Backward Walking Observation Training in People With Stroke and Gait Quality in Stroke

The Effect of Backward Walking Observation Training on Improving Brain Activity and Gait Quality in People With Stroke

Walking impairment is one of the most common and concerning issues for individuals with stroke. Previous studies have often used improvements in walking speed and distance as reference indicators for gait performance progress in individuals with stroke. However, for people with chronic stroke, it may be more appropriate to prioritize improving gait symmetry and gait variability to enhance gait quality as a primary intervention goal. Additionally, stroke can lead to an imbalance in interhemispheric brain activity, which evolves as motor function recovers. According to the literature review, backward walking may extend the support time of the lower limbs, thereby enhancing the weight-bearing capacity of the affected limb. This, in turn, could promote gait symmetry and reduce gait variability. Changes in brain activity might also accompany such improvements in gait quality. Therefore, this study aims to investigate the immediate, short-term and post carryover intervention effects of backward walking observation training on gait quality in individuals with chronic stroke as well as to explore its effects on interhemispheric activity balance in individuals with chronic stroke.

Inclusion Criteria:

• ≥ 6 months after the diagnosis of stroke
• Independent walking over at least 7m with or without a walking aid
• Mini-mental state examination score ≥ 24

Exclusion Criteria:

• Had difficulty in backward walking
• Any neuromuscular disorders history
• With visual or auditory disorders
• Unstable cardiac status or uncontrolled hypertension
• Any musculoskeletal disorders that would affect walking ability