; p = 0.04*), while the use of kinesthetic imagery (KIN) led to better Isochrony Efficiency (t32,25 =  - 2.34; p = 0.03*). These results suggest a close relation between motor experience and complex motor imagery processes and open new insights for studying these mental processes.

Transcranial direct current stimulation facilitates backward walking training

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.

Taoist way of a balanced exercise training cocktail for the management of primary hypertension in older persons

High blood pressure is the world's leading risk factor for mortality, affecting nearly half of the global population aged 50-79 years. Physical inactivity is one factor contributing to the prevalence of hypertension. This paper discusses a new concept for the management of hypertension in older persons. We are inclined to fade the current guidelines used in China, the United States, and Europe. Although demonstrating irrefutable benefits for blood pressure regulation, the guidelines fail to address the need to incorporate balance exercises, which are crucial for mitigating the risk of falling. We address three pressing questions regarding the efficacy of various combinations of exercise modes for blood pressure regulation, alongside providing an overview of balance exercises. At the core of our concept, we explicate the challenges inherent in addressing the global pandemic of physical inactivity and hypertension in regular socioeconomic people. No guidelines could change the state of inactivity by jumping between zero and all things, where "zero" symbolizes conditions such as physical inactivity and hypertension, and the concept of "all things" encompasses the ideals of an active lifestyle and healthy aging. We advocate a Taoist way, "zero-one-all things," where "one" in this context refers to an inclusive and culturally diverse exercise training cocktail. The Tao guides us to illuminate an ancient way of overcoming physical inactivity-associated diseases in the present day.

The relationship between the backward walking and proprioception, trunk control, and muscle strength in children with cerebral palsy

OBJECTIVE

This study was planned to determine the factors affecting backward walking in children with cerebral palsy (CP).

METHODS

The study included 30 children with CP, with a mean age of 10.43 ± 2.76 years. Backward walking abilities were evaluated with the 3-Meter Back Walk Test (3MBWT). A digital goniometer was used to evaluate proprioception, the Trunk Control Measurement Scale (TCMS) was used for trunk control, a digital muscle dynamometer was used for muscle strength, and the Gillette Functional Assessment Questionnaire (FAQ) was used for gait evaluation.

RESULTS

When the spasticity of children at levels I and II according to the Gross Motor Function Classification System (GMFCS) was compared, a significant difference was found in favor of level I in hamstring, gastro-soleus, and gastrocnemius spasticity (p < 0.05). When the results of the 3MBWT, TCMS, and FAQ were compared, a significant difference was found in favor of level I (p < 0.05). No significant relationship was revealed between the 3MBWT and lower extremity proprioception and TCMS (p > 0.05). A significant negative correlation was observed between the 3MBWT and FAQ (p < 0.05). No significant correlation was found between the 3MBWT and lower extremity muscle strengths (p > 0.05). A significant positive correlation was found only between hip extension proprioception and iliopsoas muscle strength (p = 0.023). There was no significant correlation between the FAQ and lower extremity muscle strength (p > 0.05).

CONCLUSION

It was revealed that the backward walking ability increased as the forward walking function improved in children with CP, but it was not affected by proprioception, trunk control, and muscle strength.

CLINICAL TRIALS

NCT05088629 (10/11/2021).

Forward and Backward Walking: Multifactorial Characterization of Gait Parameters

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.

The Immediate Effect of Backward Walking on External Knee Adduction Moment in Healthy Individuals

Backward walking (BW) has been recommended as a rehabilitation intervention to prevent, manage, or improve diseases. However, previous studies showed that BW significantly increased the first vertical ground reaction force (GRF) during gait, which might lead to higher loading at the knee. Published reports have not examined the effects of BW on medial compartment knee loading. The objective of this study was to investigate the effects of BW on external knee adduction moment (EKAM). Twenty-seven healthy adults participated in the present study. A sixteen-camera three-dimensional VICON gait analysis system, with two force platforms, was used to collect the EKAM, KAAI, and other biomechanical data during BW and forward walking (FW). The first ( $P<0.001$ ) and second ( $P<0.001$ ) EKAM peaks and KAAI ( $P=0.02$ ) were significantly decreased during BW when compared with FW. The BW significantly decreased the lever arm length at the first EKAM peak ( $P=0.02$ ) when compared with FW. In conclusion, BW was found to be a useful strategy for reducing the medial compartment knee loading even though the first peak ground reaction force was significantly increased.

Differences in backward and forward treadmill locomotion in decerebrated cats

Locomotion in different directions is vital for animal life and requires fine-adjusted neural activity of spinal networks. To compare the levels of recruitability of the locomotor circuitry responsible for forward and backward stepping, several electromyographic and kinematic characteristics of the two locomotor modes were analysed in decerebrated cats. Electrical epidural spinal cord stimulation was used to evoke forward and backward locomotion on a treadmill belt. The functional state of the bilateral spinal networks was tuned by symmetrical and asymmetrical epidural stimulation. A significant deficit in the backward but not forward stepping was observed when laterally shifted epidural stimulation was used but was not observed with central stimulation: only half of the cats were able to perform bilateral stepping, but all the cats performed forward stepping. This difference was in accordance with the features of stepping during central epidural stimulation. Both the recruitability and stability of the EMG signals as well as inter-limb coordination during backward stepping were significantly decreased compared to those during forward stepping. The possible underlying neural mechanisms of the obtained functional differences of backward and forward locomotion (spinal network organisation, commissural communication, and supraspinal influence) are discussed.

Serial Backward Locomotor Treadmill Training Improves Bidirectional Walking Performance in Chronic Stroke

Background and Research Question

Walking impairment remains a major limitation to functional independence after stroke. Yet, comprehensive and effective strategies to improve walking function after stroke are presently limited. Backward Locomotor Treadmill Training (BLTT) is a promising training approach for improving walking function; however, little is known about its mechanism of effect or the relationship between backward walking training and resulting overground forward walking performance. This study aims to determine the effects of serial BLTT on spatial aspects of backward and forward walking in chronic post-stroke individuals with residual walking impairment.

Methods

Thirty-nine adults (>6 months post-stroke) underwent 6 days of BLTT (3 × /week) over 2 weeks. Outcome measures included PRE-POST changes in backward and forward walking speeds, paretic and non-paretic step lengths, and single-support center of pressure distances. To determine the association between BLTT and overground walking, correlation analyses comparing training-related changes in these variables were performed.

Results

We report an overall improvement in BLTT and overground walking speeds, bilateral step lengths, and single-support center of pressure distances over six training sessions. Further, there were weak positive associations between PRE-POST changes in BLTT speed, BLTT paretic step length, and overground forward walking speed.

Conclusion and Significance

Our findings suggest that individuals with chronic post-stroke walking impairment experience improvements in spatial walking measures during BLTT and overground. Therefore, BLTT may be a potential adjunctive training approach for post-stroke walking rehabilitation.

Backward Walking Training Impacts Positive Effect on Improving Walking Capacity after Stroke: A Meta-Analysis

Objective: The meta-analysis aimed to investigate the potential effect of backward walking training (BWT) on walking function improvement among stroke patients. Data sources: Eligible studies were systematically searched in PubMed, Embase, Web of Science, and Cochrane Library. Methods: Heterogeneity among enrolled studies was assessed. Weighted mean difference (WMD) with its 95% confidence interval (CI) was used to pool the outcomes. Results: Seven articles were included. BWT significantly improved motor functions of stroke patients including 10-meter walk test (WMD (95% CI) = 0.11 (0.01, 0.21) meters/second; p = 0.03); cadence (WMD (95% CI) = 4.00 (0.99, 7.02) step/minute; p < 0.01); Berg balance scale (WMD (95% CI) = 4.38 (2.60, 6.15); p < 0.01); paretic step length (WMD (95% CI) = 5.32 (1.97, 8.67) cm; p < 0.01); and stride length (WMD (95% CI) = 6.61 (0.70, 12.51) cm; p = 0.03) as compared with control group. Conclusion: Our study revealed that BWT had a positive influence on walking function improvement among patients after stroke.

Backward Locomotor Treadmill Training Differentially Improves Walking Performance across Stroke Walking Impairment Levels

Background: Post-stroke walking impairment is a significant cause of chronic disability worldwide and often leads to loss of life roles for survivors and their caregivers. Walking impairment is traditionally classified into mild (>0.8 m/s), moderate (0.41–0.8 m/s), and severe (≤0.4 m/s), and those categorized as “severe” are more likely to be homebound and at greater risk of falls, fractures, and rehospitalization. In addition, there are minimal effective walking rehabilitation strategies currently available for this subgroup. Backward locomotor treadmill training (BLTT) is a novel and promising training approach that has been demonstrated to be safe and feasible across all levels of impairment; however, its benefits across baseline walking impairment levels (severe (≤0.4 m/s) vs. mild–moderate (>0.4 m/s)) have not been examined. Methods: Thirty-nine adults (>6 months post-stroke) underwent 6 days of BLTT (3×/week) over 2 weeks. Baseline and PRE to POST changes were measured during treadmill training and overground walking. Results: Individuals with baseline severe walking impairment were at a more significant functional disadvantage across all spatiotemporal walking measures at baseline and demonstrated fewer overall gains post-training. However, contrary to our working hypothesis, both groups experienced comparable increases in cadence, bilateral percent single support times, and step lengths. Conclusion: BLTT is well tolerated and beneficial across all walking impairment levels, and baseline walking speed (≤0.4 m/s) should serve as a covariate in the design of future walking rehabilitation trials.

Application of Real-Time Visual Feedback System in Balance Training of the Center of Pressure with Smart Wearable Devices

Balance control with an upright posture is affected by many factors. This study was undertaken to investigate the effects of real-time visual feedback training, provided by smart wearable devices for COP changes for healthy females, on static stance. Thirty healthy female college students were randomly divided into three groups (visual feedback balance training group, non-visual feedback balance training group, and control group). Enhanced visual feedback on the screen appeared in different directions, in the form of fluctuations; the visual feedback balance training group received real-time visual feedback from the Podoon APP for training, while the non-visual feedback balance training group only performed an open-eye balance, without receiving real-time visual feedback. The control group did not do any balance training. The balance training lasted 4 weeks, three times a week for 30 min each time with 1-2 day intervals. After four weeks of balance training, the results showed that the stability of human posture control improved for the one leg static stance for the visual feedback balance training group with smart wearable devices. The parameters of COP max displacement, COP velocity, COP radius, and COP area in the visual feedback balance training group were significantly decreased in the one leg stance (p < 0.05). The results showed that the COP real-time visual feedback training provided by smart wearable devices can better reduce postural sway and improve body balance ability than general training, when standing quietly.

The Efficacy of Backward Walking on Static Stability, Proprioception, Pain, and Physical Function of Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Objective

Impaired static stability and proprioception have been observed in individuals with knee osteoarthritis (KOA), which serves as a major factor increasing risk of fall. This study aimed to investigate the effects of backward walking (BW) on static stability, proprioception, pain, and physical function in KOA patients.

Methods

Thirty-two subjects with knee osteoarthritis were randomly assigned to either an BW group (BG, n = 16) or a control group (CG, n = 16). The participants in the BG received combination treatment of a 4-week BW training and conventional treatments, while those in the CG was treated with conventional treatments alone. All the participants were tested for the assessment of static stability [center of pressure (COP) sway, including sway length (SL, mm) and sway area (SA, mm²)] and proprioception [average trajectory error (ATE, %) and completion time (CT, second)]. Additionally, pain and knee function scores were measured by the numerical rating scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, respectively. The assessments were conducted before and after intervention.

Results

The COP sway (SA and SL), ATE, NRS, and WOMAC showed a significant decline at week 4 in the two groups in contrast to their baseline (P < 0.05). Moreover, after 4-week intervention, the SA [(610.50 ± 464.26) mm² vs. (538.69 ± 420.52) mm²], NRS [(1.56 ± 0.63) vs. (2.25 ± 0.86)], and WOMAC [(11.69 ± 2.50) vs. (16.19 ± 3.94)] showed a significantly greater decrease in the BG compared to the CG (P < 0.05, respectively). However, the proprioception (ATE and CT) was closely similar between both groups at week 4 (P > 0.05).

Conclusion

BW is an effective adjunct to conventional treatment in reducing pain, improving physical function and static stability for KOA patients. It should be taken into consideration when developing rehabilitation programs for people with KOA.

Are Gait and Balance Problems in Neurological Patients Interdependent? Enhanced Analysis Using Gait Indices, Cyclograms, Balance Parameters and Entropy

Background: Balance and locomotion are two main complex functions, which require intact and efficient neuromuscular and sensory systems, and their proper integration. In many studies the assumption of their dependence is present, and some rehabilitation approaches are based on it. Other papers undermine this assumption. Therefore the aim of this study was to examine the possible dependence between gait and balance in patients with neurological or sensory integration problems, which affected their balance. Methods: 75 patients (52 with neurological diseases, 23 with sensory integration problems) participated in the study. They underwent balance assessment on Kistler force plate in two conditions, six tests on a Balance Biodex System and instrumented gait analysis with VICON. The gait and balances parameters and indices, together with entropy and cyclograms were used for the analysis. Spearman correlation, multiple regression, cluster analysis, and discriminant analysis were used as analytical tools. Results: The analysis divided patients into 2 groups with 100% correctly classified cases. Some balance and gait measures are better in the first group, but some others in the second. Conclusions: This finding confirms the hypothesis that there is no direct link between gait and balance deficits.

Exercise effects on backward walking speed in people with dementia: A randomized controlled trial

BACKGROUND

Multidirectional walking, including backward walking, is integral to daily activities, and seems particularly challenging in older age, and in people with pathology affecting postural control such as dementia.

RESEARCH QUESTION

Does exercise influence backward walking speed in people with dementia, when tested using habitual walking aids and without, and do effects differ according to walking aid use?

METHODS

This study included 141 women and 45 men (mean age 85 years) with dementia from the Umeå Dementia and Exercise (UMDEX), a cluster-randomized controlled trial study set in 16 nursing homes in Umeå, Sweden. Participants were randomized to a High-Intensity Functional Exercise (HIFE) program targeting lower limb strength-, balance and mobility exercise or to a seated attention control activity. Blinded assessors measured 2.4-meter usual backward walking speed, at baseline, 4 - (intervention completion) and 7-month follow-up; tested 1) with habitual walking aids allowed, and 2) without walking aids.

RESULTS

Linear mixed models showed no between-group effect in either backward walking speed test at 4 or 7 months; test 1) 0.005 m/s, P = .788 and -0.006 m/s, P = .754 and test 2) 0.030 m/s, P = .231 and 0.015 m/s, P = .569, respectively. In interaction analyses, exercise effects differed significantly between participants who habitually walked unaided compared with those that used a walking aid at 7 months (0.094 m/s, P = .027).

SIGNIFICANCE

In this study of older people with dementia living in nursing homes, the effects of exercise had no overall effects on backwards walking speed. Nevertheless, some benefit was indicated in participants who habitually walked unaided, which is promising and merits further investigation in future studies.

Rostrocaudal Distribution of the C-Fos-Immunopositive Spinal Network Defined by Muscle Activity during Locomotion

The optimization of multisystem neurorehabilitation protocols including electrical spinal cord stimulation and multi-directional tasks training require understanding of underlying circuits mechanisms and distribution of the neuronal network over the spinal cord. In this study we compared the locomotor activity during forward and backward stepping in eighteen adult decerebrated cats. Interneuronal spinal networks responsible for forward and backward stepping were visualized using the C-Fos technique. A bi-modal rostrocaudal distribution of C-Fos-immunopositive neurons over the lumbosacral spinal cord (peaks in the L4/L5 and L6/S1 segments) was revealed. These patterns were compared with motoneuronal pools using Vanderhorst and Holstege scheme; the location of the first peak was correspondent to the motoneurons of the hip flexors and knee extensors, an inter-peak drop was presumably attributed to the motoneurons controlling the adductor muscles. Both were better expressed in cats stepping forward and in parallel, electromyographic (EMG) activity of the hip flexor and knee extensors was higher, while EMG activity of the adductor was lower, during this locomotor mode. On the basis of the present data, which showed greater activity of the adductor muscles and the attributed interneuronal spinal network during backward stepping and according with data about greater demands on postural control systems during backward locomotion, we suppose that the locomotor networks for movements in opposite directions are at least partially different.

Backward Walking Induces Significantly Larger Upper-Mu-Rhythm Suppression Effects Than Forward Walking Does

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.

A randomized control trial on retro-walking improves symptoms, pain, and function in primary knee osteoarthritis

BACKGROUND

Primary knee osteoarthritis is the leading cause of chronic disability and pain among adults worldwide. Retro-walking has been shown to reduce patellofemoral pain, increases functional capability while strengthening the lower limbs and improving proprioception and balance. We aim to examine the effects of retro-walking on symptoms, pain, and perceived ability to perform daily activities in comparison to forward-walking in subjects with primary knee osteoarthritis.

METHODS

This was a single-blinded, randomized control trial involving 34 subjects between the age of 45-70 years (58.41±5.93) comparing retro-walking (RW) to forward-walking (FW). Subjects were randomly allocated to receive either RW with structured resistance training (SRT) or FW with SRT; 3 times a week for 12 weeks. The symptoms, pain, and function of daily living sub scores of the Knee Injury and Osteoarthritis Outcome Score (KOOS) along with Timed up and go (TUG) and Chair stand test (CST) were assessed at baseline and after 12 weeks. The outcomes were analyzed with two-way repeated measure analysis of variance.

RESULTS

Significant improvements for all outcomes were observed intra-group (P value <0.05) after 12 weeks. The KOOS sub scores, TUG and CST times was not statistically significant between study groups (P value >0.05). However, the partial eta squared scores for all outcomes were better in the RW group compared to FW except for CST.

CONCLUSIONS

It can be concluded that RW is a feasible and non-inferior option to FW in the rehabilitation of subjects with bilateral knee OA.

Effectiveness of backward walking for people affected by stroke: A systematic review and meta-analysis of randomized controlled trials

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.

Combined effects of backward treadmill training and botulinum toxin type A therapy on gait and balance in patients with chronic stroke: A pilot, single-blind, randomized controlled trial

BACKGROUND

Backward walking is recommended to improve the components of physiological gait in neurological disease. Botulinum toxin type A is an effective safe first line-treatment for post-stroke spasticity.

OBJECTIVE

To compare the effects of backward treadmill training (BTT) versus standard forward treadmill training (FTT) on motor impairment in patients with chronic stroke receiving botulinum toxin type A therapy.

METHODS

Eighteen chronic stroke patients were randomly assigned to receive BTT (n = 7) or FTT (n = 11) as adjunct to botulinum toxin type A therapy. A total of twelve 40-minute sessions (3 sessions/week for 4 weeks) of either BTT or FTT were conducted. A blinded assessor evaluated the patients before and after treatment. The primary outcome was the 10-meter Walking Test (10 MWT). Secondary outcomes were the modified Ashworth Scale, gait analysis, and stabilometric assessment.

RESULTS

Between-group comparison showed a significant change on the 10 MWT (P = 0.008) and on stabilometric assessment [length of centre of pressure CoP (P = 0.001) and sway area (P = 0.002) eyes open and length of CoP (P = 0.021) and sway area (P = 0.008) eyes closed] after treatment.

CONCLUSIONS

Greater improvement in gait and balance was noted after BTT than after FTT as an adjunct to botulinum toxin therapy in patients with chronic stroke.

Effects of dynamic exercise utilizing PNF patterns on the balance of healthy adults

[Purpose] The purpose of this study is to examine the effects of dynamic exercise utilizing the proprioceptive neuromuscular facilitation patterns accompanied by the abdomen drawing-in on balance of healthy adults. [Participants and Methods] The total number of participants was 30, and 15 were randomly placed in the training group (TG) and 15 in the control group (CG). The participants in the TG have conducted the 3 sets to 5 sets of dynamic exercise utilizing the proprioceptive neuromuscular facilitation patterns per day, 3 times a week for 6 weeks. The balance was measured by the Terax, a balance-measuring device with force plates. [Results] Comparing the TG's balance pre-test and post-test, there was a statistical significance in stability score (SS), weight distribution index (WDI), CD force plates and AC force plates (A: left rearfoot, B: left forefoot, C: right rearfoot, D: right forefoot). [Conclusion] Dynamic trunk stabilization exercise utilizing the proprioceptive neuromuscular facilitation patterns seem to help increase the balance of healthy adults.