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Exploring temporospatial gait asymmetry, dynamic balance, and locomotor capacity after a 12-week split-belt treadmill training in adolescents with unilateral cerebral palsy: a randomized clinical study
Elnaggar RK, Alhowimel A, Alotaibi M, Abdrabo MS, Elfakharany MS
Physical & Occupational Therapy in Pediatrics 2023;43(6):660-677
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

To investigate the effects of a 12-week split-belt treadmill walking (Sb-TW) practice using an error augmentation strategy on temporospatial gait asymmetries, dynamic balance, and locomotor capacity in adolescents with unilateral cerebral palsy (ULCP). Fifty-two adolescents with ULCP (age 10 to 16 years) were randomized into either the Sb-TW group (n = 26; underwent repeated Sb-TW practice, with exaggeration of the initial step-length asymmetry, three times/week, for 12 sequential weeks) or control group (n = 26; received equivalent dosages of traditional single-belt treadmill training). Step-length and swing-time asymmetries, directional (LoSdirectional) and overall (LoSoverall) limits of stability, and locomotor capacity (6-minute walk test (6-MWT), Timed Up and Down Stair test (TUDS), and 10-m Shuttle Run Test (10mSRT)) were assessed pre- and post-intervention. The Sb-TW group demonstrated more favorable changes in step-length asymmetry (p < 0.001, eta2partial = 0.27), LoSdirectional (affected side direction (p = 0.033, eta2partial = 0.09), forward direction (p = 0.004, eta2partial = 0.16), and backward direction (p = 0.01, eta2partial = 0.12)), and LoSoverall (p < 0.001, eta2partial = 0.31) than the control group. Also, the Sb-TW group showed significantly higher locomotor capacity (6-MWT (p < 0.001, eta2partial = 0.38), TUDS (p = 0.032, eta2partial = 0.09), 10mSRT (p = 0.021, eta2partial = 0.10)) as compared to the control group. The Sb-TW-induced adaptations can be capitalized on for remediating spatial gait asymmetry, dynamic balance deficits, and impaired locomotor performance in adolescents with ULCP.
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