Backward walking treadmill therapy can improve walking ability in children with spastic cerebral palsy

Abstract

The aim of this study was to determine whether an 8-week period of backward walking (BW) training on the treadmill can improve the gross motor function measure (GMFM), weight-bearing symmetry, and temporospatial gait parameters in individuals with spastic cerebral palsy. Twelve participants aged 5-15 years with spastic cerebral palsy participated in this study. The BW training was conducted on a treadmill for up to 20 min, with three sessions per week for 8 consecutive weeks. Before each treadmill training session, lower limb stretching was included in the session. Interlimb differentials of vertical ground reaction force while standing, temporal-distance gait parameters, and scores of dimension D and dimension E of the GMFM were determined. Participants showed statistically significant improvements in a measure of GMFM (P<0.01) and weight-bearing symmetry value (P<0.05), forward walking velocity (P<0.05), and step/stride length (P<0.05 or P<0.01). This pilot study suggests that BW therapy on a treadmill may help to improve walking abilities and other gross motor skills in this sample of patients.

The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta‐analysis

“…Figure shows the within‐group effect size for each gait outcome reported, and pooled effect of treatment type: physical therapy and strength training; OGT; PBWSTT; treadmill training; gait training enhanced with virtual reality and feedback; and miscellaneous. The miscellaneous studies could not be considered to fit into other groups because of their diverse nature, including studies investigating backward walking, OGT with PBWS, treadmill training with transcranial direct current stimulation, treadmill training with ankle load, and treadmill training after surgery . While interpretation of results of this meta‐analysis should be treated with caution, a tendency towards increased effect size of gait training on walking speed can be observed in gait training groups with gait training enhanced with virtual reality and feedback.…”

“…28 Supporting the trend of improved GMFM dimension E, nine studies in levels IV and V showed improvements in gross motor function surpassing the MCID. 36,38,42,48,54,55,59,63,64 One study reported a significant improvement below the MCID, 57 while Crowley et al 37 found no change in score in a single patient case report. Four studies reported lasting positive effects in gross motor function retained in follow-up from 1 month 31,46,47 up to 6 months after intervention.…”

The effects of backward walking training on balance and mobility in an individual with chronic incomplete spinal cord injury: A case report

“…Studies of the effects of rehabilitation that incorporate backward walking support these assumptions and have demonstrated beneficial effects in individuals with neurologic injuries such as stroke (Weng et al, 2006; Yang et al, 2005) and children with cerebral palsy (Kim et al, 2013). Evidence of the effects of backward walking in individuals with SCIs, however, is currently limited to a single case report.…”

“…Backward walking training is an emerging rehabilitation approach used to promote the recovery of forward walking (Kim et al, 2013; Moriello et al, 2014; Weng et al, 2006; Yang et al, 2005). Backward walking training may afford some unique and potentially beneficial differences compared with forward walking approaches.…”

Steps Forward in Understanding Backward Gait

“…Furthermore, they found that balance function and the motor function of the lower limbs were increased significantly in the BW group compared with those of the control group. Only one study was found that investigated BW training in children with cerebral palsy (25). This study was aimed at examining whether a BW training program would improve the gait characteristics in children with cerebral palsy.…”