The TBW test measures balance and gait while backwards walking.
1; 3 trials
5-10 minutes
Adult
18 - 64
yearsElderly Adult
65 +
yearsInitially reviewed by Suzanne O’Neal, PT, DPT, NCSand the PD EDGE task force of the Neurology Section of the APTA in April, 2013.
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:
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Abbreviations: |
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HR |
Highly Recommend |
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R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations Based on Parkinson Disease Hoehn and Yahr stage:
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I |
II |
III |
IV |
V |
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PD EDGE |
LS/UR |
LS/UR |
LS/UR |
LS/UR |
NR |
Recommendations for entry-level physical therapy education and use in research:
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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) |
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PD EDGE |
No |
No |
No |
Not reported |
Gait velocity was found to not be a good predictor of falls (Duncan & Earhart, 2012).
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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
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
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Forward Walking |
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Backward Walking |
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PD |
Control |
PD |
Control |
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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 |
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FAP |
92.7 ± 1.1*? |
96.9 ± 1.1? |
60.4 ± 1.1* |
74.2 ± 1.1 |
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Stride Length (m) |
1.3 ± 0.01*? |
1.4 ± 0.01? |
0.7 ± 0.01* |
1.0 ± 0.01 |
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Base of Support (m) |
0.1 m ± 0.04 |
0.1 m ± 0.04 |
0.2 m ± 0.04 |
0.2 m ± 0.04 |
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Cadence (steps/min) |
109 ± 1.4 |
105 ± 1.4 |
112 ± 1.4 |
105 ± 1.4 |
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Swing % |
34.5 ± 0.3*? |
35.7 ± 0.3? |
31.4 ± 0.3* |
34.8 ± 0.3 |
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Double Support % |
31.3 ± 0.8? |
28.7 ± 0.8? |
39.3 ± 0.8* |
32.0 ± 0.8 |
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Stance % |
65.5 ± 0.3*? |
64.3 ± 0.3? |
68.8 ± 0.3* |
65.2 ± 0.3 |
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VARIABILITY |
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Stride Length SD(m) |
0.05 ± 0.006 |
0.05 ± 0.006 |
0.09 ± 0.006 |
0.09 ± 0.006 |
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Swing % SD |
2.1 ± 1.3 |
1.9 ± 1.4 |
7.4 ±1.3 |
4.9 ± 1.4 |
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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)
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Forward Walking |
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Backward Walking |
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Freezers |
Non Freezers |
Freezers |
Non Freezers |
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Velocity (m/s) |
1.1 ± 0.04 |
1.2 ± 0.04 |
0.61 ± 0.05 |
0.73 ± 0.05 |
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FAP |
91.4 ± 7.9 |
93.7 ± 8.2 |
55.8 ± 2.2? |
64.1 ± 2.5 |
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Stride Length (m) |
1.2 ± 0.03 |
1.3 ± 0.03 |
0.7 ± 0.04? |
0.8 ± 0.05 |
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Base of Support (m) |
0.1 ± 0.007 |
0.1 ± 0.005 |
0.2 ± 0.01 |
0.2 ± 0.01 |
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Cadence (steps/min) |
109 ± 2.4 |
109 ± 1.7 |
114 ± 4.7 |
110 ± 3.5 |
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Swing % |
33.7 ± 0.42* |
35.2 ± 0.34 |
30.3 ± 0.8* |
32.4 ± 0.6 |
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Double Support % |
32.8 ± 0.84* |
30.0 ± 0.70 |
41.2 ± 2.3 |
37.8 ± 11.6 |
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Stance % |
66.4 ± 0.42* |
64.8 ± 0.34 |
70.0 ± 0.9? |
67.7 ± 0.6 |
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VARIABILITY |
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Stride Length SD(m) |
0.06 ± 0.04 |
0.05 ± 0.04 |
0.1 ± 0.01 |
0.1 ± 0.01 |
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Swing % SD |
2.5 ± 0.2? |
107 ± 0.1 |
8.6 ± 3.2? |
6.4 ± 2.8 |
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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
Parkinson’s Disease:
(Hackney & Earhart, 2009)
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.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.