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.

Study Overview

• Status: Recruiting
• Conditions: Stroke
• Intervention / Treatment: Other: Backward walking observation training; Other: Non-motor observational backward walking training

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yea-Ru Yang, PhD; Phone Number: +886228267279; Email: yryang@nycu.edu.tw

Study Locations

• Taiwan
  • Taipei, Taiwan, 112
    • Recruiting
    • Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University
    • Contact: Yea-Ru Yang, PhD; Phone Number: +886-2-2826-7279; Email: yryang@nycu.edu.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Backward walking observation training group; The intervention is a 50-minute session and 3 sessions/week, totaling 4 weeks.	Other: Backward walking observation training; Backward treadmill training after watching a video of backward walking.
Active Comparator: Non-motor observational backward walking training group; The intervention is a 50-minute session and 3 sessions/week, totaling 4 weeks.	Other: Non-motor observational backward walking training; Backward treadmill training after watching a video of landscape without any movements.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	Baseline, 4 weeks after training, and 4-week follow-up
Gait symmetry	Using GAITRite system to measure the symmetry of spatiotemporal parameters	Baseline, post-intervention, 4 weeks after training, and 4-week follow-up
Gait varability	Using GAITRite system to measure the coefficient of variation of spatiotemporal parameters	Baseline, post-intervention, 4 weeks after training, and 4-week follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gait performance	Using GAITRite system to measure the gait spatiotemporal parameters	Baseline, post-intervention, 4 weeks after training, and 4-week follow-up
Time Up & Go test	Using Time Up & Go test to assess functional mobility	Baseline, 4 weeks after training, and 4-week follow-up
Activities-specific Balance Confidence Scale	Using Activities-specific Balance Confidence Scale to evaluate individual's balance confidence in performing daily activities	Baseline, 4 weeks after training, and 4-week follow-up
Taiwan Chinese version Falls Efficacy Scale	Using Taiwan Chinese version Falls Efficacy Scale to evaluate concerns about falling	Baseline, 4 weeks after training, and 4-week follow-up

Collaborators and Investigators

• Sponsor: National Yang Ming Chiao Tung University

Study record dates

Study Major Dates

• Study Start (Actual): April 24, 2025
• Primary Completion (Estimated): March 1, 2028
• Study Completion (Estimated): September 30, 2028

Study Registration Dates

• First Submitted: February 17, 2025
• First Submitted That Met QC Criteria: February 22, 2025
• First Posted (Actual): February 27, 2025

Study Record Updates

• Last Update Posted (Actual): June 12, 2025
• Last Update Submitted That Met QC Criteria: June 11, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Keywords: Stroke; Brain activity; Gait symmetry; Gait variability; Backward walking; Action observation training
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke
• Other Study ID Numbers: NYCU113210AF2

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No