Background: Post-stroke walking impairment is a significant cause of chronic disability worldwide and often leads to loss of life roles for survivors and their caregivers. Walking impairment is traditionally classified into mild (>0.8 m/s), moderate (0.41–0.8 m/s), and severe (≤0.4 m/s), and those categorized as “severe” are more likely to be homebound and at greater risk of falls, fractures, and rehospitalization. In addition, there are minimal effective walking rehabilitation strategies currently available for this subgroup. Backward locomotor treadmill training (BLTT) is a novel and promising training approach that has been demonstrated to be safe and feasible across all levels of impairment; however, its benefits across baseline walking impairment levels (severe (≤0.4 m/s) vs. mild–moderate (>0.4 m/s)) have not been examined. Methods: Thirty-nine adults (>6 months post-stroke) underwent 6 days of BLTT (3 x/week) over 2 weeks. Baseline and PRE to POST changes were measured during treadmill training and overground walking. Results: Individuals with baseline severe walking impairment were at a more significant functional disadvantage across all spatiotemporal walking measures at baseline and demonstrated fewer overall gains post-training. However, contrary to our working hypothesis, both groups experienced comparable increases in cadence, bilateral percent single support times, and step lengths. Conclusion: BLTT is well tolerated and beneficial across all walking impairment levels, and baseline walking speed (≤0.4 m/s) should serve as a covariate in the design of future walking rehabilitation trials.

Introduction: Stroke is a major cause of balance and walking impairment and is on the rise. The most widely used walking impairment measure is the 10-meter walk test (10-mWT), which provides information about walking speed but does not inform about walking kinematics or neuromuscular control. Objective: Herein, we evaluate single support center of pressure distance (SS CoP Dist), a kinematic measure of dynamic postural control and walking stability, as a complementary measure of walking impairment. We hypothesize that SS CoP Dist will be closely associated with baseline walking speed, and will improve with Backward Locomotor Treadmill Training (BLTT). Methods: Thirty-six chronic stroke survivors with residual walking impairment, based on 10-mWT speed [ mild >0.8 m/s (n =7); moderate 0.4-0.8m/s (n =18); and severe <0.4 m/s (n = 11)] , underwent six 30-minute BLTT sessions over two consecutive weeks. During testing (10-mWT), participants were instructed to walk as fast as possible over the gait analysis mat to capture SS CoP Dist and walking speed. Results: At baseline, there was a weak to moderate positive relationship between walking speed and SS CoP Dist (R 2 paretic = 0.22, p = 0.0036; R 2 Nonparetic = 0.44, p < 0.0001). Following BLTT, SS COP Dist increased (more stable) in the mild and moderate groups [mild paretic ( p = 0.0039)/mild Nonparetic ( p = 0.0034) , moderate paretic ( p = 0.0360)/ moderate Nonparetic ( p = 0.0087)], with improved interlimb symmetry in the mild group. In contrast, no significant improvement in SS CoP Dist was seen in participants with severe walking impairment ( p = 0.3830). Training-related changes in walking speed were strongly correlated with change in SS CoP Dist (R 2 Nonparetic = 0.54, p = 0.0007). Conclusion: Our preliminary findings suggest that SS CoP Dist compliments walking speed for characterizing walking severity and response to training in chronic stroke survivors. In addition, BLTT significantly improved SS CoP Dist in mild-moderately impaired stroke survivors but not in survivors with severe walking impairment. Future well-powered, prospective studies with BLTT and other training paradigms are needed to validate these findings.

Background and Research QuestionWalking impairment remains a major limitation to functional independence after stroke. Yet, comprehensive and effective strategies to improve walking function after stroke are presently limited. Backward Locomotor Treadmill Training (BLTT) is a promising training approach for improving walking function; however, little is known about its mechanism of effect or the relationship between backward walking training and resulting overground forward walking performance. This study aims to determine the effects of serial BLTT on spatial aspects of backward and forward walking in chronic post-stroke individuals with residual walking impairment.MethodsThirty-nine adults (&gt;6 months post-stroke) underwent 6 days of BLTT (3 × /week) over 2 weeks. Outcome measures included PRE-POST changes in backward and forward walking speeds, paretic and non-paretic step lengths, and single-support center of pressure distances. To determine the association between BLTT and overground walking, correlation analyses comparing training-related changes in these variables were performed.ResultsWe report an overall improvement in BLTT and overground walking speeds, bilateral step lengths, and single-support center of pressure distances over six training sessions. Further, there were weak positive associations between PRE-POST changes in BLTT speed, BLTT paretic step length, and overground forward walking speed.Conclusion and SignificanceOur findings suggest that individuals with chronic post-stroke walking impairment experience improvements in spatial walking measures during BLTT and overground. Therefore, BLTT may be a potential adjunctive training approach for post-stroke walking rehabilitation.

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