Timed Backwards Walk

Last Updated

January 08, 2014

Purpose

The TBW test measures balance and gait while backwards walking.

Acronym TBW

Area of Assessment

Balance – Non-vestibular
Gait

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Cost not listed on the website

Diagnosis/Conditions

Parkinson's Disease & Movement Disorders

Parkinson's Disease

Testing procedures (Hackney & Earhart, 2009):
1) Forward and backward gait were measures using a 5 meter instrumented, computerized GAITRite walkway.
2) Participants were requested to walk at their normal pace forward to accustom themselves to the mat.
3) Participants then walked backward.
4) Participants then performed three trials of each direction.
5) Participants were given adequate rest time and allowed to sit in between trials.
6) Results from each trial were averaged.
Primary variables of interest were:
1) Gait velocity
2) Stride length
3) Cadence
4) Heel to heel base of support
5) Double support percent
6) Swing and stance percent
7) Functional ambulation profile

Number of Items

1; 3 trials

Studies used a GAITRite system for kinematics. However, a 5 meter measured walkway will suffice to record gait speed and for observable postural instability and/or losses of balance.

5-10 minutes

Required Training

Reading an Article/Manual Training Course

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Suzanne O’Neal, PT, DPT, NCSand the PD EDGE task force of the Neurology Section of the APTA in April, 2013.

Body Part

Lower Extremity

ICF Domain

Body Function

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:
HR	Highly Recommend
R	Recommend
*LS / UR*	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

	I	II	III	IV	V
PD EDGE	LS/UR	LS/UR	LS/UR	LS/UR	NR

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
PD EDGE	No	No	No	Not reported

Considerations

Gait velocity was found to not be a good predictor of falls (Duncan & Earhart, 2012).

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Cut-Off Scores

Parkinson’s Disease:

(Duncan & Earhart, 2012; n = 56, non-faller n = 44, faller n = 12; Mean age = 69.5(1.2); age range = 48-89; Average Hoehn and Yahr Stage = 2.4(0.5), range 2-4)

Cut-off score: 0.50 m/s to predict a faller from a non-faller

Normative Data

Parkinson’s Disease:

(Hackney & Earhart, 2010; n = 78; mean age = 65.1(9.5) years, female: 28%; Disease duration = 8.2(5) years; Hoehn and Yahr scores range: 0.5-3 (0.5 = 1, 1 = 1, 1.5 = 11, 2 = 49, 2.5 = 8, 3 = 8); Matched with age- and sex-matched controls:n = 74; mean age = 65.0(10.0), female: 23%)

Table 1: Spatiotemporal Gait Parameters of Forward and Backward Walking

	Forward Walking		Backward Walking
	PD	Control	PD	Control
Velocity (m/s)	1.2 m/s ± 0.2†	1.2 m/s ± 0.2†	0.7 m/s ± 0.2*	0.9 m/s ± 0.2
FAP	92.7 ± 1.1*†	96.9 ± 1.1†	60.4 ± 1.1*	74.2 ± 1.1
Stride Length (m)	1.3 ± 0.01*†	1.4 ± 0.01†	0.7 ± 0.01*	1.0 ± 0.01
Base of Support (m)	0.1 m ± 0.04	0.1 m ± 0.04	0.2 m ± 0.04	0.2 m ± 0.04
Cadence (steps/min)	109 ± 1.4	105 ± 1.4	112 ± 1.4	105 ± 1.4
Swing %	34.5 ± 0.3*†	35.7 ± 0.3†	31.4 ± 0.3*	34.8 ± 0.3
Double Support %	31.3 ± 0.8†	28.7 ± 0.8†	39.3 ± 0.8*	32.0 ± 0.8
Stance %	65.5 ± 0.3*†	64.3 ± 0.3†	68.8 ± 0.3*	65.2 ± 0.3
		VARIABILITY
Stride Length SD(m)	0.05 ± 0.006	0.05 ± 0.006	0.09 ± 0.006	0.09 ± 0.006
Swing % SD	2.1 ± 1.3	1.9 ± 1.4	7.4 ±1.3	4.9 ± 1.4
Stance % SD	3.0 ± 0.7†	3.2 ± 0.7	8.0 ± 0.7*	5.0 ± 0.7

Values are Means ± SE

*Significant difference between groups within walking condition

†Significant difference between FW and BW within group

Table 2: Spatiotemporal Gait Parameters in Freezers (n = 35) versus Non-Freezers (n = 43)

	Forward Walking		Backward Walking
	Freezers	Non Freezers	Freezers	Non Freezers
Velocity (m/s)	1.1 ± 0.04	1.2 ± 0.04	0.61 ± 0.05	0.73 ± 0.05
FAP	91.4 ± 7.9	93.7 ± 8.2	55.8 ± 2.2†	64.1 ± 2.5
Stride Length (m)	1.2 ± 0.03	1.3 ± 0.03	0.7 ± 0.04†	0.8 ± 0.05
Base of Support (m)	0.1 ± 0.007	0.1 ± 0.005	0.2 ± 0.01	0.2 ± 0.01
Cadence (steps/min)	109 ± 2.4	109 ± 1.7	114 ± 4.7	110 ± 3.5
Swing %	33.7 ± 0.42*	35.2 ± 0.34	30.3 ± 0.8*	32.4 ± 0.6
Double Support %	32.8 ± 0.84*	30.0 ± 0.70	41.2 ± 2.3	37.8 ± 11.6
Stance %	66.4 ± 0.42*	64.8 ± 0.34	70.0 ± 0.9†	67.7 ± 0.6
		VARIABILITY
Stride Length SD(m)	0.06 ± 0.04	0.05 ± 0.04	0.1 ± 0.01	0.1 ± 0.01
Swing % SD	2.5 ± 0.2†	107 ± 0.1	8.6 ± 3.2†	6.4 ± 2.8
Stance % SD	3.7 ± 0.4†	2.5 ± 0.1	10.8 ± 3.0†	5.7 ± 0.5

Values are Means ± SE. Independent t-tests were used to test for significant differences between groups

*Significant difference between freezers and non-freezers

†Significant difference with Mann Whitney Rank Sum test

Criterion Validity (Predictive/Concurrent)

Parkinson’s Disease:

(Hackney & Earhart, 2009)

Correlations of UPDRS and Forward or Backward Velocity:
- As UPDRS scores increased, BW velocity decreased: r = -0.290, p = 0.010
- UPDRS not correlated with FW velocity: r = -0.126, p = 0.272
Correlations of Berg Balance Scale and Forward or Backward Velocity:
- As BBS scores increased, both BW (r = 0.538) and FW (r = 0.486) velocity increased (p, 0.001)
- As FW velocity increased, BW velocity increased (r = 0.766, p ,0.001)
- No significant relationships were found between duration of PD and FW or BW (r = 0.012, p = 0.917; r = -0.200, p= 0.079)
BW performance is predictive of walking difficulty in high-functioning older adults

Bibliography

Duncan, R. P. and Earhart, G. M. (2012). "Should one measure balance or gait to best predict falls among people with Parkinson disease?" Parkinson's disease 2012.

Hackney, M. E. and Earhart, G. M. (2009). "Backward walking in Parkinson's disease." Movement Disorders 24(2): 218-223.

Last Updated

Purpose

Area of Assessment

Assessment Type

Administration Mode

Cost

Cost Description

Diagnosis/Conditions

Number of Items

Required Training

Instrument Reviewers

Body Part

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Cut-Off Scores

Normative Data

Criterion Validity (Predictive/Concurrent)

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