The effect of backward walking observational training on gait parameters and balance in chronic stroke: randomized controlled study

Abstract

BACKGROUND: Backward walking (BW) and action observation training may potentially help people at risk of falls. Moreover, action observation training could be a potential intervention to improve gait after a stroke. AIM: We aimed to identify the effects of BW action observational training (BWOT) on gait parameters and balance in chronic stroke patients. DESIGN: Randomized, controlled study. SETTING: Rehabilitation center. POPULATION: Twenty-four chronic stroke patients were randomly assigned to BWOT (N.=12) and landscape observational training (LOT) (N.=12) groups. METHODS: The BWOT group performed BW after watching a video of a BW, while the LOT group performed BW training after watching a video of a landscape. Both groups received traditional therapy for 5 days per week and BWOT for 3 days a week for 4 weeks. The primary and secondary outcomes were gait and balance, respectively. Static balance was measured using the 5 Times Sit-To-Stand Test (5TSTS), the center of pressure (COP) displacement, and weight distribution (WD) of the affected side. Dynamic balance was measured using the activity-specific balance confidence (ABC) scale. RESULTS: The BWOT group showed significant improvements in gait velocity (p=0.001, η2=0.470), step length (P=0.007, η2=0.313), stride lengths (P<0.002, η2=0.431), 5TSTS (P=0.021, η2=0.231), COP velocity (P=0.022, η2=0.226), length (P=0.001, η2=0.504), WD of the affected side (P=0.033, η2=0.193), and ABC score (P=0.023, η2=0.226) than the LOT group. CONCLUSIONS: The 4-week BWOT training program significantly improved the gait parameters and static and dynamic balance in stroke patients. CLINICAL REHABILITATION IMPACT: BWOT is an accessible and effective method of rehabilitation training that can also be applied to conventional therapy as a useful method for improving the gait and balance after stroke.