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 BS scores increased from 21.45 ± 3.79 to 28.50 ± 2.96 (DTT) and 22.36 ± 3.96 to 29.00 ± 3.30 (DTT + BW), with no significant Group × Time interaction ( p = 0.680). TUG times decreased from 20.82 ± 4.04 to 17.23 ± 4.05 s (DTT) and 21.41 ± 3.22 to 16.86 ± 3.24 s (DTT + BW), with a significant interaction ( p = 0.003, partial η 2 = 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 )