Clinical application of backward walking training to improve walking function, balance, and fall-risk in acute stroke: a case series.

Background: With limited inpatient rehabilitation (IR) length of stays for patients post-stroke, it is critical to maximize the effectiveness of interventions to address their balance and gait speed deficits. Backward walking (BW) is an emerging training approach; however, its application to patient populations consistent with those in IR is limited. Objectives: To describe the effects of an additional BW training program to standard IR care on balance, walking ability and fall-risk in a heterogenic caseload of adults <2 weeks post-stroke with a broad range of lesion locations and physical sequelae. Methods: Eight patients with first-time stroke (5 male; average age 66.5 ± 11.7 years; average stroke onset 7.6 ± 1.6 days; 6 right hemiparesis) participated in 10-daily sessions that included 20 min of over ground BW training for each session, in addition to standard IR. Standard outcome measures were used to assess balance, walking ability and fall-risk at admission and post-intervention. Results: All eight patients demonstrated improvements in all outcomes with a clinically meaningful increase in forward walking speed, as measured by 10MWT. Four participants exceeded fall-risk cut-off scores for all balance-related outcome measures. Conclusions: In a diverse patient population early after stroke, individuals successfully participated in an additional BW training program. Despite the patients' acuity and severe impairments in walking, significant gains in balance and walking function were noted. This program may be useful in improving outcomes with patient characteristics commonly seen in IR.

The effects of backward walking training on balance and mobility in an individual with chronic incomplete spinal cord injury: A case report.

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.

A case report: application of the upright motor control test on physical therapy intervention of an individual following a stroke.

This case report shows the application of the upright motor control test in the physical therapy management of an individual following a stroke. The individual is a 43-year-old male who sustained an infarct of the right thalamus 2 days prior to inpatient rehabilitation admission. Observational gait analysis and the upright motor control test isolated the primary gait deficit as left hip and ankle extension in the stance phase of gait. Physical therapy interventions focused on specific functional tasks that challenged hip extension so that he could resume the activities in which he engaged prior to the stroke. After a 3 week length of stay in inpatient rehabilitation, the individual demonstrated an improvement in the outcome measures, functional progression with ambulation (level and stairs), and transfers sufficient to be discharged home. This case illustrates how standardized outcome measures assisted the clinician in isolating the gait impairments that limited his ability to ambulate within his home environment. Subsequently, the plan of care and physical therapy interventions focused on these deficits to maximize the functional outcomes.