Evaluation of the Applicability and Reliability of the Three Meter Backwalk Test in Children With Cerebral Palsy (CP)

Cerebral palsy (CP) is a non-progressive disturbance in the development of movement and posture that occurs in the prenatal or postnatal period, causing activity limitations. Most children and adolescents with CP experience limitations in their walking skills. Restrictions in the walking ability of children with CP are an important issue for both parents and healthcare professionals involved in their treatment.

The evaluation of walking is of great importance in terms of determining the effectiveness of the physiotherapy program, shaping the program, planning orthopedic and surgical applications, and determining the effectiveness, especially in children with CP who have walking potential. In the literature, easy-to-use, valid and reliable observational gait analysis that can evaluate gait pathologies and clinical gait in children with CP are emphasized. These measurements are of great importance in clinical practice.The ability of backward walking gives the child a different task than normal, allowing the observation of body perception, trunk stability provided by anterior-posterior co-contractions, balance, correction and protective reactions.

The main purpose of CP rehabilitation is to ensure that the child gains maximum functional independence by obtaining the optimal development potential. Therefore, walking restrictions are one of the important problems in children with CP.

The most common type in the CP classification is the spastic type. The types with the best functional independence level in this group are; hemiparetic and diparetic CP. They do not have a good motor coordination due to stability problems caused by deviations in the center during walking. This situation affects balance and walking performance. As children get older, impairments in their walking ability become more pronounced. In addition to all these problems, hypertonus, increased stretching reflex, muscle weakness, coactivation in antagonist muscles, posture disorders, loss of proprioception, muscle and joint deformities are other factors that cause gait disturbances in children with CP. Therefore, the walking problems of the child with CP should be examined more clearly. At this point, it assigns a different task to the child with the evaluation of backward walking, and provides observation of body perception, trunk stability provided by anterior-posterior co-contractions, balance, correction and protective reactions. This observation ensures that the problem that will guide the treatment is precisely determined.The only test that can be applied to evaluate the ability to walk back is the three meter backward walk test. This test has been found to be valid and reliable in both the elderly population and patients with total knee arthroplasty.In the literature, there is no study about the three-meter backwalk test in children with CP. In this study, it was aimed to evaluate the backward walking skills of children with CP with the three meter backward walk test and to examine the applicability and reliability of the three meter backward walk test in children with CP.

Eligibility Criteria:
Inclusion Criteria:

* Children aged 8-18 years with a diagnosis of Hemiparetic and Diparetic SP with a Gross Motor Function Classification System (GMFCS) Level ≤ 3
* Children diagnosed with CP with Communication Function Classification System (CFCS) ≤ 3
* Children with ≤ 3 according to the Modified Ashworth Scale (MASH)
* Complete range of passive range of motion in the ankle and knee joints
* Volunteering to participate in the study

Exclusion Criteria:

* Not having Botulinum toxin or surgical operation in the last 6 months
* Having contracture in the ankle and knee joints