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

Aim: 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). Methods: Fifty-two adolescents with ULCP (age: 10–16 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 (LoS_directional) and overall (LoS_overall) 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. Results: The Sb-TW group demonstrated more favorable changes in step-length asymmetry (p <.001, η ²_partial = 0.27), LoS_directional [affected side direction (p =.033, η ²_partial = 0.09), forward direction (p =.004, η ²_partial = 0.16), and backward direction (p =.01, η ²_partial = 0.12)], and LoS_overall (p <.001, η ²_partial = 0.31) than the control group. Also, the Sb-TW group showed significantly higher locomotor capacity [6-MWT (p <.001, η ²_partial = 0.38), TUDS (p =.032, η ²_partial = 0.09), 10mSRT (p =.021, η ²_partial = 0.10)] as compared to the control group. Conclusion: 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.