Abstract

Background and Purpose: Cerebral palsy is associated with persistent impairments in movement control, balance, and walking. This study aimed to compare walking training with and without task constraint manipulation regarding walking performance, balance, and participation in children with unilateral spastic cerebral palsy.

Methods: This quasi-experimental study employed a pretest-posttest design with a control group. Thirty children (aged 7–12 years) with unilateral spastic cerebral palsy were selected via convenience sampling and randomly assigned to three groups of ten: constraint manipulation training, training without constraint manipulation, and a control group. The intervention lasted eight weeks, consisting of three 30-minute sessions per week. Walking performance, balance, and participation were assessed using the 10-Meter Walk Test, the Berg Balance Scale, and the CAPE questionnaire, respectively. Data were analyzed using mixed-model ANOVA; robust tests were used in cases where the assumption of homogeneity of variance was violated.

Findings: The group-by-time interaction was significant for 10-meter walk time (P<0.001), balance (P=0.003), and participation diversity (P<0.001). At posttest, the constraint manipulation group showed a faster 10-meter walk time and higher balance scores compared to both other groups. Regarding participation diversity, the posttest difference was significant only between the constraint manipulation group and the control group (P=0.006). No significant effect was observed for participation intensity. For participation enjoyment, despite a significant interaction (P=0.002), the posttest differences between groups were not significant.

Conclusion: Walking training based on constraint manipulation was associated with improvements in walking performance and balance; However, the differences in participation were limited and uneven.