Effect of the Forward, Backward and Sideways Gait Training Intervention on Balance and Gait in Children with Spastic Diaplegic Cerebral Palsy

Abstract

Abdullah Ghazi K Al Thobaiti*, Mohamed Bedair Ibrahim, Osama Abd Elfattah El-Agamy, Nesma EM. Barakat

Background: Cerebral palsy (CP) causes movement and posture issues, affecting balance and independence. Rehab aims to improve motor function. Multidirectional gait training boosts balance and gait, as daily movement involves all directions Backward and sideways walking enhance strength, balance, and joint control. This study aimed to compare the effects of forward, backward, and sideways gait training interventions on balance and gait parameters in children with spastic diplegic CP.

Methods: This prospective randomized research included 60 children diagnosed with diplegic CP by pediatricians or Pediatric neurologists. Participants exhibited spasticity graded between 1 and 1+ on the MAS, were classified as level I or II on the Gross Motor Function Classification System (GMFCS), and had no history of Orthopedic surgery. The children were randomly assigned into four equal groups (GPs). GP I received forward gait training on the floor; GP II received backward gait training; GP III underwent sideways gait training; and GP IV received a combination of forward and sideways gait training. All interventions were conducted on the floor and supplemented with a traditional physiotherapy program. Training was performed in both closed and open environments across all GPs.

Results: Post hoc analysis showed the combination training GP significantly outperformed others. In static balance (surface area and length), it differed from forward (P3), backward (P5), and sideway (P6) GPs (all p < 0.0016). In dynamic balance, significant differences were found in surface area (vs. backward, P5 = 0.0242) and length (vs. forward, backward, and sideway; all p < 0.0012). For motor function, gross motor function measure (GMFM-D) was higher than sideway (P6 = 0.0259), and GMFM-E was higher than forward (P3 = 0.0028) and sideway (P6 = 0.0041). The combination GP also showed longer stride length and faster gait speed than all others (all p < 0.0021), and had narrower step width than forward, backward, and sideway GPs (P3 = 0.0461, P5 = 0.0127, P6 = 0.0011).

Conclusions: Multi-directional gait training, which includes walking forward, backward, and sideways, is better for balance, gross motor function, and gait performance in children with spastic diplegic CP than single-directional training methods. After the intervention, the improvements were due to the specific training regimens. The combined training GP had far bigger decreases in balancing surface area and path length, as well as superior GMFM scores and gait parameters. This means they had better control over their posture, were more mobile, and walked more efficiently.