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.
≥ 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
Had difficulty in backward walking
Any neuromuscular disorders history
With visual or auditory disorders
Unstable cardiac status or uncontrolled hypertension
Parallel
Backward walking observation training
Other interventionBackward treadmill training after watching a video of backward walking.
Non-motor observational backward walking training
Other interventionBackward treadmill training after watching a video of landscape without any movements.
Brain activity
Using functional near infrared spectroscopy to measure the oxygenated hemoglobin (HbO) and deoxygenated hemoglobin (HbR) in the bilateral prefrontal cortex, supplementary motor area and primary motor cortex.
Gait symmetry
Using GAITRite system to measure the symmetry of spatiotemporal parameters
Gait varability
Using GAITRite system to measure the coefficient of variation of spatiotemporal parameters
Gait performance
Using GAITRite system to measure the gait spatiotemporal parameters
Time Up & Go test
Using Time Up \& Go test to assess functional mobility
Activities-specific Balance Confidence Scale
Using Activities-specific Balance Confidence Scale to evaluate individual's balance confidence in performing daily activities
Taiwan Chinese version Falls Efficacy Scale
Using Taiwan Chinese version Falls Efficacy Scale to evaluate concerns about falling
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