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Monaghan PG, VanNostrand M, Fritz NE. Backwards walking speed reserve in persons with multiple sclerosis. Mult Scler Relat Disord 2024; 85:105556. [PMID: 38520947 PMCID: PMC11070283 DOI: 10.1016/j.msard.2024.105556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/15/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Decreased gait speed is common in persons with Multiple Sclerosis (PwMS) and has been associated with elevated fall risk. The walking speed reserve (WSR) indicates the ability to increase gait speed on demand and has previously been examined in PwMS. Backward walking is a sensitive measure of fall risk in PwMS; however, no studies have reported on the utility of backward walking speed reserve (BW-WSR) as a clinical assessment tool of functional mobility or fall risk in PwMS, nor have they associated this measure with cognition. METHODS 23 PwMS completed walking trials at their preferred walking speed (PWS) and maximal walking speed (MWS). Participants performed these walking trials in both the forward (FW) and backward direction (BW). The forward walking speed reserve (FW-WSR) was calculated as the difference between MWS and PWS in the forward direction, while the backward walking speed reserve (BW-WSR) was calculated as the difference between MWS and PWS in the back backward direction. Correlation analyses examined the relationship between the FW- and BW-WSR with clinical assessments of functional mobility (the timed up-and-go) as well as cognitive functioning (the Symbol Digit Modalities Test, the Brief Visuospatial Memory Test-Revised, the California Verbal Learning Test, and the Trail Making Test A and B). Correlations also examined the relationship between FW- and BW-WSR with prospective falls. RESULTS A lower BW-WSR was associated with disease severity and poorer performance on clinical walking and balance assessment, as well as with decreased information processing speed and attentional performance. Interestingly, FW-WSR showed similar relations. Neither FW- or BW-WSR were associated with prospective risk in this small sample of PwMS. CONCLUSION The BW-WSR did not offer a distinct advantage over other measures, such as the FW-WSR, PWS, or MWS, in the forward or backward direction. The selection of the most sensitive clinical measures of functional mobility and fall risk is crucial; our study holds valuable clinical implications for PwMS by providing novel insights into functional mobility assessments in PwMS.
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Affiliation(s)
- Patrick G Monaghan
- Department of Health Care Sciences, Wayne State University, Detroit, MI, United States.
| | - Michael VanNostrand
- Department of Health Care Sciences, Wayne State University, Detroit, MI, United States
| | - Nora E Fritz
- Department of Health Care Sciences, Wayne State University, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit, MI, United States
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Hao J, Pu Y, He Z, Remis A, Yao Z, Li Y. Measurement properties of the backward walk test in people with balance and mobility deficits: A systematic review. Gait Posture 2024; 110:1-9. [PMID: 38458049 DOI: 10.1016/j.gaitpost.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/21/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
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.
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Affiliation(s)
- Jie Hao
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Yuqi Pu
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Zhengting He
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21025, USA
| | - Andréas Remis
- Health Research Association of Keck Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Zixuan Yao
- Department of Rehabilitation Medicine, Beijing Hospital, National Center of Gerontology, Institution of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100051, PR China
| | - Yanfei Li
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Abdel-Aziem AA, El-Basatiny HMY, Draz AH, Aglan DAAA. Back geometry and mobility function changes in cerebral palsy children after backward walking training: arandomized controlled trial. Dev Neurorehabil 2024:1-9. [PMID: 38597393 DOI: 10.1080/17518423.2024.2340461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
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.
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Affiliation(s)
- Amr Almaz Abdel-Aziem
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Heba Mohamed Youssr El-Basatiny
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy, College of Applied Medical Sciences, Najran University, Saudi Arabia
| | - Amira Husien Draz
- Department of Basic Sciences, Faculty of physical therapy, Cairo university, Giza, Egypt
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Sasaki A, Aisawa A, Takeuchi N. Transcranial direct current stimulation facilitates backward walking training. Exp Brain Res 2024; 242:67-77. [PMID: 37955707 DOI: 10.1007/s00221-023-06728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
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.
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Affiliation(s)
- Ayuka Sasaki
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Anri Aisawa
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Naoyuki Takeuchi
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita, 010-8543, Japan.
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DeMark LA, Fox EJ, Manes MR, Conroy C, Rose DK. The 3-Meter Backward Walk Test (3MBWT): Reliability and validity in individuals with subacute and chronic stroke. Physiother Theory Pract 2023; 39:2698-2705. [PMID: 35658807 DOI: 10.1080/09593985.2022.2085638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Backward walking (BW) is an important gait adaptation and BW speed may be an important indicator of walking function and fall risk. However, the measurement characteristics of a standardized assessment of BW post-stroke have not been fully established. OBJECTIVES To determine intra- and interrater reliability, concurrent validity and minimal detectable change (MDC) scores for the 3-Meter Backward Walk Test (3MBWT) post-stroke. METHODS Thirty-four individuals with subacute and 29 individuals with chronic stroke participated. Two trials of comfortable BW was measured over a total distance of 5-meters, while speed was calculated during the middle 3-meters of the walking distance. Intra and interrater reliability were determined by comparing the two trials from one rater and simultaneous assessment of two raters, respectively. Two additional trials were performed and BW speed was calculated using 3MBWT and an instrumented walkway to determine concurrent validity. Intraclass correlation coefficients (ICC) estimated reliability and validity. The MDC was calculated from the standard error of measurement. RESULTS Excellent ICC values were obtained for the 3MBWT in the subacute (interrater: ICC2,1 = 0.99; intrarater: ICC2,1 = 0.96; validity: ICC2,1 = 0.96) and chronic (interrater: ICC2,1 = 0.99; intrarater: ICC2,1 = 0.94; validity: ICC2,1 = 0.97) groups. The MDC was 0.07 m/s (subacute) and 0.11 m/s (chronic). CONCLUSIONS Establishment of the 3MBWT as a reliable and valid measure in assessing BW speed is an important addition to the assessment toolbox for rehabilitation post-stroke.
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Affiliation(s)
| | - Emily J Fox
- Brooks Rehabilitation, Jacksonville, FL, USA
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | | | | | - Dorian K Rose
- Brooks Rehabilitation, Jacksonville, FL, USA
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
- Malcolm Randall VA Medical Center, Gainesville, FL, USA
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Koçer B, Gülşen Ç, Söke F, Özcan Gülşen E, Ersoy N, Tunca Yılmaz Ö, Çomoğlu SS. Comparison of dual-task costs during different types of walking in people with Parkinson's disease: a controlled study. Acta Neurol Belg 2023; 123:2221-2227. [PMID: 37036604 DOI: 10.1007/s13760-023-02271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/05/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Many of the activities in daily living require different walking skills such as straight walking (SW), walking with turning (WwT), curved walking (CW) or backward walking (BW) in a dual-task condition. However, there is a lack of evidence regarding the dual task cost (DTC) during different types of walking. Therefore, this study was planned to compare the DTC during different types of walking in people with Parkinson's disease (PwPD) and healthy controls. METHODS Thirty-one PwPD and 31 healthy controls were included. Different types of walking were assessed using the 10-Meter Walk Test for SW, the Timed Up and Go Test for WwT, the Figure-of-Eight Walk Test for CW, and the Three-Meter Backward Walk Test for BW. Walking assessments were performed in a single-task and a dual-task condition. RESULTS The DTC on SW was the lowest in both groups. The DTC on WwT, BW, and CW were similar in healthy controls, whereas the order of the DTC on remaining walking types from lowest to highest was; WwT, BW, and CW in PwPD. Also, the DTC on WwT, BW, and CW were higher in PwPD than healthy controls. However, the DTC on SW was similar in PwPD and healthy controls. CONCLUSION The DTC is different during SW, WwT, BW, and CW in PwPD. Therefore, walking type should be considered in studies investigating dual task walking in PwPD. Also, dual task exercises consisting of different types of walking should be included in rehabilitation programs of PwPD.
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Affiliation(s)
- Bilge Koçer
- Neurology Clinic, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Çağrı Gülşen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Eskişehir Osmangazi University, Eskişehir, Turkey.
| | - Fatih Söke
- Gülhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Elvan Özcan Gülşen
- Yunus Emre Vocational School, Department of Health Care Services, Program in Geriatric Care, Anadolu University, Eskişehir, Turkey
| | - Nursena Ersoy
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara University, Ankara, Turkey
| | - Öznur Tunca Yılmaz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Selim Selçuk Çomoğlu
- Neurology Clinic, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Celik OF, Adiguzel H, Kirmaci ZIK, Erel S, Demirguc A. Validity and reliability of the 3-meter backward walk test in children with cerebral palsy. Acta Neurol Belg 2023:10.1007/s13760-023-02259-1. [PMID: 37014515 DOI: 10.1007/s13760-023-02259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To examine the validity and reliability of 3-Meter Backwalk Test (3MBWT) in children with Cerebral Palsy (CP). METHODS Study included 55 children with CP with the mean age of 12.34 ± 3.78 years, at Expanded and Revised Gross Motor Functional Classification System (GMFCS-E&R) I and II levels. Intraclass Correlation Coefficient (ICC) was used for the intra-rater and inter-rater reliability of 3MBWT according to the GMFCS-E&R levels. MDC estimates were calculated using baseline data. Convergent validity of 3MBWT was evaluated with its correlation between the Timed Up and Down Stairs Test (TUDS), Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), Pediatric Reach Test (PRT), Four Square Step Test (FSST). RESULTS Intra-rater and inter-rater reliability of 3MBWT was determined excellent at GMFCS-E&R I (Intra-rater ICC = 0.981-0.987, inter-rater ICC = 0.982-0.993), and GMFCS-E&R II (ICC = 0.927-0.933, ICC = 0.954-0.968). Intra-rater MDC values for GMFCS-E&R I were 1.17-1.22 s (s); 1.40-1.42 s for GMFCS-E&R II. Inter-rater MDC values for GMFCS-E&R I were 1.00-1.28 s, and MDC values for GMFCS-E&R II were 1.08-1.22 s. There was strong correlation between 3MBWT and PBS, TUG, and FSST in GMFCS-E&R I, moderate correlation between 3MBWT and TUDS, strong correlation between BBS, moderate correlation between TUG, and strong correlation between FSST in GMFCS-E&R II (p < 0.05). CONCLUSION The 3MBWT was found to be valid and reliable in children with CP. According to the MDC results, small differences in CP children can be adequately detected with 3MBWT. The 3MBWT also may add some more information on to GMFCS (E&R) data for following the disease progression as well as rehabilitation responses. TRIAL REGISTRATION NUMBER NCT04653363.
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Affiliation(s)
- Omer Faruk Celik
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, SANKO University, 27060, Sahinbey, Gaziantep, Turkey
| | - Hatice Adiguzel
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Kahramanmaras Sutcu Imam University, 46100, Dulkadiroglu, Kahramanmaras, Turkey.
| | - Zekiye Ipek Katirci Kirmaci
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Kahramanmaras Sutcu Imam University, 46100, Dulkadiroglu, Kahramanmaras, Turkey
| | - Suat Erel
- School of Physical Therapy and Rehabilitation, Pamukkale University, Kınıklı, 20070, Denizli, Turkey
| | - Arzu Demirguc
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, SANKO University, 27060, Sahinbey, Gaziantep, Turkey
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Bilek F, Demir CF. Validity and reliability of the 3-meter backward walk test in mildly disabled persons with multiple sclerosis. Mult Scler Relat Disord 2022; 58:103532. [PMID: 35066275 DOI: 10.1016/j.msard.2022.103532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/12/2021] [Accepted: 01/14/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND One of the biggest problems for persons with Multiple Sclerosis (PwMS) is dizziness, poor posture, and balance problems that cause injury-causing falls. The aim of our study was to reveal the test-retest reliability and validity of the 3-Meter Backward Walk Test (3MBWT) in mildly disabled PwMS. METHODS This study included a total of 93 mildly disabled PwMS with mean EDSS of 1.89. 3MBWT, Functional Access Test (FRT), Dynamic Gait Index (DGI), Timed 25-Foot Walk (T25FW), and Timed-Up and Go (TUG) were applied to the patients. To measure test-retest reliability, a second evaluation was performed three days after the first evaluation. RESULTS Cronbach's alpha coefficient was found to be 0.998 (excellent). For intra-rater agreement, the ICC values in the individual test were 0.998. The SEM value was 0.18, the MDC value was found to be 0.50. A very strong correlation was revealed between the 3MBWT and FRT (r: -0.931, p: 0.001), TUG (r: 0.968, p: 0.001), T25FW (r: 0.879, p: 0.001), DGI (r: -0.871, p: 0.001) and falling history (r: 0.932, p: 0.001). CONCLUSION The 3MBWT was observed to be valid and reliable in mildly disabled PwMS. 3MBWT is an effective and reliable tool for measuring ability to walk backward in mildly disabled PwMS.
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Affiliation(s)
- Furkan Bilek
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Fırat University, Elazığ, Turkey.
| | - Caner Feyzi Demir
- Department of Neurology, Faculty of Medical, Fırat University, Elazığ, Turkey
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Kellaher GK, Baudendistel ST, Roemmich RT, Terza MJ, Hass CJ. Persons with Parkinson's disease show impaired interlimb coordination during backward walking. Parkinsonism Relat Disord 2022; 94:25-29. [PMID: 34871827 PMCID: PMC9284669 DOI: 10.1016/j.parkreldis.2021.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/16/2021] [Accepted: 11/26/2021] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Grace K. Kellaher
- Department of Kinesiology & Applied Physiology, University of Delaware, STAR Campus, 540 S College Ave, Newark, Delaware, 19713,Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Road, Gainesville, Florida, 32611
| | - Sidney T. Baudendistel
- Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Road, Gainesville, Florida, 32611
| | - Ryan T. Roemmich
- Center for Movement Studies, Kennedy Krieger Institute, 707 N Broadway, Baltimore, Maryland, 21205,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, Maryland, 21287
| | - Matthew J. Terza
- Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Road, Gainesville, Florida, 32611
| | - Chris J. Hass
- Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Road, Gainesville, Florida, 32611
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Yun SH, Cho MJ, Kwon JW. Comparison of forward versus backward walking on spatiotemporal and kinematic parameters on sand: A preliminary study. J Biomech 2021; 130:110876. [PMID: 34871892 DOI: 10.1016/j.jbiomech.2021.110876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Seong Ho Yun
- Department of Physical Therapy, College of Health Sciences, Dankook University, Republic of Korea
| | - Min Jye Cho
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
| | - Jung Won Kwon
- Department of Physical Therapy, College of Health Sciences, Dankook University, Republic of Korea.
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Abit Kocaman A, Aydoğan Arslan S, Uğurlu K, Katırcı Kırmacı Zİ, Keskin ED. Validity and Reliability of The 3-Meter Backward Walk Test in Individuals with Stroke. J Stroke Cerebrovasc Dis 2020; 30:105462. [PMID: 33197801 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Ayşe Abit Kocaman
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey.
| | - Saniye Aydoğan Arslan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey.
| | - Kübra Uğurlu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey.
| | - Zekiye İpek Katırcı Kırmacı
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Sanko University, Gaziantep, Turkey.
| | - E Dilek Keskin
- Faculty of Medical Sciences, Department of Physical Medicine and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey.
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Abstract
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.
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Affiliation(s)
- Mei Shen
- Department of Rehabilitation Medicin, The People's Hospital of Longhua District, Shenzhen, Guangdong Province, China
| | - Shiqin Che
- Department of Rehabilitation Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Dongmei Ye
- Department of Rehabilitation Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Yangjun Li
- Department of Rehabilitation Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Fangkun Lin
- Department of Rehabilitation Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
| | - Yinliang Zhang
- Department of Rehabilitation Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, China
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Gilmore G, Gouelle A, Adamson MB, Pieterman M, Jog M. Forward and backward walking in Parkinson disease: A factor analysis. Gait Posture 2019; 74:14-19. [PMID: 31437733 DOI: 10.1016/j.gaitpost.2019.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/09/2019] [Accepted: 08/08/2019] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Greydon Gilmore
- School of Biomedical Engineering, Western University, London, Canada; Department of Clinical Neurological Sciences, University Hospital, London, Canada.
| | - Arnaud Gouelle
- Gait and Balance Academy, ProtoKinetics, Havertown, PA, United States; Laboratory Performance, Sante, Metrologie, Societe (PSMS), UFR STAPS, Reims, France
| | - Mitchell B Adamson
- Department of Clinical Neurological Sciences, University Hospital, London, Canada
| | - Marcus Pieterman
- Department of Clinical Neurological Sciences, University Hospital, London, Canada
| | - Mandar Jog
- School of Biomedical Engineering, Western University, London, Canada; Department of Clinical Neurological Sciences, University Hospital, London, Canada
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Hawkins KA, Balasubramanian CK, Vistamehr A, Conroy C, Rose DK, Clark DJ, Fox EJ. Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators. Top Stroke Rehabil 2019; 26:382-388. [PMID: 31081491 DOI: 10.1080/10749357.2019.1609182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators. Objective: To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls. Methods: Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition). Results: The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p < .01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p < .05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p < .05). Conclusions: Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation.
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Affiliation(s)
- Kelly A Hawkins
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Brooks Rehabilitation , Jacksonville , FL , USA
| | | | | | | | - Dorian K Rose
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Brooks Rehabilitation , Jacksonville , FL , USA.,d Brain Rehabilitation Research Center of Excellence, North FL/South GA Veterans Health System , Gainesville , FL , USA
| | - David J Clark
- d Brain Rehabilitation Research Center of Excellence, North FL/South GA Veterans Health System , Gainesville , FL , USA.,e Department of Aging and Geriatric Research , University of Florida , Gainesville , FL , USA
| | - Emily J Fox
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Brooks Rehabilitation , Jacksonville , FL , USA
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Abdelraouf OR, Abdel-Aziem AA, Ahmed AA, Nassif NS, Matar AG. Backward walking alters vastus medialis oblique/vastus lateralis muscle activity ratio in females with patellofemoral pain syndrome. Turk J Phys Med Rehabil 2019; 65:169-76. [PMID: 31453558 DOI: 10.5606/tftrd.2019.2445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/22/2018] [Indexed: 12/11/2022] Open
Abstract
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.
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Wang J, Xu J, An R. Effectiveness of backward walking training on balance performance: A systematic review and meta-analysis. Gait Posture 2019; 68:466-75. [PMID: 30616175 DOI: 10.1016/j.gaitpost.2019.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 12/30/2018] [Accepted: 01/01/2019] [Indexed: 02/02/2023]
Abstract
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.
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17
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Balasukumaran T, Olivier B, Ntsiea MV. The effectiveness of backward walking as a treatment for people with gait impairments: a systematic review and meta-analysis. Clin Rehabil 2018; 33:171-182. [PMID: 30229667 DOI: 10.1177/0269215518801430] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Tharani Balasukumaran
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Benita Olivier
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mokgobadibe Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hösl M, Böhm H, Eck J, Döderlein L, Arampatzis A. Effects of backward-downhill treadmill training versus manual static plantarflexor stretching on muscle-joint pathology and function in children with spastic Cerebral Palsy. Gait Posture 2018; 65:121-8. [PMID: 30558918 DOI: 10.1016/j.gaitpost.2018.07.171] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/31/2018] [Accepted: 07/21/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with spastic Cerebral Palsy are prone to equinus deformities, likely affected by short and inextensible plantarflexor muscles. Manual stretching is a popular treatment but its effectiveness concerning joint mobility, muscle-tendon morphometrics and walking function is debated. Eccentric exercise by backward-downhill treadmill training could be a therapeutic alternative for ambulatory patients improving gait and muscle function. RESEARCH QUESTION What are the effects of eccentric training by backward-downhill treadmill training and plantarflexor stretching concerning gait and muscle function in patients with spastic Cerebral Palsy? METHODS 10 independent ambulators with spastic Cerebral Palsy (12 [SD 4] years old, 2 uni- and 8 bilaterally affected) participated in a randomized crossover-study. One group started with manual static stretching, the other one with backward-downhill treadmill training. Each treatment period lasted 9 weeks (3 sessions per week). Pre and post treatments, 3D gait was assessed during comfortable and during fastest possible walking. Ultrasonography and dynamometry were used to test plantarflexor strength, passive joint flexibility, as well as gastrocnemius morphometrics, stiffness and strain on muscle-tendon and joint level. RESULTS When comparing both treatments, backward-downhill treadmill training lead to larger single stance dorsiflexion at comfortable walking speed (+2.9°, P = 0.041) and faster maximally achievable walking velocities ( + 0.10 m/s, P = 0.017). Stretching reduced knee flexion in swing, particularly at faster walking velocities (-5.4°, P = 0.003). Strength, ankle joint flexibility, as well as stiffness on muscle-tendon and joint level were not altered, despite similar increases in passive muscle and fascicle strain with both treatments (P ≤ 0.023). SIGNIFICANCE Backward-downhill treadmill training can be an effective gait treatment, probably improving coordination or reducing dynamic stretch sensitivity. More intense BDTT might be necessary to further alter muscle-tendon properties. Manual static plantarflexor stretching may not be optimal in Cerebral Palsy patients with high ambulatory status.
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Mahaki M, De Sá E Souza GS, Mimar R, Vieira MF. The comparison of ground reaction forces and lower limb muscles correlation and activation time delay between forward and backward walking. Gait Posture 2017; 58:380-385. [PMID: 28888906 DOI: 10.1016/j.gaitpost.2017.08.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 02/02/2023]
Abstract
This study aimed to compare the ground reaction forces (GRF) and lower limb muscles correlation and activation time delay between Forward (FW) and Backward (BW) walking. Twenty-four male students participated in this research. Electromyogram activities of gluteus medius, biceps femoris, medial gastrocnemius, soleus and anterior tibialis muscles along with GRFs were measured. Each participant performed two FW and two BW trials bare foot. Statistical parametric mapping (SPM) analysis was performed over anterior-posterior and vertical GRFs time series. The paired t-test was used in SPM analysis. Cross-correlation analysis compared similarity in shape and time delay of EMG pattern. SPM analysis of GRFs showed that these two walking modes have asymmetrical kinetic behavior during most parts of stance phase. Based on cross-correlation analysis, the shape of EMG activation profiles differed, where a phase shift in the muscle activation pattern of approximately 60% occurred. This shift may indicate different control mechanisms, at the spinal level, underpin FW and BW walking modalities.
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Affiliation(s)
- Mohammadreza Mahaki
- Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran.
| | | | - Raghad Mimar
- Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran.
| | - Marcus Fraga Vieira
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Brazil.
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20
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Ding X, Yin J, Shui R, Zhou J, Shen M. Backward-walking biological motion orients attention to moving away instead of moving toward. Psychon Bull Rev 2017; 24:447-52. [PMID: 27368634 DOI: 10.3758/s13423-016-1083-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Walking direction is an important attribute of biological motion because it carries key information, such as the specific intention of the walker. Although it is known that spatial attention is guided by walking direction, it remains unclear whether this attentional shift is reflexive (i.e., constantly shifts to the walking direction) or not. A richer interpretation of this effect is that attention is guided to seek the information that is necessary to understand the motion. To investigate this issue, we examined how backward-walking biological motion orients attention because the intention of walking backward is usually to avoid something that walking forward would encounter. The results showed that attention was oriented to the walking-away direction of biological motion instead of the walking-toward direction (Experiment 1), and this effect was not due to the gaze direction of biological motion (Experiment 2). Our findings suggest that the attentional shift triggered by walking direction is not reflexive, thus providing support for the rich interpretation of these attentional effects.
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Makino M, Takami A, Oda A. Comparison of forward walking and backward walking in stroke hemiplegia patients focusing on the paretic side. J Phys Ther Sci 2017; 29:187-190. [PMID: 28265136 PMCID: PMC5332967 DOI: 10.1589/jpts.29.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/19/2016] [Indexed: 11/24/2022] Open
Abstract
[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.
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Affiliation(s)
- Misato Makino
- Hirosaki University Graduate School of Health Sciences: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan
| | - Akiyoshi Takami
- Hirosaki University Graduate School of Health Sciences: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan
| | - Atsushi Oda
- Hirosaki University Graduate School of Health Sciences: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan
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Elboim-Gabyzon M, Rotchild S. Spatial and temporal gait characteristics of elderly individuals during backward and forward walking with shoes and barefoot. Gait Posture 2017; 52:363-366. [PMID: 28049108 DOI: 10.1016/j.gaitpost.2016.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 11/28/2016] [Accepted: 12/04/2016] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Michal Elboim-Gabyzon
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | - Shira Rotchild
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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Foster H, DeMark L, Spigel PM, Rose DK, Fox EJ. The effects of backward walking training on balance and mobility in an individual with chronic incomplete spinal cord injury: A case report. Physiother Theory Pract 2016; 32:536-45. [PMID: 27482619 DOI: 10.1080/09593985.2016.1206155] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND/PURPOSE Individuals with incomplete spinal cord injuries (ISCIs) commonly face persistent gait impairments. Backward walking training may be a useful rehabilitation approach, providing novel gait and balance challenges. However, little is known about the effects of this approach for individuals with ISCIs. The purpose of this case report was to describe the effects of backward walking training on strength, balance, and upright mobility in an individual with chronic ISCI. METHODS A 28-year-old female, 11-years post ISCI (C4, AIS D) completed 18-sessions of backward walking training on a treadmill with partial body-weight support and overground. Training emphasized stepping practice, speed, and kinematics. Outcome measures included: Lower Extremity Motor Score, Berg Balance Scale (BBS), Sensory Organization Test (SOT), 10-Meter Walk Test (10MWT), 3-meter backward walking test, Timed Up and Go (TUG), and Activities-Specific Balance Confidence (ABC) Scale. RESULTS Strength did not change. Improved balance was evident based on BBS (20 to 37/56) and SOT scores (27 to 40/100). Upright mobility improved based on TUG times (57 to 32.7 s), increased 10MWT speed (0.23 to 0.31 m/s), and backward gait speed (0.07 to 0.12 m/s). Additionally, self-reported balance confidence (ABC Scale) increased from 36.9% to 49.6%. CONCLUSIONS The results suggest that backward walking may be a beneficial rehabilitation approach; examination of the clinical efficacy is warranted.
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Affiliation(s)
| | - Lou DeMark
- a Brooks Rehabilitation , Jacksonville , FL , USA
| | | | - Dorian K Rose
- a Brooks Rehabilitation , Jacksonville , FL , USA.,b Malcolm Randall VAMC , Brain Rehabilitation Research Center , Gainesville , FL , USA.,c Department of Physical Therapy , University of Florida , Gainesville , FL , USA
| | - Emily J Fox
- a Brooks Rehabilitation , Jacksonville , FL , USA.,c Department of Physical Therapy , University of Florida , Gainesville , FL , USA
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Cha HG, Kim TH, Kim MK. Therapeutic efficacy of walking backward and forward on a slope in normal adults. J Phys Ther Sci 2016; 28:1901-3. [PMID: 27390443 PMCID: PMC4932084 DOI: 10.1589/jpts.28.1901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022] Open
Abstract
In this study, the therapeutic effects of backward walking were examined. [Subjects and
Methods] In all, 16 subjects were randomly assigned to an experimental group and 17 to a
control group. All subjects walked barefoot on a treadmill (HM50EX, Daeho, Korea) for
20 min, five times per week, for a total of 4 weeks. The average gait velocity of the
subjects was 3 km/h on a 10% slope. The experimental group walked backwards and the
control group walked forwards. [Results] The experimental group showed significant
increments in both medial-lateral and anterior-posterior balance, step length, and
velocity compared with the pre-intervention results. In addition, the control group showed
significant increments in anterior-posterior balance and velocity compared to the
pre-intervention results. Significant differences in post-training gains in
anterior-posterior balance, step length, and velocity were observed between the
experimental and control groups. [Conclusion] Backward walking positively affected gait
and balance ability after intervention.
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Affiliation(s)
- Hyun-Gyu Cha
- Department of Physical Therapy, Kyungbuk College, Republic of Korea
| | - Tae-Hoon Kim
- Department of Food Science and Biotechnology, College of Engineering, Daegu University, Republic of Korea
| | - Myoung-Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Republic of Korea
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Kim WH, Kim WB, Yun CK. The effects of forward and backward walking according to treadmill inclination in children with cerebral palsy. J Phys Ther Sci 2016; 28:1569-73. [PMID: 27313373 PMCID: PMC4905912 DOI: 10.1589/jpts.28.1569] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/02/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the effects of forward and backward walking using
different treadmill incline positions on lower muscle activity in children with cerebral
palsy, to provide baseline data for gait training intensity. [Subjects and Methods]
Nineteen subjects with cerebral palsy walked forward and backward at a self-selected pace
on a treadmill with inclines of 0%, 5%, 10%, and 15%. Activation of the rectus femoris,
biceps femoris, tibialisanterior, and lateral gastrocnemius was measured using surface
electromyography during the stance phase. [Results] As treadmill incline increased during
forward walking, muscle activation of the paralyzed lower limbs did not significantly
change. However, as treadmill incline increased during backward walking, rectus femoris
activation significantly increased and a significant difference was found between
treadmill inclines of 0% and 10%. A comparison of backward and forward walking showed a
significant difference in rectus femoris activation at treadmill inclines of 0%, 5%, and
10%. Activation of the tibialis anterior was only significantly higher for backward
walking at the 10% gradient. [Conclusion] Backward walking may strengthen the rectus
femoris and tibialis anterior in walking training for cerebral palsy. Gradient adjustment
of the treadmill can be used to select the intensity of walking training.
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Affiliation(s)
- Won-Hyo Kim
- Department of Physical Therapy, College of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea
| | - Won-Bok Kim
- Department of Physical Therapy, College of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea
| | - Chang-Kyo Yun
- Department of Physical Therapy, College of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea
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Sagawa K, Ohkubo K. 2D trajectory estimation during free walking using a tiptoe-mounted inertial sensor. J Biomech 2015; 48:2054-9. [PMID: 25907547 DOI: 10.1016/j.jbiomech.2015.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 03/10/2015] [Accepted: 03/22/2015] [Indexed: 11/26/2022]
Abstract
An estimation method for a two-dimensional walking trajectory during free walking, such as forward walking, side stepping and backward walking, was investigated using a tiptoe-mounted inertial sensor. The horizontal trajectory of the toe-tip is obtained by double integration of toe-tip acceleration during the moving phase in which the sensor is rotated before foot-off or after foot-contact, in addition to the swing phase. Special functions that determine the optimum moving phase as the integral duration in every one step are developed statistically using the gait cycle and the resultant angular velocity of dorsi/planter flexion, pronation/supination and inversion/eversion so that the difference between the estimated trajectory and actual one gives a minimum value during free walking with several cadences. To develop the functions, twenty healthy volunteers participated in free walking experiments in which subjects performed forward walking, side stepping to the right, side stepping to the left, and backward walking at 39 m down a straight corridor with several predetermined cadences. To confirm the effect of the developed functions, five healthy subjects participated in the free walking experiment in which each subject performed free walking with different velocities of normal, fast, and slow based on their own assessment in a square course with 7 m side. The experimentally obtained results of free walking with a combination of forward walking, backward walking, and side stepping indicate that the proposed method produces walking trajectory with high precision compared with the constant threshold method which determines swing phase using the size of the angular velocity.
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Affiliation(s)
- Koichi Sagawa
- Faculty of Science and Technology, Hirosaki University, 3 Bunkyo-cho, Hirosaki, Aomori 036-8561, Japan.
| | - Kensuke Ohkubo
- Fujitsu Systems East Limited, 1-6-5 Michiba-kita, Chuo-ku, Chiba city, Chiba, Japan
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Kachanathu SJ, Alenazi AM, Algarni AD, Hafez AR, Hameed UA, Nuhmani S, Melam G. Effect of forward and backward locomotion training on anaerobic performance and anthropometrical composition. J Phys Ther Sci 2014; 26:1879-82. [PMID: 25540487 PMCID: PMC4273047 DOI: 10.1589/jpts.26.1879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/05/2014] [Indexed: 11/26/2022] Open
Abstract
[Purpose] Forward walking (FW) and backward walking (BW) on a treadmill is a common tool
for lower extremity rehabilitation in the clinical setting. The purpose of this study was
to evaluate the effects on anaerobic performance and anthropometrical adaptations during
FW and BW on a treadmill. [Subjects and Methods] A convenience sample of thirty healthy
male subjects with a mean age of 20.93 ± 2.54 years participated in this study. Subjects
were divided into 2 groups, a Forward Walking Group (FWG) (n=15) and a Backward Walking
Group (BWG) (n=15), which performed FW and BW on a treadmill at 10° inclination,
respectively. The training consisted of three sessions per week for 6 weeks. Study
outcomes such as anaerobic performance and anthropometrical body composition were measured
at pre- and post-intervention. [Results] Both FW and BW improved anaerobic performance
significantly, and the BW group showed better performance than FW. However, changes in
anthropometrical body composition were found to be not significant after six weeks of
intervention in both the FW and BW groups. [Conclusions] BW training in rehabilitation can
be considered more effective than FW at improving anaerobic performance. We also conclude
that six weeks of FW and BW training is insufficient for eliciting changes in the body
composition.
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Affiliation(s)
- Shaji John Kachanathu
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Kingdom of Saudi Arabia
| | | | | | | | | | | | - Ganeshwerarao Melam
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Kingdom of Saudi Arabia
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Kim K, Lee S, Lee K. Effects of Progressive Body Weight Support Treadmill Forward and Backward Walking Training on Stroke Patients' Affected Side Lower Extremity's Walking Ability. J Phys Ther Sci 2014; 26:1923-7. [PMID: 25540499 PMCID: PMC4273059 DOI: 10.1589/jpts.26.1923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/17/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of the present study was to examine the effects of progressive body weight supported treadmill forward and backward walking training (PBWSTFBWT), progressive body weight supported treadmill forward walking training (PBWSTFWT), progressive body weight supported treadmill backward walking training (PBWSTBWT), on stroke patients' affected side lower extremity's walking ability. [Subjects and Methods] A total of 36 chronic stroke patients were divided into three groups with 12 subjects in each group. Each of the groups performed one of the progressive body weight supported treadmill training methods for 30 minute, six times per week for three weeks, and then received general physical therapy without any other intervention until the follow-up tests. For the assessment of the affected side lower extremity's walking ability, step length of the affected side, stance phase of the affected side, swing phase of the affected side, single support of the affected side, and step time of the affected side were measured using optogait and the symmetry index. [Results] In the within group comparisons, all the three groups showed significant differences between before and after the intervention and in the comparison of the three groups, the PBWSTFBWT group showed more significant differences in all of the assessed items than the other two groups. [Conclusion] In the present study progressive body weight supported treadmill training was performed in an environment in which the subjects were actually walked, and PBWSTFBWT was more effective at efficiently training stroke patients' affected side lower extremity's walking ability.
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Affiliation(s)
- Kyunghoon Kim
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Sukmin Lee
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Kyoungbo Lee
- Department of Rehabilitation Medicine, St. Vincent's Hospital, Republic of Korea
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Davalos-Bichara M, Zuniga MG, Agrawal Y, Carey JP, Schubert MC. Forward and backward locomotion in individuals with dizziness. Gait Posture 2014; 40:499-503. [PMID: 25042815 DOI: 10.1016/j.gaitpost.2014.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 05/13/2014] [Accepted: 06/16/2014] [Indexed: 02/02/2023]
Abstract
The vestibular system plays an important role in locomotion. Individuals with vestibular pathology present with gait abnormalities, which may increase their fall frequency. Backward walking (BW) has been suggested as a predictor of falls in other patient populations; however it has not been studied in individuals with dizziness. Our aims were: (1) to investigate the differences in forward walking (FW) and BW both between and within 3 groups: Healthy controls, individuals with dizziness and vestibular pathology, and individuals with dizziness without vestibular pathology, (2) describe differences in FW and BW between individuals that have fallen and those that have not. We studied 28 healthy controls (mean 53.8 ± 17 years), 21 individuals with pathophysiology of the vestibular system (mean 68.5 ± 13 years), and 18 individuals without a vestibular cause for their dizziness (mean 67.4 ± 17 years). Subjects performed 2 FW and 2 BW trials over the GAITRite walkway. Data on history of falls in the preceding year were collected. We found BW was different to FW within each group. When comparing between groups and correcting for age and gender, only BW velocity (beta=-11.390, p=0.019), cadence (beta=-8.471, p=0.021), step time (beta=0.067, p=0.007) and stride time (beta=0.137, p=0.005) were significantly affected by having dizziness, with no differences in FW characteristics. There were no differences between FW and BW between fallers and non-fallers. BW appears to be a better biomarker than FW for identifying individuals with symptoms of dizziness; though it does not appear to characterize those who fall.
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Affiliation(s)
- Marcela Davalos-Bichara
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Maria Geraldine Zuniga
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Yuri Agrawal
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - John P Carey
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Michael C Schubert
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Abstract
Backward walking (BW) is a recently emerging exercise. However, limited studies exist regarding the motion analysis of BW compared with that of forward walking (FW). The present study identified the mechanisms of BW through kinetic analysis and focused on BW time-reversed data. A three-dimensional motion capture system was used to acquire the joint movements and to calculate the joint moments and the powers during walking. Ground reaction force curves were acquired from force plates. Each participant performed 10 FW trials and 40 BW trials with bare feet. All data were analyzed using paired t-tests (p<0.05) to verify the significant differences between FW and BW. In BW, since the progress is in the direction in which the person cannot see, the walker's speed is generally decreased compared to FW. As a result, the stride characteristics for each respective activity showed significant differences. The characteristics of angular displacement in all joints were almost identical in FW and time-reversed BW. However, selected crucial points of joint angles were significantly different. The moment pattern of the ankle joint was very similar in FW and time-reversed BW. In the knee and the hip joint, the joint moment pattern of time-reversed BW was simpler than FW. The joint power patterns of the ankle, the knee and the hip were different in FW and BW. An original finding of this study was that the main propulsion and shock absorption joint during BW is the ankle joint. The knee and hip joint did not generate propulsion power.
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Affiliation(s)
- Minhyeon Lee
- Department of Biomedical Engineering, Yonsei University, Room 204, Medical Industry Techno Tower, Heungup, Wonju, Gangwon 220-710, South Korea.
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Abstract
[Purpose] The purpose of this study was to perform kinematic and kinetic analyses of the ankle during both forward and backward walking using three-dimensional motion analysis. [Subjects] The subjects were 11 healthy adults. [Methods] Measurements of forward and backward walking motions were taken using a three-dimensional motion analysis device and 3 ground reaction force plates. The analysis segment was the standing phase and the items analyzed were walking time, maximum dorsal flexion of the ankle, maximum angle of plantar flexion, peak ankle power in the sagittal plane, workload of the ankle, and work rate. Statistical analysis consisted of comparisons using the t-test for each of the items measured during both forward and backward walking. [Results] The backward walking group had significantly lower ankle power, workload, and work rate. [Conclusion] The propulsive force in backward walking must come from some factor other than the ankle. The analysis of joint power is an important index for understanding the motion.
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Affiliation(s)
- Naoki Soda
- Department of Rehabilitation, Major in Physical Therapy, Heisei College of Health Sciences ; Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine
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