Comparison of forward versus backward walking using body weight supported treadmill training in an individual with a spinal cord injury: A single subject design

Purpose/Hypothesis: Body weight supported treadmill training (BWSTT) is a task-specific intervention that promotes functional locomotion. There is no research evaluating the effect of backward walking (BW) using BWSTT in individuals with spinal cord injury (SCI). The purpose of this single subject design was to examine the differences between forward walking (FW) and BW training using BWSTT in an individual with quadriparesis. Methods: The participant was a 57-year-old male with incomplete C3-C6 SCI. An ABABAB design (A = BW; B = FW; each phase = 3 weeks of biweekly sessions) was utilized. Outcome measures included: gait parameters; a timed 4-meter walk; the 5-repetition sit-to-stand test (STST); tandem stance time; and 6-minute walk test (6MWT). Data was analyzed with split level method of trend estimation. Results: Improvements in gait parameters, on the timed 4-meter walk, 6MWT, tandem balance and aerobic endurance were similar with FW and BW training. The only difference between FW and BW training was that BW training resulted in greater improvements in the STST. Conclusions: The results of this study suggest that in this individual backward walking training was advantageous, resulting in improved ability to perform the 5-repetition STST. It is suspected that these changes can be attributed to the differences in muscle activation and task difficulty between FW and BW.