Effect of backward walking treadmill training on walking capacity after stroke: a randomized clinical trial

All this information out there on backward walking and no one in stroke is smart enough to put this all together in a protocol?  WHAT STROKE 'LEADER' DO I REAM OUT FOR COMPLETE INCOMPETENCY? It took me 1 minute to find this.

Effect of backward walking treadmill training on walking capacity after stroke: a randomized clinical trial 2005

Effects of partial body weight support while training acute stroke patients to walk backwards on a treadmill-a controlled clinical trial using randomized allocation 2010

A backward walking training program to improve balance and mobility in acute stroke: a pilot randomized controlled trial 2018 

Comparison of forward walking and backward walking in stroke hemiplegia patients focusing on the paretic side 2017

 

 

Effect of backward walking treadmill training on walking capacity after stroke:a randomized clinical trial 2014

Stella Maris Michaelsen
1
*
, Angélica Cristiane Ovando
2
, Fernanda Romaguera
1
, andLouise Ada
3
Rationale
 Residual walking deficits are common in people after stroke. Treadmill training can increase walking speed and walking distance. A new way to increase the challenge of walking is to walk backwards.
 Backward
 treadmill walking may provide advantages by promoting improvement in balance, walking spatiotemporal parameters and quality that may reflect in improving walking distance.
 Aim
 This study will test the hypothesis that backward  treadmill walking is superior to
 forward  treadmill walking in improving walking capacity, walking parameters, quality and balance in people with stroke.
Design
 A prospective, single-blinded, randomized trial will randomly allocate 88 community-dwelling people after stroke into either an experimental or control group. The experimental group will undertake 30-min sessions of backward  treadmill walking, three-days/week for six-weeks, while the control group will undertake the same dose of forward  treadmill walking. Training will begin at the baseline overground walking speed and will increase each week by 10% of baseline speed.
Study outcomes
 The primary outcome will be distance walked in the 6-min Walk Test. Secondary outcomes will be walking speed, step length, cadence, and one-leg stance time. Out-comes will be collected by a researcher blinded to group allocation at baseline (Week 0), at the end of training period(Week 6), and three-months after the cessation of intervention(Week 18).
Discussion
 If backward  treadmill walking can improve walking capacity more than forward  treadmill training in stroke, it may have broader implications because walking capacity has been shown to predict physical activity level and community participation.
Key words: ambulation, clinical trial, intervention, rehabilitation, stroke
Introduction and rationale
Walking is one of the most important activities to enable community participation. After stroke, although the majority of patients recover independent walking, many have residual walking disabilities. Many individuals after stroke cannot walk fast or far enough, which reduces their ability to walk outside the house. Even for those undergoing inpatient rehabilitation,walking quality can be surprisingly poor at the time of discharge from hospital,with one study finding that only 7% of people after stroke are able to have independent community ambulation at discharge of rehabilitation (1) and mobility problems persist in the chronic phase after stroke (2). The walking speed of community-dwelling people after stroke has been reported to be 40% less, and six-minute walking distance about half the value expected in age- and gender-matched people (3). This reduced capacity to walk long distances can restrict the access for community exercise programs as well as result in major limitations in community participation.The treadmill is frequently used for walking training in people after stroke. It allows a controlled speed and an intensive amount of practice (4), working as a ‘forced use’ (5). A recent review on treadmill training (6) suggests that treadmill training can increase walking speed by 0·12 m/s and improve walking distance by 40 m.A relatively new way to increase the challenge of walking is to walk backwards. At a given speed, when compared with forward walking, backward  walking elicits more electromyographic activity which in turn results in higher physiological cost and greater perceived exertion (7–9). Hip extension is more active in backward  walking due to the concentric contraction of knee flexorsduring early swing phase (10,11) which may be beneficial at improving lower limb coordination after stroke. Also, backward
walking is more difficult and demanding than forward  walking due to its postural instability and may therefore provide a training challenge to balance (12). There have been three clinical trials of backward walking. One trial (13) in chronic stroke found that backward overgound walking increased walking speed while another trial (14) found that backward treadmill walking also increased speed compared with overground walking. The only trial to compare backward treadmill walking with forward treadmill walking (15) was carried out in acute just-ambulatory patients and was therefore performed with body weight support, but it found that backward walking produced more independent walking.The main objectives of this trial are: to determine whether six weeks of  backward  treadmill walking is more effective than six weeks of  forward  treadmill walking in improving walking capacity, walking parameters, walking quality, and balance in  community-dwelling people after stroke. We hypothesize that
backward  treadmill walking will lead to a greater increase in walking capacity compared with
 forward  treadmill walking.
Correspondence: Stella Maris Michaelsen
*
, Department of PhysicalTherapy – Centro de Ciências da Saúde e do Esporte, Universidade doEstado de Santa Catarina, Rua Pascoal Simone, 358 – Coqueiros,88080-350, Florianópolis, SC, Brazil.E-mail: michaelsenstella@hotmail.com
1
Departmentof PhysicalTherapy,PhysicalTherapyMasterProgram,Uni-versidade do Estado de Santa Catarina, Florianópolis, Santa Catarina,Brazil
2
Department of Physical Therapy, Universidade do Estado de Santa Cata-rina, Florianópolis, Santa Catarina, Brazil
3
Discipline of Physiotherapy, The University of Sydney, Lidcombe, New South Wales, AustraliaReceived: 30 August 2013; Accepted: 16 December 2013; Published online15 April 2014Conflict of interest: The authors declare that there is no conflict of interest.Funding: The trial is funded by the Brazilian National funding agency (Conselho Nacional de Pesquisa).
DOI: 10.1111/ijs.12255
Protocols
© 2014 The Authors.International Journal of Stroke © 2014 World Stroke OrganizationVol 9, June 2014, 529–532
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