Objective: Explore the effectiveness of backwards walking and backwards stepping interventions to improve gait stability and balance in persons with Dementia with Lewy Bodies (DLB).

Background: DLB is a progressive neurocognitive disorder associated with the accumulation of alpha-synuclein, which leads to cognitive decline, sleep disturbances, and Parkinsonian motor symptoms. These motor symptoms often lead to referral for physical therapy (PT). While there are clear guidelines for PT interventions for Parkinson’s Disease, limited literature is available to support its efficacy with DLB. Backwards walking has been shown to be effective in improving balance and gait in other neurological conditions such as Parkinson’s Disease and Multiple Sclerosis.

Method: A 74-year-old man with a two-year history of DLB participated in a four-week (twice weekly) PT program that incorporated backwards treadmill training (with overhead support and external cues), overground walking (with and without resistance), dynamic backwards stepping activities (e.g., balloon volleying, soccer ball passing, stepping over hurdles/obstacles of varying heights and widths), functional strengthening, and a standing home exercise program was implemented. Gait stability, balance, and backwards walking assessments were assessed with the Functional Gait Assessment, Four-Square Step Test, and the 3-meter backwards walking test before beginning the 4-week program and at the program’s conclusion. 

Results: Functional improvement was measured across three outcome measures: Functional Gait Assessment (26.7% improvement), 3-Meter Backward Walk Test (47.6% improvement), and Four-Square Step Test (57.1% improvement).

Conclusion: Backwards walking is a safe and feasible addition to PT interventions with persons with DLB to improve dynamic balance, gait, and stepping stability. Further research is warranted to validate its inclusion for broader use.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/stepping-backwards-to-move-forward-a-case-study-on-novel-pt-interventions-for-dlb/