Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators

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.

KEYWORDS:

• Backward walking
• stroke rehabilitation
• walking adaptability

Acknowledgments

This work was supported by the Brooks-PHHP Research Collaboration, the Brooks Rehabilitation Collaborative Research Fund, University of North Florida, NIH National Center for Medical Rehabilitation Research T32 Neuromuscular Plasticity Training Program grant (T32HDO43730), NIH/NICHD K12 Rehabilitation Research Career Development Program (HDO55929) and a Promotion of Doctoral Studies (PODS) – Level I Scholarship from the Foundation for Physical Therapy. The funding sources had no involvement in the study design, data analysis, writing of the manuscript or decision to submit for publication. There are no conflicts of interest.

Additional information

Funding

This work was supported by the Foundation for Physical Therapy [PODSI]; National Center for Medical Rehabilitation Research [T32HDO43730]; Brooks-PHHP Research Collaboration [N/A]; Brooks Rehabilitation Collaborative Research Fund [N/A]; NIH/NICHD K12 Rehabilitation Research Career Development Program [HDO55929]; University of North Florida [N/A].