Comparison of forward and backward gait in males with and without intellectual disabilities.

BACKGROUND: Intellectual disabilities (ID) affect both cognitive and motor functions. The backward gait is a daily activity and its assessment is used for fall risk estimation and training in the general population. For proper use of backward gait as a rehabilitation tool and in fall prevention programmes for people with ID, it is necessary to determine the backward gait characteristics in the ID population. The aim of this study was to compare the differences between forward and backward gait in persons with nonsyndromic mild and moderate ID, persons with Down syndrome (DS) and a control group of healthy adults. METHODS: Fifty males divided into four groups (mild ID: n = 15, moderate ID: n = 19, DS: n = 6, controls: n = 10) participated in this study. All participants were asked to walk both forward and backward, barefooted and at their natural velocity on a Zebris FDM platform. The Kruskal-Wallis H test was used to compare differences between the analysed groups in forward and backward gait. The Mann-Whitney U test was used to compare the differences between forward and backward gait within each group. RESULTS: The velocity was significantly slower in moderate ID and DS compared to controls in forward and backward gait. When comparing forward and backward gait within each group, the gait velocity decreased in backward gait compared with forward gait by 21.80% in controls, by 33.89% in mild ID, by 34.45% in moderate ID, and by 40.32% in DS. In both moderate ID and DS, the mean backward velocity was slower than 2.16 km/h, the velocity used to identify elderly fallers in the general population. CONCLUSIONS: Gait velocity was especially affected in DS and moderate ID compared with controls. In both mentioned groups, the backward gait velocity suggests an increased risk of falling. Future studies are necessary to examine the possibility of improving balance control and leg muscle strength by backward walking training in the ID population.

Lower Quarter Y-Balance Test in healthy women 50-79 years old.

The Lower Quarter Y-Balance Test (LQ-YBT), a measure of dynamic balance used in young adults, has not been adequately studied in older women. We determined the reliability, normative values, and relationships to other balance measures for LQ-YBT in women aged 50-79 years. Interrater reliability was strong, and test-retest reliability was moderate to strong. Results by decade showed women 50-59 years had significantly better scores than both older groups. There were moderate positive correlations between single leg stance, gait speed, and LQ-YBT composite score. LQ-YBT may be used as a dynamic balance assessment in healthy older women.

Association Between Baseline Gait Parameters and Future Fall Risk in Patients With De Novo Parkinson's Disease: Forward Versus Backward Gait.

BACKGROUND AND PURPOSE: Falls are not uncommon even in patients with early stages of Parkinson's disease (PD). The aims of this study were to determine the relationships between gait parameters and falls and identify crucial gait parameters for predicting future falls in patients with de novo PD. METHODS: We prospectively recruited patients with de novo PD, and evaluated their baseline demographics, global cognitive function on the Montreal Cognitive Assessment test, and parkinsonian motor symptoms including their subtypes. Both forward gait (FG) and backward gait (BG) were measured using the GAITRite system. The history of falls in consecutive patients with de novo PD was examined along with 1 year of follow-up data. RESULTS: Among the 76 patients with de novo PD finally included in the study, 16 (21.1%) were classified as fallers. Fallers had slower gait and shorter stride for FG and BG parameters than did non-fallers, while stride-time variability was greater in fallers but only for BG. Multivariable logistic regression analysis revealed that slow gait was an independent risk factor in BG. CONCLUSIONS: Among the patients with de novo PD, gait speed and stride length were more impaired for both FG and BG in fallers than in non-fallers. It was particularly notable that slow BG was significantly associated with future fall risk, indicating that BG speed is a potential biomarker for predicting future falls in patients with early-stage PD.

Association Between Gait and Dysautonomia in Patients With De Novo Parkinson's Disease: Forward Gait Versus Backward Gait.

OBJECTIVE: Studies on gait and autonomic dysfunction have been insufficient so far, particularly de novo Parkinson's disease (PD). The aim of this study was to identify the association between gait dynamics and autonomic dysfunction in patients with de novo PD. METHODS: A total 38 patients with de novo PD were retrospectively included in this study. Details of patients' dysautonomia were assessed using the Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT). For assessment of gait, a computerized gait analysis was performed using the GAITRite system for forward gait and backward gait. High SCOPA-AUT score (PD-HSAS) group and low SCOPA-AUT score (PD-LSAS) group were identified according to their SCOPA-AUT scores. RESULTS: Nineteen (50%) patients with high SCOPA-AUT scores above median value (12.5) were assigned into the PD-HSAS group and others were assigned to the PD-LSAS group. Compared with the PD-LSAS group, the PD-HSAS group exhibited slower gait, shorter stride, decreased cadence, increased double support phase, decreased swing phase, and increased variability in swing time. Total SCOPA-AUT score showed significantly positive correlations with gait variability and instability but a negative correlation with gait hypokinesia. In subdomain analysis, urinary dysautonomia was highly associated with impairment of gait dynamics. All significant results were found to be more remarkable in backward gait than in forward gait. CONCLUSION: Our findings suggest that alteration in gait dynamics, especially backward gait, is highly associated with autonomic dysfunction in patients with de novo PD.

Case report: Backward gait training combined with gait-synchronized cerebellar transcranial alternating current stimulation in progressive supranuclear palsy.

Progressive supranuclear palsy (PSP) is characterized by recurrent falls caused by postural instability, and a backward gait is considered beneficial for postural instability. Furthermore, a recent approach for rehabilitation combined with gait-oriented synchronized stimulation using non-invasive transcranial patterned stimulation could be promising for balance function. Here, we present a case of PSP with backward gait training combined with gait-synchronized transcranial alternating current stimulation (tACS). A 70-year-old woman with PSP-Richardson's syndrome underwent backward gait training combined with synchronized cerebellar tACS. Initially, she underwent short-term intervention with combined training of backward gait with synchronized cerebellar tACS, asynchronized, or sham stimulation according to the N-of-1 study design. Synchronized tACS training demonstrated a decrease in postural instability, whereas asynchronized or sham stimulation did not. The additional long-term interventions of combined backward gait training with synchronized cerebellar tACS demonstrated further decrease in postural instability with improvements in gait speed, balance function, and fall-related self-efficacy in daily life. The present case describes a novel approach for motor symptoms in a patient with PSP. Backward gait training with synchronized cerebellar tACS may be a promising therapeutic approach.

Use of real-time multimodal sensory feedback home program improved backward stride and retention for people with Parkinson Disease: A pilot study.

INTRODUCTION: Parkinson disease (PD) impairs sensory integration, contributes to motor dysfunction, loss of gait automaticity, and increased fall risk. Employing multimodal sensory feedback (MMSF) has the potential to improve proprioceptive integration and gait safety while reducing exercise burden especially for backward gait. METHODS: This single-blinded, randomized controlled pilot study used a home program with or without real-time visual, proprioceptive, and auditory feedback with stepping exercises which progressed in speed and distance. Both groups completed a six-week intervention followed by 6 weeks without exercise to assess long-term retention. Six additional weeks of exercises were completed to assess recovery of potential losses after the washout session.Eleven people with PD exercised with real-time MMSF and 7 exercised without MMSF. Outcome measures included backward stride length, velocity, cadence, and double support time. The Dual Timed Up and Go measured automaticity. Self-perceived improvements in gait, activities of daily living, participation, and quality of life were registered by a questionnaire. RESULTS: Analysis was by repeated measures ANOVA. Using MMSF significantly improved backward stride length at 12 and 18 weeks, p = .007, η2 = 0.239. Both groups improved in all outcome measures after the initial 6-week exercise program, supporting efficacy of stepping exercises. The MMSF + ex group's significant improvements after a 6-week washout supported automaticity development. Questionnaire items received higher agreement percentages from MMSF + ex participants. CONCLUSION: Using real-time MMSF in a home program for pwPD provided significant and lasting improvements in backward stride, and potentially decreased fall risk and exercise burden compared to the same program without MMSF.

Backward Gait is Associated with Motor Symptoms and Fear of Falling in Patients with De Novo Parkinson's Disease.

BACKGROUND AND PURPOSE: Many previous studies have investigated forward gait (FG), backward gait (BG), and dual-task gait (DG) in patients with Parkinson's disease (PD). However, it remains uncertain whether gait parameters are implicated in motor symptoms or the risk of falling, especially in patients with de novo PD. METHODS: Demographic and clinical characteristics including the Fear of Falling Measure (FFM) were assessed in patients with de novo PD and in healthy subjects. A computerized gait analysis using the GAITRite system was performed for FG, BG, and DG. The Unified Parkinson's Disease Rating Scale Part III was assessed in patients with PD. RESULTS: This prospective study included 24 patients with de novo PD and 27 controls. Compared with controls, patients with de novo PD showed a slower gait and shorter stride in all three gaits. Patients with de novo PD also exhibited increases in the stride-to-stride variability in the stride time and stride length of the gait for BG, increased length for DG, and no increase for FG. Moreover, the BG speed in de novo PD patients was significantly associated with their motor symptoms (bradykinesia, postural instability, gait difficulty, and total motor score) and negatively correlated with the FFM score. CONCLUSIONS: The BG dynamics were more impaired and more closely related to motor symptoms and fear of falling than were the FG or DG dynamics in patients with de novo PD, indicating that BG parameters are potential biomarkers for the progression of PD.