Conditioning Effects of Backward Treadmill Training in Children With Spastic Diplegic Cerebral Palsy

Abstract

Background: A new way to increase the challenge of walking is to walk backwards. Backward treadmill walking may provide advantages by promoting improvement in balance, walking spatiotemporal parameters and quality that may reflect in improving walking speed. Information about the energy expended by the patient during ambulation could provide objective data to help guide the decision-making process.Objective: To evaluate the effects of a backward treadmill training program in improving walking endurance in children with cerebral palsy. Materials and Methods:Twelve children diagnosed with spastic diplegic cerebral palsy from both gender were included in this study. They were divided into 2 groups, group A (control) received the regular therapeutic exercise program according to neurodevelopmental approach for such cases and group B (study) received the regular therapeutic exercise program for such cases along with 20 min backward treadmill walking using Biodex gait trainer equipment. Heart rate was monitored continuously each session for both groups. walking speed was assessed using The Biodex Gait Trainer 2TM and energy expenditure index was assessed by measuring heart rate using pulsometer (Japan model Tunturi TPN-400) for both groups before and after three months of the treatment program.Results: There was statistically significant improvement in walking speed in the study group (P<0.05) with significant difference when comparing post treatment results between groups (p<0.05), but The change in mean EEI scores was not significant when comparing post treatment results between groups while there were a significant improvement in mean EEI scores within groups. Conclusion:This study demonstrated an effective protocol using backward treadmill training to increase walking speed and endurance in children with CP. Although no significant change in EEI scores was noted and the sample size was small. This gait training method provides a safe and controlled environment for children to perform continuous walking at a cardiovascular training intensity to improve their gait and fitness.

Effects of backward gait training on balance, gross motor function, and gait in children with cerebral palsy: a systematic review

“…After screening titles and abstracts and removing duplicates, 38 full papers were retrieved. After assessing articles against the eligibility criteria, seven papers [14][15][16][17][18][19][20] were included in the review ( Figure 1 25 ; see Supplementary Appendix 1 for search strategy and the list of excluded studies). Table 2 presented the summary of the included studies.…”

“…All the papers were randomized, analyzed the between-group difference, reported point estimates and variability. Most studies 14,16,17,19,20 (71%) did not report < 15% loss to follow-up, conceal the allocation list nor had blinded assessors. None of the studies carry out an intention-to-treat analysis, nor blind participants or therapists.…”

“…6 Another reported explanation was the greater muscle strength gain in the lower limbs during backward gait training that was attributed to the longer period of muscle activity when compared with forward gait training, also the sufficient practice opportunities was stated as an explanation for stability improvement in children with cerebral palsy who practiced backward gait training. 18,28 Findings of this review revealed limited evidence from two low-quality studies 16,20 that backward gait training increases gait speed when compared to no intervention, while moderate evidence from one high-quality study 18 was found that backward gait training improves gait parameters including walking velocity when compared to the same dose of forward gait training. Although results of the three studies 16,18,20 were consistent that backward gait training improves gait speed, the present evidence is limited and not clear by considering also the heterogeneity between the inclusion criteria of the high-quality study 18 with the other two studies 16,20 and the method of training.…”

“…Studies in this review included children with cerebral palsy of hemiparetic type (Gross Motor Function Classification System (GMFCS) levels I and II) 14,15,18 and diplegic type (GMFCS levels I to III). 16,17,19,20 Moderate evidence from one high-quality study 18 was found that backward gait training improves gross motor function and gait parameters when compared to the same dose of forward gait training. Improvement in gross motor skills as standing and walking that involve upright posture was attributed to the improved neuromuscular control after backward gait training that overcomes the lower limbs extensor synergy pattern by repeated practicing of knee flexion combined with hip extension.…”

“…12 A narrative review of the literature was done in 2015 by Joshi et al 13 about the role of retro-walking or backward gait training in physiotherapy and rehabilitation; it showed the limited evidence of retro-walking effect on balance and gait in children with cerebral palsy. Afterward, several studies [14][15][16][17][18][19][20] suggested that backward gait training could be used in children with cerebral palsy.…”