Gait impairment is a common cause of disability in patients who have experienced a stroke and recovery of walking is a priority goal. Gait outcome is a significant factor that influences a patient's chance of returning to the social life activity and rehabilitation is an effective treatment for restoring gait in these patients. Learning to walk backwards correctly has been recommended to improve the movement components required for walking forwards. Several studies demonstrated that during backward walking the muscle activity is higher, more oxygen consumption, metabolic and cardiorespiratory activity are required and the same motor program is used comparing to during the forward walking. It has been suggested that backward walking therapy may be promoted as a treatment strategy to improve gait in stroke patients.
The main goal of this project is to investigate the effectiveness of the backward walking therapy on gait improvement and spasticity in post stroke patients.
Loss of walking ability is a one of the major problem after stroke and recovery of walking is a priority goal for most patients. Several studies demonstrated that rehabilitation could be an effective treatment on improving gait following stroke. Learning to walk backwards correctly has been recommended to improve the movement components required for walking forwards. Backward walking, therefore, has been promoted as a treatment strategy to improve gait. During backward walking the same motor programme is used as during forward walking, but possibly running in reverse. It has been suggested that backward walking may offer some benefits beyond those experienced through forward walking alone. Backward walking appears to create more muscle activity in proportion to effort than forward walking. This suggests a greater level of energy expenditure in backward walking than in forward walking. Additionally, backward walking also demands a greater oxygen consumption, metabolic response and cardiorespiratory than forward walking. Up to our knowledge, only two studies demonstrated the positive effects of an additional backward walking training in post stroke patients. Yang and coll. examined the effectiveness of additional backward walking training on gait outcome of 25 subacute stroke patients and they demonstrated that asymmetric gait pattern could improve. In a recently study, a randomized control trail was conducted on 36 acute stroke patients evaluating the efficacy of a walk backwards on a treadmill. The patients were randomly allocated to three groups and they received 3 weeks of intervention: first group (n=12) underwent partial body weight support treadmill training in backwards, the second group (n=12) received partial body weight support treadmill training and the third group underwent conventional rehabilitation training. The results showed significant improvements in walking speed and in the rivermead Mobility Index, suggesting that Partial Body Weight Support treadmill backward training for patients in the early phase of acute stroke is effective at improving mobility.
Recently, gait rehabilitation methods in patients with neurological impairment have relied on technological devices, which drive the patient's gait in a body-weight support condition and emphasize the beneficial role of repetitive practice. The rationale for these approaches originates from animal studies which have shown that repetition of gait movements may enhance spinal and supraspinal locomotor circuits.
Two reviews concludes that treadmill training with partial body weight support is effective to improve walking speed and endurance without worsening gait quality
- Treadmill Training Behavioral
Intervention Desc: The intervention will consist of 20 minutes of forward walking on a treadmill device. ARM 1: Kind: Experimental Label: Treadmill training Description: The subjects will perform a walking training on treadmill device
- Backward walking treadmill training Other
Intervention Desc: The intervention will consist of 5 minutes of forward walking (warm-up phase), 10 minutes of backward walking (intervention phase) and 5 minutes of forward walking (cool-down phase). The session will be performed on a treadmill device. The backward training speed will be increase consecutively: during the week 1, the intervention will be performed at 0,8 km/h; during the week 2 the speed will be 1,0 km/h; finally, during the week 3 the speed will be increased till 1,2 km/h. ARM 1: Kind: Experimental Label: Backward Walking Treadmill Training Description: The subjects will perform a backward walking training on treadmill device
- Allocation: Randomized
- Masking: Double Blind (Subject, Outcomes Assessor)
- Purpose: Treatment
- Endpoint: Efficacy Study
- Intervention: Parallel Assignment
|Type||Measure||Time Frame||Safety Issue|
|Primary||10 meters Walking test (10-MtWT) change in gait speed||Baseline time 0 and up to 16 weeks||Yes|
|Secondary||Gait analysis||Baseline time 0 and up to 16 weeks||Yes|
|Secondary||Stroke Impact scale||Baseline time 0 and up to 16 weeks||Yes|
|Secondary||Health Survey Questionnaire short form 36||Baseline time 0 and up to 16 weeks||Yes|
|Secondary||Modified Ashworth Scale||Baseline time 0 and up to 16 weeks||Yes|
|Secondary||Modified "Tardieu" Scale||Baseline time 0 and up to 16 weeks||Yes|
|Secondary||Body's Centre of Pressure length (mm)||Baseline time 0 and up to 16 weeks||Yes|
|Secondary||Body's Centre of Pressure Area Path (mm2)||Baseline time 0 and up to 16 weeks||Yes|
- Universita di Verona Lead