An Overview of the Available Intervention Strategies for Postural Balance Control in Individuals with Autism Spectrum Disorder

The effects of balance training intervention on postural control of children with autism spectrum disorder: Role of sensory information

Anodal transcranial direct current stimulation (tDCS) over the primary motor cortex and cerebellum is gaining prominence in the literature due to its potential to favor learning and motor performance. If administered during motor training, tDCS is capable of increasing the effect of training. Considering the motor impairment presented by children with Autism Spectrum Disorders (ASD), atDCS applied during motor training may contribute to the rehabilitation of these children. However, it is necessary to examine and compare the effects of atDCS over the motor cortex and the cerebellum on the motor skills of children with ASD. This information may benefit future clinical indications of tDCS for rehabilitation of children with ASD. The aim of the proposed study is to determine whether anodal tDCS over the primary motor cortex and cerebellum can enhance the effects of gait training and postural control on motor skills, mobility, functional balance, cortical excitability, cognitive aspects and behavioral aspects in children with ASD. Our hypothesis is the active tDCS combined with motor training will enhance the performance of the participants in comparison to sham tDCS. A randomized, sham-controlled, double-blind clinical trial will be conducted involving 30 children with ASD that will be recruited to receive ten sessions of sham or ten sessions of active anodal tDCS (1 mA, 20 min) over the primary motor cortex or cerebellun combined with motor training. The participants will be assessed before as well as one, four and eight weeks after the interventions. The primary outcome will be gross and fine motor skills. The secondary outcomes will be mobility, functional balance, motor cortical excitability, cognitive aspects and behavioral aspects. Although abnormalities in gait and balance are not primary characteristics of ASD, such abnormalities compromise independence and global functioning during the execution of routine activities of childhood. If demonstrated that anodal tDCS administered over areas of the brain involved in motor control, such as the primary motor cortex and cerebellum, can enhance the effects of gait and balance training in only ten sessions in two consecutive weeks, the clinical applicability of this stimulation modality will be expanded as well as more scientifically founded.Clinical trial registration February 16, 2023 (https://ensaiosclinicos.gov.br/rg/RBR-3bskhwf).

Notes from membership

Postural control adaptation to optic flow in children and adults with autism spectrum disorder

Effect of Optic Flow on Postural Control in Children and Adults with Autism Spectrum Disorder

Introduction: Comorbid problems are common in adults with autism spectrum disorder (ASD). The number of studies on the effects of behavioural interventions in adults with ASD is limited, the needs of adults with ASD differ from individual to individual, and the numbers of ASD diagnoses are on the rise worldwide. For this reason, it is of great importance to develop new interventions for adults with ASD and to examine the effectiveness of those interventions on reducing comorbid symptoms. In children with ASD, preliminary positive results are found in interaction with an animal. The effects of Animal Assisted Therapy (AAT) have not yet been studied in adults with ASD. Therefore, this study is focused on the effects of AAT in adults with ASD, without intellectual disability. Methods: The explorative study will be conducted in adults with ASD and aims to provide insight into the effects and feasibility of AAT. The intervention consists of ten weekly one- on-one sessions conducted in the presence of a dog. Participants in this study will be randomized after the baseline measurement and equally distributed towards the AAT or waiting-list control condition. The study outcome measures are self-reported stress, psychological distress, self-confidence, levels of autistic traits, heart rate variability, salivary cortisol, and α-amylase. Data will be analysed with mixed models. A comprehensive process evaluation will be conducted for more insight into barriers and facilitators and into feasibility of the intervention. The medical ethics committee CMO region Arnhem-Nijmegen, the Netherlands, approves this study. Written informed consent will be obtained from all participants before enrolment. Discussion: This study protocol describes a research designed to explore the effects and feasibility of Animal Assisted Therapy in adults with autism spectrum disorder.

“How could I apply this information?” Given the large number of children diagnosed with autism spectrum disorder (ASD), accurate identification of causes for associated deficiencies in acquisition and refinement of motor skills is necessary to develop appropriate treatment strategies. This study provided useful information regarding distinctive differences in landing strategies between children diagnosed with ASD and children developing typically. These differences may guide intervention. Findings of atypical muscle timing pre- and postimpact for children with ASD are consistent with prior research highlighting challenges with postural control, coordination, motor planning, and motor skill imitation. Increased extensor muscle activation preimpact may indicate the need to target feedforward strategies. Increased time in flexion postimpact may indicate the need to address feedback strategies. Cerebellar involvement, common in ASD, may explain these challenges in coordination and muscle activation. “What should I be mindful about when applying this information?” Generalization of the findings of this pilot study is not possible based on the small sample size. The findings, however, provide a place from which to determine next steps for investigation. As ASD has wide variation in symptom type and severity, it is important to understand how this diversity may influence landing preparation and reaction. The ability to predict is commonly impaired in ASD. Investigating the impact of this impairment on preparatory stiffness may provide insight. Future studies may investigate how muscle strength, muscle tone, and range of motion affect kinematic findings for children with ASD. Examining the implication of providing 3 different motor cues postimpact may support clinical decision-making. The results of this study help guide potential interventions for landing preparation and reaction. Further, these findings indicate the need for clinicians to be mindful of injury risk, should immature landing strategies persist for children with ASD. Deb Chamberlain, DPT, DHS, PCS, CBIS Franklin Pierce University Goodyear, Arizona Jennifer Parent-Nichols, DPT, EdD, PCS, CBIS Franklin Pierce University Manchester, New Hampshire

Postural stability and control are essential motor skills for successfully performing various activities of daily living. However, children with autism spectrum disorder (ASD) exhibit significant sensorimotor impairments. The aim of this study was to investigate the efficacy of psychomotricity training on postural control (PC) of children with ASD. We recruited thirty children (age = 8.01 ± 1.2; weight = 31.66 ± 8.1 kg; height = 129.7 ± 10.8 cm) diagnosed with ASD (intellectual quotient > 50) to participate in this study. They were divided into two groups: the experimental group (n = 16) and control group (n = 14). Children in the experimental group were trained with psychomotor activities two times a week for nine weeks. Statistic postural balance was assessed before and after intervention and on different vision conditions. The results showed that the psychomotor training significantly improved PC in standing position under different conditions when compared to the control group, in all parameters (CoPA; CoPLX; CoPLy) (p < 0.01). Our preliminary findings suggest the usefulness of the psychomotor training in children with ASD on static PC.

Transcranial direct current stimulation (tDCS) has gained attention as a potential intervention to improve social cognition in children with autism spectrum disorder (ASD). However, its effects across social domains and the influence of stimulation parameters remain unclear. This systematic review and meta-analysis evaluate the effectiveness of tDCS in enhancing social functioning in children with ASD, focusing on emotion recognition, theory of mind (ToM), and social responsiveness. A comprehensive search identified randomized controlled trials (RCTs) investigating tDCS effects on social cognition in children with ASD. Studies were assessed for effect sizes and statistical significance. A meta-analysis pooled results, and moderators of tDCS effectiveness were examined. Screening 14 studies revealed that anodal tDCS applied to the left dorsolateral prefrontal cortex (DLPFC) produced the most consistent improvements in emotion recognition, ToM, and social responsiveness. However, results varied, with some studies reporting improvements, while others showed no substantial effects. Dual-stimulation or cathodal stimulation yielded mixed outcomes. Evidence was limited by small sample sizes, risk of bias, and variability in stimulation parameters. Anodal tDCS over the left DLPFC shows promise for improving social cognition in ASD. Larger controlled trials are needed to determine the effectiveness of combining tDCS with social skills training. • The left DLPFC is the top targeted brain region for enhancing social cognition in children with ASD. • Emotional recognition, theory of mind, and social responsiveness scale are the most tasks utilized. • Dual stimulation protocols, combining anodal and cathodal tDCS stands out as the most promising stimulation intervention for social cognition enhancements. • Further research with large-scale randomized trials and standardized protocols is needed to optimize tDCS efficacy for children with ASD.

Restricted, repetitive behaviors (RRBs) are one of the core diagnostic criteria of autism spectrum disorders (ASD), and include simple repetitive motor behaviors and more complex cognitive behaviors, such as compulsions and restricted interests. In addition to the core symptoms, impaired movement is often observed in ASD. Research suggests that the postural system in individuals with ASD is immature and may never reach adult levels. RRBs have been related to postural sway in individuals with mental retardation. Our goals were to determine whether subjects with ASD had greater postural sway and whether RBS-R scores were related to the magnitude of postural sway. We compared the center of pressure (COP) sway area during quiet stance with scores on the Repetitive Behavior Scale-Revised (RBS-R) in children with ASD and typically developing (TD) controls ages 3–16. All subjects had Non-verbal IQ > 70. Subjects performed four quiet stance trials at a self-selected stance width for 20 s. Subjects with ASD had greater postural sway area compared to controls. Not surprisingly, subjects with ASD exhibited greater frequencies and intensities of RRBs overall and on all six subscales. Further, there was a positive correlation between postural sway area and presence of RRBs. Interestingly, results of the postural sway area for the ASD group suggests that roughly half of the ASD subjects scored comparable to TD controls, whereas the other half scored >2 SD worse. Motor impaired children did not have significantly worse IQ scores, but were younger and had more RRBs. Results support previous findings of relationships between RRBs and postural control. It appears that motor control impairments may characterize a subset of individuals with ASD. Better delineation of motor control abilities in individuals with ASD will be important to help explain variations of abilities in ASD, inform treatment, and guide examination of underlying neural involvement in this very diverse disorder.

Objective:This study aimed to investigate the effect of balance rehabilitation on postural control in both low and increased cognitive load conditions in two children with Autism Spectrum Disorders (ASD). Methods: Two children diagnosed with ASD participated in a 4-week personalized balance rehabilitation program with two sessions per week. We assessed postural control in two single task (ST) conditions with low cognitive load: Eyes Closed (EC), Eyes Open (EO); and in five increased cognitive load conditions. Those dual task (DT) conditions consisted of presenting images representing a neutral condition, sadness, anger, happiness, and fear. Postural control parameters (surface, velocity, medio-lateral and antero-posterior sway amplitudes of the center of pressure (CoP)) were collected by a posturographic platform before and after the balance rehabilitation. Results: The rehabilitation program resulted in a 30–96% improvement of postural control parameters in the ST condition for both participants. In DT, participant 1 progressed on all conditions while participant 2 progressed on 3 of the 5 conditions (sadness, anger and fear). Conclusion: This suggests that these two children with ASD improved their balance control in both low and increased cognitive load conditions. These encouraging results need to be replicated before recommending balance rehabilitation as standard health rehabilitation in children with ASD.

Introduction: Autism Spectrum Disorder (ASD) is among the most common childhood disorders. The current study aimed to investigate the effect of Kangoo Jump (KJ) exercises on dynamic balance and overall postural oscillations in children with ASD. Materials and Methods: This was a quasi-experimental study. Among children with ASD in the Autism Association and Autism Schools in Tehran City, Iran, 20 subjects were selected using screening tests; after assessing the dynamic balance and general postural sway as a pretest, they were randomly divided into two groups of experimental and control. The experimental group performed KJ exercises for 8 weeks; eventually, all individuals were tested for dynamic balance and postural control as a posttest. The obtained data were analyzed using Analysis of Covariance (ANCOVA). Results: This study suggested that performing KJ significantly improved the dynamic balance in children with an ASD disorder. There was a significant difference between the mean scores of the control and experimental groups in the posttest stage in dynamic equilibrium (P&lt;0.001); however, no difference was observed between the study groups in postural control. Conclusion: Using KJ to improve dynamic balance in children with ASD is beneficial. Therefore, these interventions can improve various aspects of development and balance in children with ASDs.

Stroke is the leading cause of death and disability worldwide. Stroke survivors often have deficit in motor control which contributed to reduced balance, postural control and mobility. The majority of published studies reported positive results but traditional rehabilitation programmes tend to be tedious and require specialized facilities or equipment. Virtual reality (VR) has a prominent role in promoting functional recovery after stroke. It has the potential to deliver the effective intervention at low cost. VR provides enriched motivational training and goal-orientated tasks which improve patients’ adherence to programme. Previous studies indicated that it might be more effective in improving dynamic balance control and preventing falls in subacute and chronic stroke patients compared to conventional therapy. To critically evaluate the studies that were conducted and to assess the impact of virtual reality on static and dynamic balance control in the stroke population.Methods: We did a systematic review and network meta-analysis. We searched PubMed, Google Scholar and MedRxiv for correct data. In this study we included all the descriptive studies, meta-analysis and statistical analysis studies which deals with virtual reality on postural and balance control among stroke. We extracted data following predefined hierarchy. In this studies, we assessed the knowledge of virtual reality of postural and balance control among stroke patients.Findings: According to the 15 studies we identified, involving 1000 individuals, Reduced balance and postural control is a major contributor to functional limitations and barriers to perform activities of daily living in patients with stroke. This study reviewed existing evidence on the effect of the virtual reality training on balance and postural control.With the fair and moderate quality evidences, the study found that the virtual reality training is an effective alternate to the routine rehabilitation to improve dynamic balance and static balance in patients with chronic stroke. But simply the virtual reality training wouldn’t be an effective way to deliver balance control in patients within a home setting without therapist's input. However, the virtual reality training combined with conventional rehabilitation program with some therapeutic exercises will be more effective in delivering static and dynamic balance control in stroke patients.

Decreased dynamical complexity during quiet stance in children with Autism Spectrum Disorders

Effects of visual search vs. auditory tasks on postural control in children with autism spectrum disorder