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One step forward and two steps back: The dangers of walking backwards in therapy
Abstract
Walking backwards has been used in therapy to improve balance and gait. There has not been any systematic investigation into the effectiveness or safety of walking backwards. We present two cases in which walking backwards during physical therapy resulted in a fall and considerable morbidity. The only clear indication for treatment by walking backwards should be a task-specific need to do so, and only then if adequate safety can be assured.
... This test involves walking forward, balance, and turning tasks. Nevertheless, walking backward, which is not contemplated in the TUG test, is more complex and requires higher neuromuscular and proprioceptive control [22]. Moreover, it is a task that can occur in everyday life situations, such as opening a door, avoiding an obstacle, or backing up to a chair [23]. ...
... In the present study, walking backward has been analyzed because it is a complex task that requires high neuromuscular and proprioceptive control [22]. Walking backward usually occurs in activities of daily living, such as opening a door, avoiding an obstacle, or backing up to a chair [23]. ...
... Previous studies have highlighted the importance of assessing backward gait in older adults [24,25], showing a reduction in performance in different parameters when comparing to young and middle-aged adults. In this regard, during backward gait, greater neuromuscular and proprioceptive control is required, in addition to faster and more frequent balance corrections due to the elimination of visual feedback [22,58]. Additionally, it has been shown that walking backward shows greater or equal sensibility than walking forward, and it is strongly related to the risk of falling [23]. ...
Background: Previous studies have reported good test–retest reliability for the 3 m backward test (3MBWT) in different populations. However, reliability of the 3MBWT has not been studied in fibromyalgia (FM) under single and dual-task conditions; Methods: A total of 21 women with FM participated in this study. Participants completed the Revised Fibromyalgia Impact Questionnaire and two physical fitness tests: the 3MBWT and the Timed Up and Go (TUG). The dual-task condition consisted of subtracting two by two while performing the test, starting from a random number less than 100; Results: Values showed that the 3MBWT can be considered reliable under single and dual-task conditions when measured with both a manual stopwatch and a Chronopic automatic stopwatch. A strong concurrent validity was shown of 3MBWT and TUG results in the test and retest and the different devices. The relationship between the performance of the 3MBWT in test and retest conditions under single and dual-task conditions measured with different devices and the impact of the disease were high; Conclusions: The 3MBWT is a reliable tool under the single and dual-task conditions in women with FM. It shows higher reliability values when time is taken using a Chronopic. This test also shows high concurrent validity with the TUG test. Its performance is related to the impact of the disease.
... However, backward walking is apparently more difficult, and an increase occurs in the dependence on neuromuscular control, proprioception, and protective reflexes. 15 It is required to walk backward to carry out tasks, e.g., opening the door, getting rid of sudden obstacles, or backing up to chair. 16 Recent research has shown that the evaluation of backward walking is more sensitive in assessing mobility and balance disorders in comparison with forward walking. ...
... 16 Recent research has shown that the evaluation of backward walking is more sensitive in assessing mobility and balance disorders in comparison with forward walking. 15 A study conducted has demonstrated that backward walking is a training approach that develops after the stroke, and it has several potential benefits in terms of promoting the improvement of forward walking and on the results of balance and walking. 17 The 3-meter backward walk test (3MBWT) is utilized to assess neuromuscular control, proprioception, protective reflexes, risk of falling, and balance. ...
... Nevertheless, backward walking is apparently more difficult and requires an increased reliance on neuromuscular control, proprioception, and protective reflexes. 15 While walking backward, there is no environmental visual feedback and visual flow used to plan movement during forward walking. Due to the lack of visual information, much more sensory feedback is required to control the step order. ...
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.
... The up and walking test, which is the component of the DFT, is similar to the TUG test, but it also evaluates the balance and mobility of individuals while walking backward. Backward walking is more difficult and necessitates more reliance on neuromuscular control, proprioception, and protective reflexes [40]. Recent studies have revealed that the evaluation of backward walking provides better diagnostic accuracy in evaluating mobility and balance disorders [40]. ...
... Backward walking is more difficult and necessitates more reliance on neuromuscular control, proprioception, and protective reflexes [40]. Recent studies have revealed that the evaluation of backward walking provides better diagnostic accuracy in evaluating mobility and balance disorders [40]. The validity and reliability study of the 3MBWT was performed by Koçer et al. [31], and the reliability value was determined to be excellent (ICC = 0.965). ...
Dubousset Functional Test (DFT) is an assessment test evaluating the functional capacity and dynamic balance. The study aimed to examine the reliability, validity, and responsiveness of the DFT in early stage Parkinson’s disease (PD) patients.
This was a cross-sectional study. Thirty-three early stage PD patients were recruited. The DFT was performed along with the Timed Up and Go (TUG) test, dual-task TUG, Functional Reach Test (FRT), 3-m backward walk test (3MBWT), Tinetti Performance-Oriented Mobility Assessment (POMA), and Berg Balance Scale (BBS).
The test–retest reliability of the subcomponents of the DFT was excellent. The ICCs were as follows: 0.952, 0.955, 0.917, and 0.919, respectively. The correlation with subcomponents of DFT and TUG, dual-task TUG, FRT, 3MBWT, BBS, and POMA was found to be statistically significant (p < 0.05). The standard measurement errors of the subcomponents of the DFT were 1.45, 1.39, 1.70, and 1.57, respectively. The minimal clinically important difference (MCID) of the subcomponents was 2.05, 1.97, 2.41, and 2.22, respectively.
The DFT is a reliable, valid, and easy-to-administer tool in assessing the balance and physical function of early stage PD patients.
... These tests primarily involve the ability to walk forward and turning, and cannot address the functional status completely. Backward walking, however, is a difficult activity requiring more complex skills as it includes neuromuscular control and depends on proprioceptive sense and protective reflex [6]. Therefore, the gait problems of the child with CP must be examined more to gain functional independence. ...
... In general, performance-based tests measuring functional mobility evaluate the ability to walk and turn. Walking back is more difficult because it involves neuromuscular control, proprioceptive, and protective reflex, which provide more dynamic balance and postural control [6]. Since these parameters can be affected in children with CP, it is considered that low 3MBWT scores cause these results. ...
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.
... 22 Backward walking demands additional reliance on proprioception because of a lack of peripheral visual feedback of people's footfalls as well as of the ground conditions behind them. 23 Unlike forward walking with eyes closed, backward walking is able to elicit this increased reliance on proprioception even with one's eyes open. Similar to walking forward with obstacle negotiation, backward walking involves increased cognitive demand and increased prefrontal activation. ...
... 18 Thus, BWS assessment may provide a significant challenge and reveal deficits even when FWS approaches a ceiling effect. 40 The novelty of backward walking, with its additional challenges of reduced visual cues, greater reliance on proprioception, 23 and increased motor activity 22 may unmask gait impairments in people who have higher falls efficacy, lower stroke severity, or in other words, may be presumed to be higher functioning. ...
Objective:
Forward walking speed (FWS) is known to be an important predictor of mobility, falls, and falls-related efficacy post-stroke. However, backward walking speed (BWS) is emerging as an assessment tool to reveal mobility deficits in people post-stroke that may not be apparent with FWS alone. Since backward walking is more challenging than forward walking, falls efficacy may play a role in the relationship between one's preferred FWS and BWS. We tested the hypothesis that people with lower falls efficacy would have a stronger positive relationship between FWS and BWS than those with higher falls efficacy.
Methods:
Forty-five individuals (12.9 ± 5.6 months post-stroke), participated in this observational study. We assessed FWS with the 10 meter walk test and BWS with the 3 meter backward walk test. The Modified Falls-Efficacy Scale (mFES) quantified falls efficacy. A moderated regression analysis examined the hypothesis.
Results:
FWS was positively associated with BWS (R2 = 0.26, p < .001). The addition of the interaction term FWS x mFES explained 7.6% additional variance in BWS (p = .03). As hypothesized, analysis of the interaction revealed that people with lower falls efficacy (mFES≤6.6) had a significantly positive relationship between their preferred FWS and BWS, whereas people with higher falls efficacy (mFES>6.6) had no relationship between their walking speed in the two directions.
Conclusions:
FWS is positively related to BWS post-stroke, but this relationship is influenced by one's perceived falls efficacy. Our results suggest that BWS can be predicted from FWS in people with lower falls efficacy, but as falls efficacy increases, BWS becomes a separate and unassociated construct from FWS.
Impact statement:
This study provides unique evidence that the degree of falls efficacy significantly influences the relationship between FWS and BWS post-stroke. Physical therapists should examine both FWS and BWS in people with higher falls efficacy, but further investigation is warranted for those with lower falls efficacy.
... Recent research has demonstrated that backward walking measures were more sensitive at evaluating mobility and balance deficits compared with forward walking. 8 The 3-m backward walk test (3MBWT) is used to evaluate neuromuscular control, proprioception, protective reflexes, fall risk, and balance. In a study of healthy older adults, the 3MBWT demonstrated similar or better diagnostic accuracy for falls in the past year than the most commonly used measures. ...
... However, walking backward is explicitly more difficult, requiring an increased reliance on neuromuscular control, proprioception, and protective reflexes. 8 Backward walking is necessary to perform such tasks as backing up to a chair, opening up a door, or getting out of the way of a sudden obstacle. This movement can be particularly challenging for older individuals or individuals with neurological deficits. ...
The 3-m backward walk test (3MBWT) is used to evaluate neuromuscular control, proprioception, protective reflexes, fall risk, and balance. The aim of the present study was to determine the test–retest reliability of the 3MBWT in patients with primary total knee arthroplasty (TKA). Twenty-eight patients with primary TKA, operated by the same surgeon, were included in this study. Patients performed trials for 3MBWT twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The 3MBWT showed an excellent test–retest reliability in this study. Intraclass correlation coefficient (ICC) for 3MBWT was 0.97. The standard error of measurement and smallest real difference at the 95% confidence level for 3MBWT were 1.06 and 2.94, respectively. The 3MBWT has an excellent test–retest reliability in patients with primary TKA. It is an effective and reliable tool for measuring dynamic balance and participant falls. As a clinical test, the 3MBWT is easy to score, requires little space, has no cost, needs no special equipment, and can be applied in a short time as part of the routine medical examination.
... Moreover, studies have reported that 3MBWT is more sensitive to mobility and balance skills than forward walking. 15,16 There is a need to clarify which parameters should be focused more on to improve backward gait in older individuals. 17 In clinical practice, emphasizing the importance of balance and proprioception training to improve daily living activities, including backward walking performance, would be valuable. ...
Objectives: Some basic and instrumental daily living activities include backward gait. There is a need to clarify which parameters should be focused more on to improve backward gait in older individuals. This research investigated the proprioception, and balance in forward-backward gait of older individuals with total knee arthroplasty (TKA).
Methods: A prospective cross-sectional research was conducted with 105 older adults with TKA. Individuals' forward and backward gait performance was assessed with the Timed Up & Go Test (TUG) and 3 Meter Walk Back Test (3MBWT), respectively. Proprioception was measured with a mobile application-based inclinometer. Berg Balance Scale (BBS) and Activity Specific Balance Confidence Scale (ABC) were used to assess balance and balance confidence levels, respectively. A single clinician evaluated the individuals.
Results: TUG was weakly and positively correlated with the Right and Left Leg Proprioception Test (RLPT and LLPT) (r1=0.386, r2=0.391, p<0.01). Also, the 3MBWT was weakly and positively correlated with RLPT and LLPT, respectively (r1=0.293, r2=0.251, p<0.01). In addition, TUG was strongly and negatively correlated with BBS and ABC, respectively (r1=-0,693, r2=-0.722, p<0.01). Besides, 3MBWT was strongly and negatively correlated with BBS and ABC (r1=-0.642, r2=-0.645, p<0.01).
Conclusion: The study revealed that forward and backward walking were similarly associated with balance and proprioception in older adults with TKA. Clinicians should focus more on balance ability than proprioception to improve backward walking performance in older individuals with THA.
... Participants in our study received 18 sessions of FLT or BLT whereas those in Bowden et al. (2013) and Combs et al. (2012) received 36 and 24 sessions of only FLT, respectively. Since BLT is more challenging than FLT (Bansal et al., 2021;Chaloupka et al., 1997;Thomas and Fast, 2000), 18 sessions were sufficient to promote improved gait speed post-BLT, as shown previously (Chen et al., 2020;Kim et al., 2014;Takami and Wakayama, 2010). However, as stroke survivors may demonstrate steady increases in gait speed for up to 24 sessions of specifically FLT (Rose et al., 2017), it is possible that 18 sessions were not sufficient to induce gait speed improvements post-FLT. ...
Backward walking training has been reported to improve gait speed and balance post-stroke. However, it is not known if gains are achieved through recovery of the paretic limb or compensations from the nonparetic limb. The purpose of this study was to compare the influence of backward locomotor training (BLT) versus forward locomotor training (FLT) on gait speed and dynamic balance control, and to quantify the underlying mechanisms used to achieve any gains. Eighteen participants post chronic stroke were randomly assigned to receive 18 sessions of either FLT (n = 8) or BLT (n = 10). Pre- and post-intervention outcomes included gait speed (10-meter Walk Test) and forward propulsion (time integral of anterior-posterior ground-reaction-forces during late stance for each limb). Dynamic balance control was assessed using clinical (Functional Gait Assessment) and biomechanical (peak-to-peak range of whole-body angular-momentum in the frontal plane) measures. Balance confidence was assessed using the Activities-Specific Balance Confidence scale. While gait speed and balance confidence improved significantly within the BLT group, these improvements were associated with an increased nonparetic limb propulsion generation, suggesting use of compensatory mechanisms. Although there were no improvements in gait speed within the FLT group, paretic limb propulsion generation significantly improved post-FLT, suggesting recovery of the paretic limb. Neither training group improved in dynamic balance control, implying the need of balance specific training along with locomotor training to improve balance control post-stroke. Despite the within-group differences, there were no significant differences between the FLT and BLT groups in the achieved gains in any of the outcomes.
... However, walking backwards is explicitly more difficult, requiring an increased reliance on neuromuscular control, proprioception, and protective reflexes. 12 Backwards walking is necessary to perform such tasks as backing up to a chair, opening up a door, or getting out of the way of a sudden obstacle. This movement can be particularly challenging for older individuals or individuals with neurological deficits. ...
Background and purpose:
Several measures of fall risk have been previously developed and include forward walking, turning, and stepping motions. However, recent research has demonstrated that backwards walking is more sensitive at identifying age-related changes in mobility and balance compared with forward walking. No clinical test of backwards walking currently exists. Therefore, this article describes a novel clinical test of backwards walking, the 3-m backwards walk (3MBW), and assessed whether it was associated with 1-year retrospective falls in a population of healthy older adults. Diagnostic accuracy of the 3MBW was calculated at different cutoff points and compared with existing clinical tests.
Methods:
This study was a retrospective cohort study including residents of a retirement community without a history of neurological deficits. Demographics, medical history, and falls in the past year were collected, and clinical tests included the 3MBW and the Timed Up and Go (TUG), the 5 times sit-to-stand, and the 4-square step test. Frequency distributions and t tests compared baseline characteristics of people who reported falling with people who did not. Diagnostic accuracy (sensitivity and specificity) was calculated for a series of cutoffs for the 3MBW, the TUG (≥8, 10, and 13.5 seconds), 5 times sit-to-stand (≥12 and ≥15 seconds), and 4-step square test (>15 seconds). Receiver operating curve analyses were used to define 3MBW optimal cutoffs, and the difference between the overall area under the curve (AUC) was statistically tested. SPSS 24.0 and MedCalc 17.1 were used for all analyses.
Results and discussion:
Fifty-nine adults with a mean (SD) age of 71.5 (7.6) years participated, with 25 people reporting falls in the past year. The mean (SD) time for the 3MBW was 4.0 (2.1) seconds. People who fell had a significantly slower 3MBW time (4.8 vs 3.5 seconds for people who did not fall, P = .015), but not a significantly slower 4-step square test (9.5 vs 8.1 seconds, P = .056), TUG (9.3 vs 8.0 seconds, P = .077), and 5 times sit-to-stand (12.5 vs 10.3 seconds, P = .121). The highest overall AUC for any measure was for the 3MBW at 3.5 seconds (0.707, 95% confidence interval = 0.570-0.821; sensitivity = 74%, specificity = 61%), which was significantly higher than the TUG at 8 seconds (AUC = 0.560, P = .023) and 13.5 seconds (AUC = 0.528, P = .011), the 4-step square test (AUC = 0.522, P = .004), but not significantly higher than the TUG at 10 seconds (P = .098) and the 5 times sit-to-stand at 12 (P = .092) or 15 seconds (P = .276). On the 3MBW, more than 75% of people who were faster than 3.0 seconds did not report any falls, and 94% of people who did not report falling were faster than 4.5 seconds. Of the people who were slower than 4.5 seconds, 81% reported falling.
Conclusions:
In a study of healthy older adults, the 3MBW demonstrated similar or better diagnostic accuracy for falls in the past year than most commonly used measures. People walking faster than 3.0 seconds on the 3MBW were unlikely to have reported falling, whereas people slower than 4.5 seconds were very likely to have reported falling. Further validation of the 3MBW in prospective studies, larger samples, and clinical populations is recommended.
... It was the lowest at 5.0km/h walking speed and the highest at 7.5km/h walking speed. (Bobath, 1970), 하지의 근력과 균형능력을 증가시키며 (Threlkeld, Horn, Wojtowitcz, Rooney & Shapirp, 1989), 보행과 균형능력을 증가시킨다고 보고하였다 (Thomas & Fast, 2000 ...
The purpose of this study was to examine the differences of lower limbs muscle activities depending on three walking speeds of 2.5km/h, 5.0km/h and 7.5km/h during forward walking and backward walking making 14 students the subjects of this study. To achieve this aim, surface electrodes for factor analysis of EMG were adhered to rectus femoris, biceps femoris, tibialis anterior and gastrocnemius medial head of right lower limbs. The conclusions through this study are as follows. 1) The muscle activity of rectus femoris was higher in backward walking group than in forward walking group and it was the highest at 7.5km/h walking speed. 2) The muscle activity of biceps femoris was higher in forward walking group than in backward walking group. It was the lowest at 5.0km/h walking speed and the highest at 7.5km/h walking speed. 3) The muscle activity of tibialis anterior was higher in backward walking group than in forward walking group. It was the lowest at 5.0km/h walking speed and the highest at 7.5km/h walking speed. 4) The muscle activity of gastrocnemius medial head was higher in backward walking group than in forward walking group except P2. It was the lowest at 5.0km/h walking speed and the highest at 7.5km/h walking speed.
... 전방보행과 후방보행의 속도변화에 따른 근전도를 비교·분석한 결과 후방보행이 전방보행보다 대퇴부위 및 하퇴부위의 근력을 많이 증가시키며 임상에서 저속 도의 후방보행은 하지에 관련된 질환자에게 유용한 방 법이다[4]. 시속 4km/h로 통제된 경사진 트레드밀에서 전방걷기 보다 후방걷기가 넙다리네갈래근의 근력을 증가시키는데 효과적이며, 경사도 10%일 때 넙다리네 갈래근의 근전도 활성도가 가장 높아, 임상에서 넙다리 무릎뼈 통증증후군, 전방십자인대 손상 등 하지에 문제 를 가지고 있는 환자들에게 전방걷기 보다 후방걷기가 재활운동으로써 보다 효과적이며[5], 후방걷기는 하지 의 근력과 신체균형 및 보행능력을 증가시키는 것으로 나타났다[6,7]. 따라서 만약 전방 시야를 확보한 후방보법으로 전방 향 보행을 할 수 있다면 안전성을 확보 할 수 있기 때문 에 새로운 보행운동으로 자리매김 할 수 있을 것이다. 이미 일반적인 보행과는 다르게 댄스에서 이루어지는 보법은 대부분 후방보법을 이용한 전방보행(이하 댄스 보행)이며, 댄스스포츠 종목 중 라틴댄스 룸바 경기에서 여성이 가장 자주 사용하는 대표적인 보법으로 이러한 댄스보행은 전방향 보행이므로 시야확보가 자유로워 낙 상의 위험을 획기적으로 감소시킬 수 있을 것이다[8]. ...
The purpose of this study was to investigate possibility of a forward gait with backward mechanism(dance gait) as rehabilitation and/or walking exercise by means of biomechanical variables. Thirteen professional women dancers(age, 21.1?1.3yrs; height, 159.3?7.2cm; body mass, 45.1?8.4kg)participated in this study. We found that speed, stride length and double limb support time of a dance gait were more greater than backward gait, but stride width of dance gait less than a backward gait. Maximum RoMs, moments and powers of the lower limb joints on a dance gait were more frequent than a backward dance. These results were judged to be sufficient by the possibility of dance gait as rehabilitation and walking exercise.
... However, during backward gait in particular, reverse action between the flexors and the extensor occurred in the ankle joints and activity of the foot flexors appeared during backward gait support. Backward gait has been reported to increase stroke patients' motor control ability, lower limb muscle strength, balance ability, and gait ability [16,17]. ...
Objective: In the present study, the effects of progressive body weight support treadmill forward & backward walking training (FBWT), progressive body weight support treadmill forward walking training (FWT), and progressive body weight support treadmill backward walking training (BWT), and on stroke patients` ambulatory abilities were examined. Design: Randomized controlled trial. 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 step length, total double support, cadence, gait were measured using optogait and the 10-m walk test (10MWT), 6 minutes walk test (6MWT). Results: In the within group comparisons, all the three groups showed significant differences between before and after the intervention (p
... Thomas and Fast presented two cases in which walking backwards during physical therapy resulted in a fall and considerable morbidity. 45 They therefore doubted the safety of walking backwards. In this study, none of our subjects fell down during backward walking training. ...
To examine the effectiveness of additional backward walking training on gait outcome of patients post stroke.
Randomized controlled trial.
Medical centre.
Twenty-five subjects with stroke, who were lower extremity Brunnstrom motor recovery stage at 3 or 4 and were able to walk 11 m with or without a walking aid or orthosis, randomly allocated to two groups, control (n = 12) and experimental (n = 13).
Subjects in both groups participated in 40 min of conventional training programme three times a week for three weeks. Subjects in experimental group received additional 30 min of backward walking training for three weeks at a frequency of three times per week.
Gait was measured using the Stride Analyzer. Gait parameters of interest were walking speed, cadence, stride length, gait cycle and symmetry index. Measures were made at baseline before commencement of training (pre-training) and at the end of the three-week training period (post-training).
After a three-week training period, subjects in experimental group showed more improvement than those in control group for walking speed (change score: 8.60 +/- 6.95 versus 3.65 +/- 2.92, p-value = 0.032), stride length (change score: 0.090 +/- 0.076 versus -0.0064 +/- 0.078, p-value = 0.006), and symmetry index (change score: 44.07 +/- 53.29 versus 5.30 +/- 13.91, p-value = 0.018).
This study demonstrated that asymmetric gait pattern in patients post stroke could be improved from receiving additional backward walking therapy.
Background
Slowed somatosensory conduction in multiple sclerosis (MS) increases postural instability and decreases proprioception. Despite these delays, individuals with MS rely more on proprioception for balance compared to controls. This heightened reliance, combined with slowed signal transduction, increases fall risk. Backward walking (BW) increases proprioceptive reliance by reducing visual cues. However, no study has conclusively linked proprioception to BW. This study aims to assess proprioception’s role in BW compared to forward walking (FW) in MS and to compare differences in proprioception between MS fallers and non-fallers.
Methods
Fifty participants (average age: 50.34 ± 11.84, median Patient Determined Disease Steps [PDDS]: 2) completed the study. Participants completed BW and FW at comfortable and fast speeds. We have previously established vibration sensation as a proxy measure for proprioception. Vibration thresholds were quantified at the great toe bilaterally using a 2-alternative forced-choice procedure.
Results
Significant correlations were seen for vibration sensation and FW comfortable ( ρ = 0.35), FW fast ( ρ = 0.34), BW comfortable ( ρ = 0.46), and BW fast ( ρ = 0.46). After controlling for age, sex, and PDDS, vibration sensation significantly predicted performance during all walking tasks, with larger beta coefficients seen during BW (comfortable β = 0.57; fast β = 0.58) compared to FW (comfortable β = 0.41; fast β = 0.45). Fallers performed significantly worse than non-fallers for vibration sensation ( P = 0.04).
Discussion and Conclusions
Considering the notable decrease in proprioception in participants with MS and the clear distinction between fallers and non-fallers, it is crucial to conduct fall risk assessments and interventions focusing on proprioception. With its heightened reliance on proprioception, BW offers a promising method for assessing fall risk and could be an effective exercise intervention.
Video Abstract available for more insights from the authors (see the Supplemental Digital Content available at: http://links.lww.com/JNPT/A490).
Background:
Backward walking training (BWT) can have a positive effect on balance, gait, and functional mobility in neurological diseases; however, the effectiveness of BWT has not been examined in multiple sclerosis (MS). Therefore, the study aimed to investigate the effects of BWT on balance, gait, and functional mobility in people with MS (PwMS).
Method:
Nineteen PwMS were randomly allocated to either the experimental group (n=10) and the control group (n=9). The experimental group received BWT in addition to conventional walking training (CWT) while the control group only received CWT. Both groups performed training three times a week for 8 weeks. Participants were assessed with the Berg Balance Scale (BBS), four square step test (FSST), activities-specific balance confidence scale (ABC), timed 25-foot walk test (T25FW), dynamic gait index (DGI), 3-meter backward walk test (3MBWT), Multiple Sclerosis Walking Scale-12 (MSWS-12), and timed up and go test (TUG) before and after training.
Results:
After training, both groups showed significant improvements on the T25FW, and TUG (p<0.05) while only the experimental group showed significant improvements on the BBS, FSST, ABC, DGI, 3MBWT, and MSWS-12 (p<0.05). The experimental group significantly improved more than the control group in all outcomes (p<0.05) except for the T25FW (p=0.202).
Conclusion:
BWT in addition to CWT is an effective way to improve balance, gait, and functional mobility for PwMS. These results suggest that BWT may be a potentially useful treatment approach when added to CWT in the rehabilitation of MS.
Objective
The aim of our study was to examine the test-retest reliability and validity of the Dubousset Functional Test (DFT) in older adults.
Methods
The DFT, 3-m Backward Walk Test (3MBWT), Timed Up and Go (TUG) test, and Tinetti Performance-Oriented Mobility Assessment (POMA) were administered to 80 older adults.
Results
Intraclass correlation coefficient (ICC) values were between 0.819 and 0.965 (excellent agreement). A correlation was found between DFT parameters and the TUG test, 3MBWT, and POMA scores. A low correlation was found between the TUG test and 3MBWT with the dual-task test; no correlation was determined between the POMA scores with the dual-task test.
Conclusion
It was concluded that the DFT is a valid and reliable test for older adults.
Background:
People with Parkinson's disease (PwPD) lose the ability in backward walking which is an important part of mobility in daily life. The 3-m backward walk test (3MBWT) evaluates backward walking; however, its reliability and validity have not been examined in PwPD yet.
Aims:
To examine (1) the test-retest reliability of the 3MBWT in PwPD; (2) the minimum detectable change in the 3MBWT times; (3) the concurrent and known-groups validity of the 3MBWT; and (4) the optimum cutoff time which best discriminates fallers from non-fallers with Parkinson's disease (PD).
Methods:
This cross-sectional study included 36 PwPD and 33 healthy people. The 3MBWT was conducted with the 10-m walk test, timed up and go test, Berg Balance Scale, four square step test, activity-specific balance confidence scale, Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale, and Hoehn and Yahr Scale.
Results:
The 3MBWT demonstrated excellent test-retest reliability (ICC = 0.965). The MDC of 2.13 s was determined. The 3MBWT had moderate to high correlations with the other outcome measures (correlation coefficient ranged from -0.592 to 0.858). On the 3MBWT times, there were significant differences between PwPD and healthy people, and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). A 3MBWT time of 10.31 s was found to best discriminate fallers from non-fallers with PD.
Conclusions:
The 3MBWT is a reliable, valid, and easy to administer outcome measure to assess backward walking performance in PwPD, indicating it to be used in practice and research.
To investigate: (a) the interrater and test-retest reliability of the 3-m backward walk test (3MBW) in ambulant people with multiple sclerosis (PwMS); (b) minimal detectable change (MDC); (c) concurrent and known-groups validity; and (d) the cutoff time to best discriminate fallers from nonfallers with multiple sclerosis (MS). Forty-nine PwMS and 36 healthy people were included in this cross-sectional study. The 3MBW was administered with the timed up and go test, Berg Balance Scale, four square step test, Falls Efficacy Scale-International, and Expanded Disability Status Scale. The 3MBW was simultaneously performed by two independent raters to examine the interrater reliability while was repeated after 7-10 days to examine the test-retest reliability. The 3MBW showed good interrater reliability [intraclass correlation coefficient (ICC) = 0.987-0.989] and excellent test-retest reliability (ICC = 0.854-0.889). The MDC was found to be 1.69 s. The 3MBW had moderate-to-strong correlations with the other measures. For the 3MBW, PwMS had worse performance than healthy people (P < 0.001), whereas fallers with MS had worse performance than nonfallers with MS (P < 0.001). The 3MBW time of 7.86 s was determined to best discriminate fallers from nonfallers with MS. The 3MBW is a reliable, simple, and easy-to-administer tool for assessing backward walking among ambulant PwMS.
Background
The 3-meter backward walk test (3MBWT) evaluates neuromuscular control, proprioception, protective reflexes, fall risk, and balance. This study aimed to examine the reliability, validity, and minimal detectable change (MDC) of the 3MBWT in patients with Multiple Sclerosis (pwMS).
Methods
40 pwMS (8 male, 32 female) were included in the study. The Intraclass Correlation Coefficient (ICC) was used for the reliability of the 3MBWT. MDC estimates were calculated using baseline data. The validity of the 3MBWT was evaluated by the correlation between The Timed Up and Go test (TUG), The 12-item Multiple Sclerosis Walking Scale (MSWS-12), The 2-Minute Walk Test (2MWT), The Timed 25-Foot Walk Test (T25FW), and The Four Square Step Test (FSST)
Results
The intra-rater (ICC 0.944-0.945) and inter-rater (ICC 0.932-0.935) reliability of the 3MBWT was determined to be excellent. MDC values for intra-rater were 1.13-1.30 sec, and MDC values for inter-rater were 1.10-1.24 sec. The correlation with 3MBWT, TUG, MSWS-12, and 2MWT was found to be statistically significant.
Conclusion
The 3MBWT was found to be valid and reliable in pwMS. It is a short and easily applied test in outpatient and inpatient clinics without any need for equipment. According to the MDC results, small differences in pwMS can be adequately detected with 3MBWT. Therefore, it may be a clinically suitable test for detecting subtle changes in synergistic motor functions related to prorioception in relapsing or remitting periods. It, also may add some more information on to EDSS data for following the disease progression as well as treatment responses.
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.
Studies have compared the differences and similarities between backward walking and forward walking, and demonstrated the potential of backward walking for gait rehabilitation. However, current evidence supporting the benefits of backward walking over forward walking remains inconclusive. Considering the proven association between gait and the cerebral cortex, we used electroencephalograms (EEG) to differentiate the effects of backward walking and forward walking on cortical activities, by comparing the sensorimotor rhythm (8–12 Hz, also called mu rhythm) of EEG signals. A systematic signal procedure was used to eliminate the motion artifacts induced by walking to safeguard EEG signal fidelity. Statistical test results of our experimental data demonstrated that walking motions significantly suppressed mu rhythm. Moreover, backward walking exhibited significantly larger upper mu rhythm (10–12 Hz) suppression effects than forward walking did. This finding implies that backward walking induces more sensorimotor cortex activity than forward walking does, and provides a basis to support the potential benefits of backward walking over forward walking. By monitoring the upper mu rhythm throughout the rehabilitation process, medical experts can adaptively adjust the intensity and duration of each walking training session to improve the efficacy of a walking ability recovery program.
This essential handbook provides clinicians with a summary of contraindications and precautions to review before treating patients seeking physical rehabilitation. This detailed resource discusses all of the contraindications in one convenient source and includes the full range of interventions, ranging from physical agents to supportive devices to therapeutic exercises. Organized by ICD categories and referenced from multiple sources, with strong coverage of adverse events, this handbook helps to ensure safe practice. Provides crucial, easily accessible information to refresh therapists on contraindications that may not fall within their routine area of treatment. Covers the full range of interventions in detail, including the purpose of the intervention, mechanism, contraindications and precautions, rationale, and references. Helps ensure that practitioners do no harm, providing safer client care and addressing clients with pre-existing conditions. Uses terminology from The Guide to Physical Therapist Practice, reinforcing the use of up-to-date language. Presents quality information from a highly renowned author, with evidence-based information throughout.
The aim of this study was to present the possibilities of application of backward gait as a rehabilitation technique in comprehensive physiotherapy of some injuries and diseases of the motor system and as a form of endurance training. Backward gait as a special kind of locomotion has been analysed in terms of kinematics, biomechanics and electromyography by several researchers. The issue of backward vs. forward gait was also discussed at the biomechanical congress in 1986, in Montreal. According to the available literature, backward gait is often applied in physiotherapy of some injuries and diseases of the knee joint, mainly of the anterior crucial ligament and the patellofemoeal joint. In neurology and geriatrics, this form of locomotion is applied in rehabilitation of patients with diseases causing muscular weakness and balance disturbances. In sports medicine, backward gait can be a part of endurance training and it is used for maintaining and improvement of oxygen efficiency of sportspeople after injuries of the knee joints. This paper presents the examples of studies which aimed at evaluating of usability of backward gait as a kind of rehabilitation training.
Generally, treadmill-walking training focuses on weight bearing and the speed of walking. However, changes in direction, speed, and slope while walking require adaptation.
The effects of task-oriented treadmill-walking training (TOTWT) on the walking ability of stroke patients were evaluated.
Subjects were randomly divided into two groups: the task-oriented treadmill-walking training (TOTWT) group and the conventional treadmill-walking training (CTWT) group. Evaluation was performed before the commencement of the training and again 4 and 8 wk after training was initiated. The OptoGait system measured gait parameters. The Timed Up and Go test and 6-min walk test were also performed.
Within each group, both the TOTWT and the CTWT groups significantly differed before and after the intervention in all tests (P < 0.05); the CTWT group showed greater improvement in all tests following TOTWT (P < 0.05).
TOTWT improves gait and rehabilitation in the stroke-affected limb, and also improves general gait characteristics.
Litigation stemming from an incident in which a middle-aged woman tripped while stepping backward to take a photograph, and without first looking in her direction of travel, led to an observational study of the frequency with which people taking photographs step back without first looking where they were stepping. Prior research on looking before stepping backward did not exist. Research assistants asked a convenience sample of middle-aged women to take a photograph of the assistants standing in front of a building. The task required the participants to step away from the building. The study found that 87% of the participants looked back at least once before or during a backward step, and that 83% of the steps away from the building were preceded by or accompanied by a look in the direction of travel. Suggestions for future research are provided.
This study examined the gait ability and foot pressure after backward walking training in hemiplegia patients after stroke to provide evidence for the application of backward walking to the rehabilitation of those patients. Twenty hemiplegia patients hospitalized at one rehabilitation hospital were enrolled in this study, which was conducted from 23 April to 18 May, 2012. The subjects were randomized into either the experimental group or control group. The control group received general physical therapy for 30 minutes and the experimental group received 20 minutes of physical therapy and 10 minutes of backwards walking training five times a week for four weeks. The gait ability and foot pressure of both feet were measured quantitatively and compared. The results showed the weight bearing (entire foot, anterior and posterior of foot) of the paralyzed foot during the stance phase showed a significant difference (p
This study examined the effects of backward walking with rhythmic auditory stimulation on the gait and balance of stroke patients. Twenty-one people were divided randomly into three groups; group I(n=7, forward walking), group II(n=7, backward walking), group III(n=7, backward walking by rhythmic auditory stimulation). Each group was trained for 30 minutes 5 times per week for 3 weeks, and was evaluated using a 10m walking test, time up and go test, functional reach test, stride length and step length asymmetry ratio. As a result, the pre- to post-test measures revealed a significant effect in each group on the gait speed, gait symmetry and balance(p
To compare the effects of forward walking and backward walking on surface electromyographic analysis of quadriceps muscles at treadmill grades of 0%, 5% and 10%, subjects were randomized to eleven athletics (5 females, 6 males), with a mean age of 17.8 years, and a SD of 4.66 years. The values of the surface electromyographic (SEMG) activity of the rectus femoris (RF), vastus lateralis (VL) and vastus medialis oblique (VMO) were measured during forward walking and backward walking on a treadmill at grades of 0, 5 and 10%. The subjects walked for approximately 10 seconds at 4.0 km/h. The data were analyzed by repeated measuring of the two-way ANOVA and analyzed by a paired t-test between forward walking and backward walking. The SEMG activity levels of the RF, VL and VMO were the highest when both the forward walking and backward walking increased incrementally for treadmill grades of 0% to 10%, but the VMO/VL ratio had no significant changes. The SEMG activity levels of the RF, VL and VMO were significantly different between directions. However, SEMG activity levels of the RF, VL, VMO and VMO/VL ratio did not show significant difference among the treadmill grades. No statistically significant interactions were detected between the direction of walking and treadmill grade. Backward walking on the treadmill at 4 km/h and grades of 0%, 5%, 10% elicited a greater SEMG activity on the quadriceps muscles than did forward walking under the same conditions. The results suggest that the quadriceps may be effectively activated by performance at treadmill grades of 10%. This investigation confirms that backward walking up an incline may place additional muscular demands on individuals.
Background:
People with Parkinson's disease (PD) often fall while multitasking or walking backward, unavoidable activities in daily living. Dual tasks involving cognitive demand during gait and unfamiliar motor skills, such as backward walking, could identify those with fall risk, but dual tasking while walking backward has not been examined in those with PD, those who experience freezing of gait (FOG), or healthy older controls.
Methods:
A total of 78 people with PD (mean age = 65.1 +/-9.5 years; female, 28%) and 74 age-matched and sex-matched controls (mean age = 65.0 +/-10.0 years; female, 23%) participated. A computerized walkway measured gait velocity, stride length, swing percent, stance percent, cadence, heel to heel base of support, functional ambulation profile, and gait asymmetry during forward and backward walking with and without a secondary cognitive task.
Results:
Direction and task effects on walking performance were similar between healthy controls and those with PD. However, those with PD were more affected than controls, and freezers were more affected than nonfreezers, by backward walking and dual tasking. Walking backward seemed to affect gait more than dual tasking in those with PD,although the subset of freezers appeared particularly affected by both challenges.
Conclusion:
People with PD are impaired while performing complex motor and mental tasks simultaneously,which may put them at risk for falling. Those with FOG are more adversely affected by both motor and mental challenges than those without. Evaluation of backward walking while performing a secondary task might be an effective clinical tool to identify locomotor difficulties.
Parkinson disease (PD) is a progressive, neurodegenerative movement disorder that is often accompanied by impaired balance and walking and reduced quality of life (QoL). Recent studies indicate that dance may be an effective alternative to traditional exercise for addressing these areas of concern to individuals with PD. This review summarizes the relatively scant literature on the benefits of dance for those with PD, discusses what is currently known with respect to appropriate dosing of dance interventions, and speculates upon potential mechanisms by which dance may convey benefits. There is a clear need for additional research using larger sample sizes to examine the potential long-term effects of dance for those with PD.
We walk backward on a daily basis, such as when backing away from the kitchen sink or stepping back from a curb as a swiftly moving bus passes. This task may be particularly difficult for individuals with Parkinson's disease (PD) who often fall as a result of moving or being perturbed in the backward direction. The aim of this study was to assess backward walking (BW) in individuals with PD. Both forward walking (FW) and BW were assessed in 78 people with idiopathic PD (H&Y range: 0.5-3) in the ON state, and 74 age- and sex-matched controls. In FW, those with PD had significantly shorter strides, lower swing percents, higher stance percents, and lower functional ambulation profiles than controls. Both groups walked significantly slower and with a wider base of support during BW than FW. Additionally, in BW those with PD walked significantly slower with shorter strides, lower swing percents, and higher double support and stance percents, and lower functional ambulation profiles compared with controls. Those with mild to moderate PD have impaired FW and BW, but differences between those with and without PD are more pronounced in BW.
An eight‐year‐old girl presented with a bizarre posture and gait and was diagnosed as having hysterical astasia‐abasia. She walked with marked lordosis and head hyper‐extended, and would walk backwards across the room to a bed or chair for support. She had a midline astrocytoma and the disorder was relieved with removal of the tumour. The unusual symptomatology accompanying many midline lesions is re‐emphasized.
RÉSUMÉ
Posture bizarre et mouvements désordonnés au cours d'un astrocytome du troisième ventricule
Un diagnostic d'astasie‐abasie hystérique a été porté chez une fillette de huit ans présentant des bizarreries dans la démarche et la posture. Elle marchait avec une lordose accentuée, la tête en hyper‐extension et se dirigeait vers I'arrière dans la pièce pour rechercher le support d'un lit ou d'une chaise. En fait, elle présentait un astrocytome médian et le trouble disparut avec l'ablation de la tumeur. Les auteurs réinsistent sur la symptomatologie très inhabituelle qui accompagne de très nombreuses lésions de la ligne médiane.
ZUSAMMENFASSUNG
Bizarre Haltungs‐ und Bewegungsmuster bei einem Astrocytom des 3. Ventrikels
Bei einem achtjährigen Mädchen, das durch einen bizarren Gang und Haltung auffiel, wurde eine hysterisch bedingte Unfähigkeit zu gehen und zu stehen festgestellt. Beim Gehen fiel eine ausgeprägte Lordose auf, sie hielt den Kopf überstreckt und lief rückwärts durch den Raum zu einem Bett oder Stuhl, um Halt zu suchen. Sie hatte ein Astrocytom im Mittellinienbereich und die Erkrankung konnte durch Tumorentfernung geheilt werden. Es wird auf die ungewöhnliche Symptomatologie hingewiesen, die bei vielen Läsionen im Mittellinienbereich auftreten.
RESUMEN
Postura extraña y alteración del movimiento con astrocitoma del tercer ventriculo
Una niña de ocho años de edad presentaba una postura rara y marcha extraña y fue diagnostica de astasis‐abasia histérica. Andaba con marcada lordosis, cabeza hiperextendida y andaba hacia atrás a través de la habitación hasta llegar a la cama o a una silla para apoyarse. Tenia una astrocitoma de linea media y la alteración se aliviá al extirpar el tumor. Se pone de relieve la sintomatologia no usual que acompaña muchas lesiones de la linea media.
Bremazocine dose-dependently induced backwards walking behavior in rats after its SC injection. Only the (-) but not the (+) enantiomer induced backwards walking. Pretreatment with either naloxone or MR 2266 reduced the bremazocine-induced backwards walking. MR 2266 was at least ten times more potent than naloxone. These findings suggest that bremazocine-induced backwards walking is mediated via an agonistic action of the drug with opioid kappa receptors. The data may contribute to the discussion concerning opioid kappa receptors and the psychotomimetic effects of some opioid analgesic drugs.
A characteristic of catecholamine-depletion-induced catalepsy is that such animals resist horizontal displacement, forward, backward or sideward, by bracing, i.e., pushing against the displacing force rather than stepping away as do normal animals. In this report the bracing responses of two cataleptic preparations were compared: (1) intact rats given haloperidol, a dopamine antagonist, and (2) rats with large lesions of the lateral hypothalamus (LH). Although both preparations exhibited exaggerated bracing responses when pushed, the LH rats acted in a non-cataleptic manner when pushed backward by the head; they retreated backward. The backward walking was a head-elicited response, because pushing the body backwards by the shoulders elicited bracing, not walking. Other forms of head displacement elicited body bracing if the body's stability was challenged: as when the head (and thus the body) was pulled forward; or no strong bracing responses if the head was displaced without affecting the body's stability, i.e., when as the head was pushed laterally. Therefore, retreating rather than bracing was elicited by one specific form of head displacement: backward. In contrast, haloperidol-treated rats braced whenever the body's stability was challenged, including when the head was pushed backward.
Forty patients with acute ruptures of the Achilles tendon were treated surgically by the same physician (T.B.Q.) during a period of 1947 to 1971. The average followup was 19 years. Ninety percent of the patients were men (average age 37.5 years) who were engaged in recreational sport activities. The majority denied a physical conditioning program. The acute ruptures were treated by a surgical procedure which consisted of a 15-cm incision on the medial aspect of the tendon with either the plantaris muscle being woven through the Achilles tendon in a clockwise fashion or a pull-out wire, supplemented with silk mattress sutures, being used to repair the ruptured tendon. The wound was closed and the patient's leg was immobilized. The wire was removed at 6 weeks. The rehabilitation plan consisted of ambulation with a heel lift and elastic stocking (the height of the lift was gradually reduced) and toe exercises. The patients began walking downstairs backwards at 3 months and continued exercises until full range of motion was attained. Subjectively, the results were excellent as graded by the patients. Objectively, there were some minor deficits but they did not impede the overall function. On a scale of 1 (poor) to 4 (excellent), the clinical results were rated excellent (42%), good (36%), fair (15%), and poor (6%). This review has supported our contention that a positive Thompson test is a reliable indicator for a rupture of the Achilles tendon and that surgical treatment of complete ruptures is a successful mode by the procedure described followed by our rehabilitation program.
The movement patterns and heart rate responses of Soccer referees during matches were examined. A movement analysis was performed using a grid method and subjects wore a PE 3000 heart rate monitor during the match. The mean distance (+/- SD) covered was 9,408 m (+/- 838m) which comprised: walking (18.9%), jogging (46.6%), running/striding (12.1%), sprinting (6.2%) and backwards movement (16.2%). If walking and jogging are pooled as low intensity activity and high intensity work is defined as running/striding and sprinting then the majority of distance was covered by low intensity activity (65.5%). No differences in the total distance covered during the two halves was evident. However, in the second half the subjects walked more than in the first half (p < 0.01), while they ran/strode more in the first when compared to the second half (p < 0.01). The subjects' mean heart rate during the first and second halves was not significantly different and were 163 and 162 beats per minute (b.min-1) respectively. If the theoretical maximum heart rate for each subject (220-age) is used, the major percentage of the time was spent at heart rates above 85% HRmax. Based upon the distance results of this study, the major energy source for Soccer refereeing would appear to be the aerobic system with the anaerobic system contributing to ATP production to a lesser extent. The results of this study suggest that refereeing at a high level places a significant physiological demand upon these athletes; they therefore require specialised assessment and training.
Level and incline backward treadmill walking techniques are used in the rehabilitation of certain lower extremity injuries (eg., anterior cruciate ligament reconstruction). Of interest to clinicians is the maintenance of cardiorespiratory fitness resulting from these activities. The purpose of the present study was to determine the cardiorespiratory and metabolic stress of backward walking compared with forward walking. The metabolic cost of backward incline walking above a 1% grade has previously not been reported. Seventeen volunteers (11 males and six females, age = 25 +/- 2 years) underwent a forward maximal running test and four random-ordered 6-minute submaximal walking bouts at 93.8 m/min (3.5 mph). The bouts consisted of forward walking at 0% and 5% elevation and backward walking at 0% and 5% elevation. Measurements taken for each exercise session were oxygen uptake, expired ventilation, heart rate, and rating of perceived exertion. Statistical analysis of these dependent variables indicates that: 1) at a given elevation, backward walking elicited greater cardiorespiratory, metabolic, and perceptual responses than forward walking and 2) backward walking at 5% elevation could provide a sufficient stimulus to maintain cardiorespiratory fitness.