Effects of Dual‐Task Training With and Without Backward Walking on Balance, Functional Mobility, and Participation in Ambulatory Children With Spastic Diplegic Cerebral Palsy: A Randomized Controlled Trial

BACKGROUND AND PURPOSE: Children with cerebral palsy (CP) commonly have impairments in balance, functional mobility, and participation. Whether adding backward walking (BW) to dual-task training (DTT) provides additional benefit is unclear; this study compared DTT alone with DTT + BW. METHODS: Forty-four children aged 6-12 years with spastic diplegic CP (Gross Motor Function Classification System [GMFCS] Levels I-II) were randomly allocated to DTT alone or DTT + BW, four 40-min sessions weekly for four weeks, in a randomized controlled trial with blinded data analysis. BW replaced an equivalent proportion of forward walking, keeping the total training time equal. Outcomes at baseline and immediately post-intervention were the Timed Up and Go test (TUG; primary), Pediatric Balance Scale (PBS), and Pediatric Outcomes Data Collection Instrument (PODCI; secondary). Analyses used mixed repeated-measures ANOVA, with ANCOVA as a sensitivity analysis for PODCI. RESULTS: = 0.190). PODCI scores increased from 163.14 ± 4.84 to 188.36 ± 3.30 (DTT) and 160.05 ± 7.91 to 187.45 ± 5.74 (DTT + BW), with no significant interaction (p = 0.052). CONCLUSIONS: In ambulatory children with spastic diplegic CP (GMFCS Levels I-II), adding BW to DTT was associated with a small additional improvement in functional mobility over 4 weeks (approximately 1 s on the TUG) of uncertain clinical importance, whereas superiority for balance or participation was not demonstrated; the trial was not powered for these secondary outcomes, so this is not evidence of equivalence. Without a non-DTT comparison group, standalone DTT efficacy cannot be established. TRIAL REGISTRATION: NCT06407765 (https://clinicaltrials.gov/study/NCT06407765).