Backward Walking Effects on Toe Walking in a Child With ASD: Single-Case Study

The child's TWB was measured using the BTS P-Walk platform \[2440x740x8 mm, 12,000 sensors\] with an additional 500mm sensor-free mat for accurate start/end measurements. The system focused on foot-ground contact surface area data.Before measurements, the child familiarized herself with the platform through play. All walks were barefoot, with at least 3 attempts per assessment and the clearest data selected. To encourage platform crossing, the child carried a small object to her mother waiting opposite. To prevent upper extremity interference with gait, only return walks (without object) were analyzed for measurement.

The backward walking exercise program was performed on a treadmill at 1±0.2 km/h speed, conducted 5 days per week between 14:00-15:00 hours when the child was most alert according to maternal reports. Initially planned for minimum 5-minute sessions with gradual increases, but the child's short attention span and unfamiliarity with backward walking limited sessions to 3 minutes during first two days. Favorite cartoons displayed via tablet during sessions successfully enabled gradual time increases. Week 1 progressed from 3-5 minutes daily. Weeks 2-5 showed progressive increases to 6-9 minutes with sessions increased to 2 daily, separated by 10-15 minute play breaks. From week 6 onwards, two 10±0.2 minute sessions continued daily. Starting week 3, sessions were restructured as 5 minutes backward + 1 minute forward + 2-7 minutes backward walking to combat attention deficits after 5 minutes, improving exercise efficiency.