Structural and Functional Changes With 8 Weeks of Backward Walking Training in Multiple Sclerosis: A Case Series.

Abstract

Background and purpose: Individuals with multiple sclerosis (MS) experience mobility declines and an increased risk of falls. Studies in MS have suggested backward walking (BW) as a promising intervention to improve mobility, yet the impact of BW on reactive balance, physical activity, prospective falls, and brain structure has not been explored. The purpose of this case series was to examine feasibility, acceptability, and impact of 8 weeks of BW training (BWT) on gait speed, static and reactive balance, fall incidence, physical activity, and white matter microstructure. A secondary aim was to explore concurrent changes in structure and function with BWT.

Case description: Eight ambulatory individuals with relapsing-remitting MS performed forward walking (FW) and BW, static and reactive balance tests, and underwent myelin water imaging (MWI) pre- (baseline) and post-intervention. MWI metrics were extracted from the body of the corpus callosum, superior cerebellar peduncle, and corticospinal tract. Physical activity was measured for 1 week before and after the intervention, and falls were monitored prospectively for 6 months.

Intervention: Eight weeks of laboratory (1×/week) and home-based (2×/week) BWT; in the laboratory, individuals performed treadmill and overground BW followed by functional exercises incorporating backward stepping. At home, participants performed overground BW and the same functional exercises.

Outcomes: BWT was feasible (100%) and acceptable (96.9%). All participants exhibited increased microstructural changes on the MWI metrics in at least 1 region of interest. Participants demonstrated decreases in sway area during static balance tasks (7/8), decreases in postural latency during reactive stepping (7/8), increases in BW velocity (6/8), and increases in FW velocity (4/8). There was a decrease in fall rate from baseline to 6 months post-intervention (4/7).

Discussion: Eight weeks of BWT resulted in structural and functional changes; however, a larger sample size is needed to determine the clinical significance and generalizability of these findings.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A536.