One Step Backward, One Step Forward to Independence

By Carlos Pineda, CTO/DOR, Southland Care Center, Norwalk, CA
We are launching our “prototype” Tandem Backward Walking I-Southland Tool in a Lunch and Learn training. This maintenance series is dedicated to the person who inspired Southland to pursue greatness with maintaining the function of our beloved residents: Bertha Spaeder (pictured with Roger Pavon, PTA). Bertha has been my inspiration in pursuing greatness for our beloved patients. I named this tool after Bertha. ” B.S.MP01″ –Stands for Bertha Spaeder Maintenance Program series 01. Standardized testing and strategies are also part of the training. This evidence-based group therapy program aims to minimize fall risk.

Bertha Spaeder Maintenance Program Series 01
Walking backward is essential in our daily life: when opening a door, backing away from a kitchen sink, stepping from the curb as a swiftly-moving bus passes, during toileting, or opening the refrigerator. An effective compensatory stepping response is the first line of defense for preventing a fall during sudden large external perturbations. Falling backwards is common among our elderly population especially with comorbidities like Parkinson’s disease and CVA.

A validated standardized test, “Backward Walk Test,” assesses ability to walk backward. On the 3-meter backward walk test, if the individual completed the backward test in more than 4.5 seconds, the person is at risk for falling. Following is the procedure:


  1. Check Vital Signs
  2. Introduce the patients to each other
  3. Educate patients on the purpose
  4. Demonstrate the procedure
  5. Start with slow pace (60bpm on metronome) or let patient count on every step or state which leg will go first (Right…, Left…)
    a. For Progression – increase by 10 bpm every week or as needed, if safe.
    b. To add cognitive challenge, ( 1. ) Ask the patient to count backward simultaneously with the metronome beat. (2.) Instruct patient to turn head Right<>Left while walking backward.
  6. Assess for any gait deviation
  7. Repeat

Group activity should be graded and have enough stimulus/challenge to promote physiological changes. This can be effectively done using the Borg Scale. It is a skilled and billable service provided by qualified therapists that requires continuous analysis, assessment and monitoring during the intervention. Tandem Backward Walking group therapy promotes teamwork and a sense of purpose. As biopsychosocial therapists, we address not only the impairments but also the psychosocial wellbeing of the patient. We identify and take aim on what is important to the patient and on how they define quality of life.