Podcast Summary

4D: Deep Dive into Degenerative Diseases – ANPT

Episode: DDSIG Bonus – CSM Poster Award 2025: Analysis of Backward Gait Assessment Performance in Typical Older Adults and Individuals with Parkinson’s Disease
Host: Karen Padgett
Guest: Dr. Lisa Ingles, Assistant Professor, Daemen University
Date: March 24, 2025

Main Theme & Purpose

This episode features an in-depth discussion with Dr. Lisa Ingles, winner of the DD SIG Best Poster Award at CSM 2025, about her research comparing backward gait assessment in typical older adults and individuals with Parkinson's Disease (PD). The conversation explores the clinical significance of backward walking as an assessment tool, the details of Dr. Ingles' methodology, results, and the implications for physical therapy practice, especially in early intervention for Parkinson’s.

Key Discussion Points and Insights

1. Introduction & Motivation for the Study

• Dr. Ingles’ Background:
  • Teaches neuromuscular courses at Daemen University with a focus on stroke, Parkinson’s, and spinal cord injury ([01:52]).
• Origins of the Study:
  • Inspired by clinical observation that backward walking seemed to reflect postural stability and could indicate unsteadiness in Parkinson’s patients.
  • Noted a lack of clinical tools assessing backward gait, despite its potential value ([02:48]).
  • Discussed evidence showing early changes in backward gait may precede changes in forward gait for PD patients, highlighting assessment importance ([03:46]).

2. Study Design

• Backward Gait Assessment:
  • Participants walked 5 meters backward at normal speed between two taped lines while both time and step count were measured ([04:24]).
  • Chose physical counting based on prior research that demonstrated no meaningful difference from instrumented walkways.
  • Included established comparative measures: Mini-BESTest, Timed Up and Go (TUG), and the Activities-specific Balance Confidence (ABC) Scale ([05:48]).
  • Participant Groups:
    • 30 individuals with Parkinson’s (avg. age 68.4), 15 female.
    • 30 age-matched controls (avg. age 66.9), neurologically typical.
    • Groups were closely age-matched ([05:54]).

3. Clinical Relevance of Method

• Why 5 Meters and Manual Count:
  • Prior research validated the non-instrumented method as consistent with instrumented walkways; greater clinical feasibility ([06:38]).
  • Emphasized clinical applicability: “Most of us don't have an instrumented walkway easily at our disposal… We're really hoping to get something that was clinically relevant.” – Dr. Ingles ([07:14]).

4. Results

• Primary Outcomes:
  • PD group took more time and steps to walk backward than controls.
    • Average Time:
      • Parkinson’s: 13.7 seconds
      • Controls: 9.5 seconds
    • Average Steps:
      • Parkinson’s: 20 steps
      • Controls: 14 steps ([08:12]).
  • Other standard measures (Mini-BEST, ABC, TUG) reflected the same statistically significant differences ([09:15]).
• Notable Quote:
  • “On average, the individuals with Parkinson's took about 13.7 seconds... whereas the older adults… about nine and a half seconds.” – Dr. Ingles ([08:12])

5. Falls Risk Analysis and Limitations

• Falls Data:
  • Retrospective self-reported falls over the prior year were collected.
  • Small subgroup sizes (e.g., only eight fallers in the control group), limiting power to establish falls risk cutoffs or analyze predictive value ([09:47]).
  • Neither this test nor the standard measures could significantly differentiate fallers vs. non-fallers in this sample.
• Hoehn & Yahr Distribution:
  • PD group mainly early-stage: 8 (Stage 1), 16 (Stage 2), 5 (Stage 3), 1 (Stage 4) ([11:31]).

6. Clinical Implications and Future Directions

• Potential Clinical Use:
  • Quick and reliable test that strongly correlates with longer, more involved balance assessments ([13:11]).
  • "We're able to do this test in 14 seconds and get data that really strongly correlates with a measure that takes 15 to 20 minutes to administer. So I think that's the clinical utility of it." – Dr. Ingles ([13:11])
  • Especially promising for early screening in multidisciplinary clinics and early PD intervention.
  • Could empower patients by demonstrating measurable differences early, motivating participation in therapy ([14:21]).
• Therapeutic Value:
  • Backward walking is both diagnostically revealing and an effective treatment focus, highlighting early deficits in proprioception and postural control ([15:32]).
  • “It sort of pulls out those challenges earlier. You can't see where you're going. It's almost like a dual task.” – Dr. Ingles ([15:32]).

7. Methodological Insights

• Single vs. Multiple Trials:
  • The team learned that a single trial is more reliable—multiple trials resulted in participants “trying to beat their time,” skewing results. Now recommend a single trial for consistent assessment ([16:19]).
  • “That for some people... seemed to serve almost as a cue, and that they were going to try to beat their time... So we ended up just changing that and going with the first trial.” – Dr. Ingles ([16:19])

Notable Quotes & Memorable Moments

• “Backward walking is more of a key potentially to their stability, their postural control, compared to forward walking.” – Dr. Ingles ([02:48])
• “I think that's always really helpful for us as clinicians… to be able to establish is there a particular number of steps... or speed at which you are at a greater risk of falling.” – Dr. Ingles ([13:11])
• “It's a very clinically useful, quick to administer score that could give someone a lot of information.” – Dr. Ingles ([13:11])
• “It sort of pulls out those challenges earlier... You have to rely a little bit more on your proprioceptive information.” – Dr. Ingles ([15:32])

Key Segment Timestamps

• 01:52: Dr. Ingles' background and clinical focus
• 02:48: Reason for choosing backward gait analysis
• 04:24: Study methodology overview
• 05:54: Participant recruitment and demographics
• 06:38: Rationale for clinical approach over instrumented testing
• 08:12: Main results: performance differences in backward gait
• 09:47: Analysis of falls data and study limitations
• 11:31: Description of PD group’s Hoehn & Yahr stages
• 13:11: Discussion on clinical applications and utility
• 15:32: Value of backward walking as both assessment and intervention
• 16:19: Lessons learned: single vs. multiple trial protocol

Tone and Atmosphere

• Engaged, collegial, and slightly humorous—filled with practical clinical wisdom, honest reflections on methodology, and enthusiasm for the growing use of backward-walking in neuro PT.

Recommendations for Clinicians

• Consider incorporating the 5-meter backward gait test into routine assessments for patients with Parkinson’s and older adults.
• Recognize its value as a quick screen to identify postural and balance deficits, especially in early Parkinson’s.
• Note current limitations on establishing falls risk cutoffs—further research is needed.
• Use the test’s results to empower patients and prompt timely intervention.

Closing

Dr. Ingles shares her love for running and watching her sons’ activities, bringing a personal touch to the discussion. The episode wraps up with gratitude for her research and encouragement to clinicians to consider backward gait assessment in their practice.

For more information and resources, visit www.neuropt.org.