What question did this study set out to answer?

To evaluate the impact of backward walking exercises on toe walking behaviors in a child with autism spectrum disorder.

March 23, 2026Acta Psychologica0 citationsOpen Access

Preliminary evidence for backward walking to reduce toe walking in autism spectrum disorder: A single-case experimental pilot study

Key Points

To evaluate the impact of backward walking exercises on toe walking behaviors in a child with autism spectrum disorder.
Single-case experimental design with A–B–A reversal phases
Implemented backward walking exercises five days per week on a treadmill
Utilized pedobarographic measurements to assess toe walking
Analyzed data through visual analysis and effect size calculations
Increased plantar surface area in both feet during intervention
Significant improvement in toe walking for the right foot (p = 0.009)
Improvement for the left foot (p ≤ 0.016)
Improvements maintained during monitoring phase, though attenuated

Abstract

This pilot study investigated whether backward walking (BW) exercises could reduce toe walking behaviors (TWB) in a child with autism spectrum disorder (ASD) and evaluated the utility of pedobarographic measurements to quantify TWB. This prospective single-case pilot study, conducted per SCRIBE guidelines, employed an A–B–A reversal design with 1-week baseline, 9-week intervention, and 1-week monitoring phases. The participant was a 41-month-old girl with ASD who exhibited TWB (pseudonym “Daisy”), and the BTS P-Walk platform was used to measure plantar surface area. Backward walking exercises were implemented on a treadmill five days per week, adapted to developmental characteristics. Data analysis included visual analysis, internal and social validity, and effect size calculations. Results showed gradual increases in plantar surface area bilaterally, suggesting a potential reduction in TWB. Preliminary findings indicated improvements for the right foot during weeks 8–9 (x̄ =42.78–42.82 cm 2 vs. baseline x̄ =33.58 cm 2 ; p = 0.009, Tau = 1, IRD = 1) the left foot (x̄ =45.22–47.28 cm 2 ; p ≤ 0.016, Tau≥0.92, IRD ≥ 0.80), with these statistics providing supportive evidence for the observed changes. The monitoring phase indicated that improvements were maintained, albeit attenuated. Pedobarographic measurements may provide a quantitative assessment of TWB. BW exercises appeared to reduce TWB and may benefit motor development in this case. The preliminary findings derived from the single-case design limit generalizability; therefore, larger samples should be tested before making clinical recommendations. Future research should include controlled studies and examine the biomechanical analyses and muscle properties underlying the mechanisms of BW. • Backward walking was associated with reduced toe walking in a single child with ASD. • Pedobarographic assessment enabled objective, quantitative monitoring of toe walking. • Backward walking may support changes in maladaptive gait patterns in ASD.

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