Backward Incline Walking in Stroke Rehabilitation: A Pilot Feasibility Study

Introduction

Restoring normal gait function remains a major clinical challenge in post-stroke rehabilitation. Backward walking may increase neuromotor demands compared with forward walking and performing it on an incline may further augment task complexity. However, the feasibility, safety, and tolerability of backward incline walking in individuals with chronic stroke have not been systematically examined.

Objective

To evaluate the feasibility of a single-session treadmill-based backward incline walking protocol in individuals with chronic stroke, focusing on recruitment, adherence, safety, tolerability, and participant acceptability.

Methods

Design

Prospective, nonrandomized pilot feasibility study.

Setting

Clinical Human Dynamic Laboratory at a university-affiliated rehabilitation program.

Participants

Six individuals with chronic stroke (≥6 months post-event) were enrolled (median age 68 years, interquartile range [IQR] 56–73, median time since stroke of 19 months IQR [15–98]). Inclusion criteria included ambulatory ability with or without a single cane for ≥10-meter and absence of cognitive, orthopedic, or cardiopulmonary contraindications, and ability to tolerate 15 min of treadmill walking. All participants met these criteria and provided informed consent.

Intervention

Participants completed three treadmill walking conditions delivered in a fixed order (level, forward incline, and backward incline walking), each for up to 15 min at self-selected speeds. Rest breaks and manual support were provided as needed.

Main Outcomes

Feasibility metrics included recruitment rate, protocol adherence, safety (adverse events), tolerability (rating of perceived exertion), and participant acceptability.

Secondary Descriptive Measures

Overground walking speed and spatiotemporal gait parameters recorded using an instrumented walkway before and after the treadmill conditions. These data were summarized descriptively without inferential statistical testing.

Results

Recruitment was feasible, with 40% of eligible individuals enrolled. All participants completed the single-session protocol without adverse events. Perceived exertion increased in our sample with task complexity and was highest during backward incline walking (median RPE = 6). Participant acceptability was high, with all individuals expressing willingness to repeat the protocol.

Significance

A single-session treadmill-based backward incline walking was feasible, safe, and well-tolerated in this pilot sample of ambulatory individuals with chronic stroke. These findings progression to adequately-powered, randomized studies designed to evaluate efficacy and to address order effects and individualized gait responses.