Backward walking training improves balance in school-aged boys

Enhancing physical attributes and performance in badminton players: efficacy of backward walking training on treadmill

BACKGROUND

Badminton, a dynamic sport, demands players to display exceptional physical attributes such as agility, core stability, and reaction time. Backward walking training on a treadmill has garnered attention for its potential to enhance physical attributes and optimize performance in athletes while minimizing the risk of injuries.

OBJECTIVE

By investigating the efficacy of this novel approach, we aim to provide valuable insights to optimize training regimens and contribute to the advancement of sports science in badminton.

METHODOLOGY

Sixty-four participants were randomized into a control group (n = 32) and an experimental group (n = 32). The control group received routine exercise training, while the experimental group received routine exercise training along with additional backward walking training on the treadmill. Pre- and post-intervention measurements were taken for core stability using the Plank test, balance using the Star Excursion Balance test, reaction time using the 6-point footwork test, and agility using the Illinois Agility test.

RESULTS

The results showed that the experimental group demonstrated significant improvements in core stability (p < 0.001), balance (p < 0.001), reaction time (p < 0.05), and agility (p < 0.001) compared to the control group. The backward walking training proved to be effective in enhancing these physical attributes in badminton players.

CONCLUSION

Incorporating backward walking exercises into the training regimen of badminton players may contribute to their overall performance.

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

AIM

To compare the effects of backward (BW) and forward (FW) walking training on back geometry and mobility function in children with hemiparetic cerebral palsy (CP).

METHODS

Fifty-five children with hemiparetic CP participated in this study. They were randomly assigned into two groups. For 12 weeks, both groups got a conventional physical therapy program three days/week. Groups A and B got a specifically developed FW walking training (25 minutes/session) and a specially designed BW walking training (25 minutes/session), respectively.

RESULTS

The trunk imbalance, lateral deviation, pelvic tilting, pelvic torsion, surface motion, and dynamic gait index of group B improved significantly more than group A (p < .05). Both groups showed significant improvements in all measured variables (p < .05).

CONCLUSION

BW walking training might be considered as an effective therapy modality for improving back geometry and mobility function in hemiparetic CP children compared with FW walking training combined with a typical program.

Balance Ability and Quality of Life in Older Adult with Recovery from Mild COVID-19

BACKGROUND

In this study, we aimed to assess the ability to balance and quality of life (QoL) among older adults without a history of coronavirus disease 2019 (COVID-19) and those who had recovered from mild COVID-19.

METHODS

We recruited 80 older adults and categorized them into the following two groups based on their history of COVID-19: those without COVID-19 (n=40) and those who had recovered from mild COVID-19 (n=40). We assessed the participants' ability to balance using the multi-directional reach test and timed up and go (TUG) test, and evaluated their QoL using the Short Form-36.

RESULTS

Compared with older adults without a history of COVID-19, those who had recovered from mild COVID-19 demonstrated no differences in the scores of the forward, backward, right, and left directions (p>0.05), but a significantly longer duration for the TUG test (p=0.02) and a reduced QoL.

CONCLUSION

Our study results demonstrated decreased ability to balance and poor QoL among older adults who had recovered from mild COVID-19.

It’s Not Just about Bicycle Riding: Sensory-Motor, Social and Emotional Benefits for Children with and without Developmental Disabilities

Background: A developing area for therapy is teaching children to ride a bicycle. Little has been written about the effectiveness of these programs. This study explored outcomes from participation in a novel bicycle riding program for children with a wide array of developmental challenges. Method: Two studies were conducted; a nonconcurrent, multiple baseline design with four participants and a pretest–posttest single group with 15 children. Results: Study 1 participants improved on broad jump. Balance positions showed variable responses. Study 2 participants showed significant improvement on broad jump, and a trend toward significance walking forwards and backwards. Parents reported improvement in following rules, participating in daily routines, interacting with peers, and feeling good about him/herself and a change in child’s participation in community and extracurricular activities. All children improved in glide time or achieved independent riding. Conclusions: Preliminary evidence was found for the effectiveness of one approach for developing motor and social skills within the context of learning to ride a bicycle. Children over the age of 6 years were able to ride a two-wheeled bicycle at the end of the program. Participation suggested improvement in motor coordination and dynamic balance as well as changes in measures of social interaction and self-esteem.

Preventing Unintentional Injuries in School-Aged Children: A Systematic Review

BACKGROUND AND OBJECTIVES

Unintentional injuries constitute the leading causes of death and long-term disabilities among children aged 5 to 15 years. We aimed to systematically review published literature on interventions designed to prevent unintentional injuries among school-aged children.

METHODS

We searched MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO and screened the reference lists of included studies and relevant reviews. We included randomized controlled trials, controlled before-and-after studies, and interrupted time series studies. The focus of included studies was on primary prevention measures. Two reviewers collected data on type of study design, setting, population, intervention, types of injuries, outcomes assessed, and statistical results.

RESULTS

Of 30 179 identified studies, 117 were included in this review. Most of these studies were conducted in high-income countries and addressed traffic-related injuries. Evidence from included studies reveals that multicomponent educational interventions may be effective in improving safety knowledge, attitudes, and behaviors in school-aged children mainly when coupled with other approaches. Laws/legislation were shown to be effective in increasing cycle helmet use and reducing traffic-related injury rates. Findings reveal the relevance of infrastructure modification in reducing falls and improving pedestrian safety among children.

CONCLUSIONS

Additional studies are needed to evaluate the impact of unintentional injury prevention interventions on injury, hospitalizations, and mortality rates and the impact of laws and legislation and infrastructure modification on preventing unintentional injuries among school-aged children.

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 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.

Comparison of forward versus backward walking on spatiotemporal and kinematic parameters on sand: A preliminary study

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

The Effect of Walking Backward on a Treadmill on Balance, Speed of Walking and Cardiopulmonary Fitness for Patients with Chronic Stroke: A Pilot Study

This study determines the effect of walking backward on a treadmill on balance, speed of walking and cardiopulmonary fitness for patients with chronic stroke. Subjects with chronic stroke for more than six months, whose level of Brunnstrom stage is greater than IV and who are able to walk more than eleven meters with or without assistive devices were recruited. After grouping for a single-blind clinical randomized controlled trial, the subjects were divided into two groups: eight in the control group and eight in the experimental group. All subjects were subjected to 30 min traditional physical therapy, three times a week for four weeks. The experimental group was subjected to an additional 30 min of walking backward on a treadmill. The Berg Balance Scale (BBS) and the Timed Up and Go test (TUG) were used to determine the functional balance and walking ability. The walking speed was evaluated using a timed 10-Meter Walk Test (10MWT), and the cardiopulmonary fitness was determined using a 6-Minute Walk Test (6MWT) and a pulmonary function test (PFT). All assessments were made at baseline before training commenced (pre-training) and at the end of the four-week training period (post-training). A paired t-test and an independent t-test were used to determine the effect on balance, speed of walking and cardiopulmonary fitness before and after training. The level of significance α was 0.05. After four weeks of training, the experimental group showed significant differences (p < 0.05) on TUG, BBS, 10MWT, 6MWT, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). This pilot study shows that the 30 min of walking backward on a treadmill three times a week for four weeks increased balance, speed of walking and cardiopulmonary fitness. Trial registration: Current Controlled Trials NCT02619110.

A Practice-Inspired Mindset for Researching the Psychophysiological and Medical Health Effects of Recreational Dance (Dance Sport)

“Dance” has been associated with many psychophysiological and medical health effects. However, varying definitions of what constitute “dance” have led to a rather heterogenous body of evidence about such potential effects, leaving the picture piecemeal at best. It remains unclear what exact parameters may be driving positive effects. We believe that this heterogeneity of evidence is partly due to a lack of a clear definition of dance for such empirical purposes. A differentiation is needed between (a) the effects on the individual when the activity of “dancing” is enjoyed as a dancer within different dance domains (e.g., professional/”high-art” type of dance, erotic dance, religious dance, club dancing, Dance Movement Therapy (DMT), and what is commonly known as hobby, recreational or social dance), and (b) the effects on the individual within these different domains, as a dancer of the different dance styles (solo dance, partnering dance, group dance; and all the different styles within these). Another separate category of dance engagement is, not as a dancer, but as a spectator of all of the above. “Watching dance” as part of an audience has its own set of psychophysiological and neurocognitive effects on the individual, and depends on the context where dance is witnessed. With the help of dance professionals, we first outline some different dance domains and dance styles, and outline aspects that differentiate them, and that may, therefore, cause differential empirical findings when compared regardless (e.g., amount of interpersonal contact, physical exertion, context, cognitive demand, type of movements, complexity of technique and ratio of choreography/improvisation). Then, we outline commonalities between all dance styles. We identify six basic components that are part of any dance practice, as part of a continuum, and review and discuss available research for each of them concerning the possible health and wellbeing effects of each of these components, and how they may relate to the psychophysiological and health effects that are reported for “dancing”: (1) rhythm and music, (2) sociality, (3) technique and fitness, (4) connection and connectedness (self-intimation), (5) flow and mindfulness, (6) aesthetic emotions and imagination. Future research efforts might take into account the important differences between types of dance activities, as well as the six components, for a more targeted assessment of how “dancing” affects the human body.

Effects of backward walking on knee proprioception after ACL reconstruction

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.

Transcutaneous spinal direct current stimulation improves locomotor learning in healthy humans

BACKGROUND

Ambulation is an essential aspect of daily living and is often impaired after brain and spinal cord injuries. Despite the implementation of standard neurorehabilitative care, locomotor recovery is often incomplete.

OBJECTIVE

In this randomized, sham-controlled, double-blind, parallel design study, we aimed to determine if anodal transcutaneous spinal direct current stimulation (anodal tsDCS) could improve training effects on locomotion compared to sham (sham tsDCS) in healthy subjects.

METHODS

43 participants underwent a single backwards locomotion training (BLT) session on a reverse treadmill with concurrent anodal (n = 22) or sham (n = 21) tsDCS. The primary outcome measure was speed gain measured 24 h post-training. We hypothesized that anodal tsDCS + BLT would improve training effects on backward locomotor speed compared to sham tsDCS + BLT. A subset of participants (n = 31) returned for two additional training days of either anodal (n = 16) or sham (n = 15) tsDCS and underwent (n = 29) H-reflex testing immediately before, immediately after, and 30 min post-training over three consecutive days.

RESULTS

A single session of anodal tsDCS + BLT elicited greater speed gain at 24 h relative to sham tsDCS + BLT (p = 0.008, two-sample t-test, adjusted for one interim analysis after the initial 12 subjects). Anodal tsDCS + BLT resulted in higher retention of the acquired skill at day 30 relative to sham tsDCS + BLT (p = 0.002) in the absence of significant group differences in online or offline learning over the three training days (p = 0.467 and p = 0.131). BLT resulted in transient down-regulation of H-reflex amplitude (Hmax/Mmax) in both test groups (p < 0.0001). However, the concurrent application of anodal-tsDCS with BLT elicited a longer lasting effect than sham-tsDCS + BLT (p = 0.050).

CONCLUSION

tsDCS improved locomotor skill acquisition and retention in healthy subjects and prolonged the physiological exercise-mediated downregulation of excitability of the alpha motoneuron pool. These results suggest that this strategy is worth exploring in neurorehabilitation of locomotor function.

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

BACKGROUND

Backward walking (BW) training is thought to impact balance performance through improving motor system proprioception and gait characteristic, but relevant evidence remains sparse and inconclusive.

OBJECTIVE

This study systematically reviewed and quantified the scientific evidence regarding the effectiveness of BW training on balance performance.

METHODS

Keyword and reference search on BW training interventions was conducted in six electronic databases (PubMed, Web of science, SPORTDiscus, CINAHL, Cochrane Library, and CNKI) for peer-reviewed articles published till November 2017. A standardized form was used to extract data from each selected article that met the pre-specified eligibility criteria. Meta-analysis was conducted to estimate the pooled effects of BW training on balance performance measures.

RESULTS

Eleven studies (nine randomized controlled trials and two pre-post studies) met the eligibility criteria and were included in the review. All studies reported some beneficial effects of BW training on balance performance. Compared to control, BW training was associated with a reduction in overall stability index score by 0.99 (95% CI = 0.37, 1.61; I² = 0.0%; fixed-effect model), medial-lateral stability index score by 0.95 (95% CI = 0.34, 1.57; I² = 0.0%; fixed-effect model), and anterior-posterior stability index score by 0.99 (95% CI = 0.37, 1.61; I² = 0.0%; fixed-effect model). Meanwhile, BW training was associated with an increase in open-eyes single leg standing duration by 0.91 s (95% CI = 0.29, 1.53; I² = 75.9%; random-effect model) in comparison to control.

CONCLUSIONS

BW training could serve as a potentially useful tool to improve balance performance among those with a high risk of fall. However, current evidence remains preliminary due to the small cohort of studies and possible learning effect in pre-post studies. Future work with larger scale and randomized experimental design is warranted to evaluate the effectiveness of BW training on balance performance across diverse population and disease subgroups, and elucidate the underlying biomechanical and neurological pathways.

Graded forward and backward walking at a matched intensity on cardiorespiratory responses and postural control

BACKGROUND

While several studies compare backward walking (BW) and forward walking (FW) in terms of heart rate (HR) and rating of perceived exertion (RPE), workload (VO₂) was not matched to control for intensity levels (Hooper et al. [1]). Moreover, acute effects of inclined BW on postural control and ankle musculature has not been investigated. This study was designed to compare cardiovascular, metabolic and perceptual responses, changes in center of pressure (COP) motion, and muscle activation of tibialis anterior (TA) and gastrocnemius (GM) to control quiet stance posture immediately following inclined BW and FW at a matched intensity.

METHODS

Seventeen healthy young adults completed three lab sessions 7-14 days apart. Session one, maximal oxygen consumption (VO_2max) was measured using open-circuit spirometry for each participant. Session two, participants performed BW for 15-min. Session three, participants performed FW for 15-min at matched intensity of BW. Surface electromyography (SEMG) measured the muscular activity of the TA and GM during bilateral stance on a force plate for 30 s prior to and immediately following BW and FW under both eyes open (EO), and eyes closed (EC) conditions.

RESULTS

HR, VCO₂, RER and RPE were significantly greater during BW compared to FW. Increased muscle activation and COP motion was elicited immediately following BW compared to FW under EO and EC.

CONCLUSION

Results of this study indicate BW requires greater cardiovascular, metabolic, perceptual and neuromuscular demands than FW, which may cause postural instability particularly to those with compromised balance. While there are benefits to BW in rehabilitation settings, these factors should be considered when prescribing BW for training and/or rehabilitation exercise program (Duffell et al. [2], Warnica et al. [3]).

Effects of backward gait training on balance, gross motor function, and gait in children with cerebral palsy: a systematic review

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.

Effect of backward walking training on postural balance in children with hemiparetic cerebral palsy: a randomized controlled study

OBJECTIVE

To study the effect of additional backward walking training on postural control in children with hemiparetic cerebral palsy.

DESIGN

Randomized controlled study.

SETTING

Physical therapy clinics.

SUBJECTS

Thirty spastic hemiparetic cerebral palsied children of both sexes (10-14 years, 14 girls and 16 boys).

INTERVENTION

Children were randomly assigned into two equal groups: experimental and control groups. Both groups received a traditional physical therapy program for 12 weeks. Experimental group additionally received backward walking training which was provided 25 min/day, 3 days/week for 3 successive months.

OUTCOME MEASURES

Baseline and post-treatment assessment for overall, anteroposterior, and mediolateral stability indices were evaluated by using Biodex balance system.

RESULTS

After treatment; two way ANOVA revealed significant improvement in overall, anteroposterior and mediolateral stability indices of experimental group at the most stable level (level 12) and moderately unstable level (level 7) (1.40 ± 0.44 and 1.73 ± 0.51; 1.11 ± 0.34 and 2.13 ± 0.52; 1.93 ± 0.51 and 2.68 ± 0.52) respectively, than control group (1.77 ± 0.44 and 2.17 ± 0.56; 1.44 ± 0.44 and 2.54 ± 0.49; 2.39 ± 0.65 and 3.11 ± 0.49) respectively, (P < 0.05). There were significant improvement in all measured variables for both groups at both levels (P < 0.05).

CONCLUSION

Additional backward walking training to traditional physical therapy program yields improvement in postural stability indices in children with spastic hemiparetic cerebral palsy than traditional physical therapy alone.

Investigating the role of backward walking therapy in alleviating plantar pressure of patients with diabetic peripheral neuropathy

OBJECTIVE

To investigate the effect of combination therapy of backward walking training and alpha-lipoic acid (ALA) treatment on the distribution of plantar pressure in patients with diabetic peripheral neuropathy (DPN).

DESIGN

This study is a double-blinded, randomized controlled trial. The test group was treated with combination therapy of backward walking exercise and ALA (ALA for 2wk, backward walking exercise for 12wk), and the control group only received ALA treatment.

SETTING

Clinical and laboratory setting.

PARTICIPANTS

Patients with DPN (N=60) were divided into the test group (n=30) or control group (n=30).

INTERVENTIONS

Backward walking exercise with ALA treatment for the test group; lipoic acid treatment for the control group.

MAIN OUTCOME MEASURE

Plantar pressure before and after treatment was tested and analyzed with the flatbed plantar pressure measurement system.

RESULTS

After treatment, peak plantar pressure in the forefoot dropped for both the test and control groups; peak plantar pressure for the test group dropped significantly. Peak plantar pressure in the medial foot slightly increased for the test group, suggesting a more even distribution of plantar pressure in the test group after treatment.

CONCLUSIONS

The combination therapy of ALA and backward walking proved to be more effective than ALA monotherapy. Backward walking also proved to have an ameliorating effect on balance ability and muscle strength of patients with DPN.