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

https://doi.org/10.1016/j.rasd.2013.09.016Get rights and content

Highlights

  • Children suffering from ASD can benefit from such balance training programs to improve their balance and postural control.

  • Autistic children can use training as normal children, may with some differences.

  • This method (use of balance training) in autistic children is done for first time in the current study.

Abstract

Purpose

The aim of this study was to investigate the effect of balance training intervention in children with autism spectrum disorder (ASD), and to explore the relative role of the sensory systems in such kids.

Methodology

We recruited 20 school children (IQ > 80) diagnosed with ASD, and categorized them in two groups; a 10-member training group (average age: 7.70 ± 1.05) and a 10-member control group (average age: 7.90 ± 1.10). Thus, following a six-week-long balance training intervention in four conditions of bipedal upright stance [compliant (Foam) vs. non-compliant (Hard) with eyes-open (EO) vs. eyes-closed (EC)], we examined measures such as mean velocity (V), anteroposterior (AP) and mediolateral (ML) axis displacement, and compared the results to those calculated prior to the initiation of the intervention using MANOVA test.

Results

This study showed that the balance training program efficiently improved the postural control in ASD suffering children, and that removing the visual and plantar proprioceptive information led to increased sway in both groups. The training group performed significantly better than the control group in all conditions.

Conclusion

It is thus concludable that children suffering from ASD can benefit from such balance training programs to improve their balance and postural control.

Introduction

Children with autism spectrum disorder (ASD) primarily suffer from impairments in communication and social interaction, though recent literature supports the prevalence of motor impairments (Fournier et al., 2010). The prevalence rate of ASD continues to increase with 1 child in 88 having ASD, with males being 5 times more likely to be diagnosed than females (Centers for Disease Control & Prevention, 2012). ASD is a disorder with a wide range of impairments of body structures and functions, many of which impact postural control. Postural stability is defined as the ability to maintain the projected center of mass (COM) in the base of support (Dusing & Harbourne, 2010). Children with ASD showed higher instability in mediolateral than anteroposterior axis though typically developing (TD) children demonstrated higher sway scores in anteroposterior than mediolateral direction (Memari et al., 2013).

On the other side, the vestibular, somatosensory (including proprioceptive and cutaneous inputs) and visual systems are the afferents involved in the complex process of maintaining upright balance in humans. Any deficit in these systems or in the integration of information from these systems could affect balance. Sensory impairments are common in children with developmental disabilities (Gal, Dyck, & Passmore, 2010), and they are at an increased risk for visual impairments (Creavin & Brown, 2009). Of particular importance are the identified deficits in postural control (Gepner & Mestre, 2002). Previous research on such children has identified deficits in motor development (Provost, Lopez, & Heimerl, 2007), coordination and general motor function (Jansiewicz et al., 2006), and the planning and execution of movement (Rinehart et al., 2006). There is a paucity of research on the use of the somatosensory and postural control for children with ASD. Kohen-Raz, Volkman, and Cohen, 1992 were the only ones to suggest that children with ASD may prefer using the somatosensory system to maintain balance. Also ASD children have been found to have deficits in various motor control areas, including hypotonia and motor apraxia (Ming, Brimacombe, & Wagner, 2007), overall gross motor development, locomotor and object control skills, manual dexterity, ball skills and balance (Green et al., 2009), and a general deficit in manual responses to visual stimuli (Todd, Mills, Wilson, Plumb, & Mon-Williams, 2009).

The efficacy of balance training programs for children is not well understood. Many interventions and exercise programs include balance components, but there are few research studies that focus solely on balance training for children with developmental disabilities. Wang and Chang (1997) specifically studied the effects of a jumping skill program on balance during gait among children with mental retardation and Down syndrome. Shumway-Cook, Hutchinson, Kartin, Msme, and Woollacott (2003) also reported improvements in balance with cerebral palsy following an intervention program. Most of the balance intervention studies involve the elderly population. But there has been no research about possible influences of balance training interventions on postural control in ASD suffering children. In general, there has been little research regarding characteristics of postural control in ASD. It has been assumed that postural control is best achieved when postural sway is held to a minimum. Based on this assumption, researches have shown that balance training can improve postural control in healthy (Kovac, Birmingham, Forwell, & Litchfield, 2004), injured/diseased (Kidgell et al., 2007, McKeon et al., 2008), and elderly populations (Nagy et al., 2007).

Some researchers have focused on examining the effects of various constraints (e.g., disease state, restricted vision, and heightened attentional awareness) on postural sway (Roerdink, Hlavckova, & Vuillerme, 2010). Much research has been devoted to improving postural control through exercise programs. However, there is insufficient research investigating the use of balance training programs in the developmental disabilities. On the other hand, based on neurobehavioral studies, children with ASD have structural or functional impairments (Nayate, Bradshaw, & Rinehart, 2005). In the present research, we aimed to examine the effect of progressive balance program on the improvement of postural control in children with ASD, and to measure the relative role of the sensory systems in this regard. We hypothesized that balance program could reduce postural sway in ASD suffering children. We further hypothesized removing the visual and plantar proprioceptive information could lead to increased levels of postural sway.

Section snippets

Participants

A total number of twenty participants were selected for this study, and were assigned to two groups: control group (average age: 7.90 ± 1.10) and training group (average age: 7.70 ± 1.05). Each group consisted of 10 boys aged 7–10 years old diagnosed with high functioning ASD (IQ > 80). Each child had to meet the criteria of ASD diagnosis on both DSM-IV (Association and DSM-IV, 2000) and the autism diagnostic inventory-revised (ADI-R) (Lord, Rutter, & Le Couteur, 1994) which was examined by a child

Results

The participants’ characteristics are presented in Table 2. Means (±SD) COP measures in different sensory conditions in pre-test and post-test for children with ASD are listed in Table 3. The significant difference between the pre- and post-test results are indicative of improvement. Multivariate analysis of variance (MANOVA) indicated no significant differences between groups (F(70, 3) = 0.443 P > 0.05), visual condition (F(70, 3) = 1.852 P > 0.05) and (F(70, 3) = 1.874 P > 0.05) in pre-test phase.

Discussion

The review of literature indicates poor postural control in children with ASD. No research has been dedicated to the improvement of the aforementioned shortcoming so far. Therefore, the present study aimed to investigate the effect of balance training on postural control in children with ASD to come over a solution for these deficiencies. Furthermore, we aimed to examine the role of sensory information. Results of the present study suggested that balance training resulted in the improvement of

Acknowledgements

The authors wish to thank the children and families who participated in the study. We gratefully acknowledge the considerable assistance and technical guides of Mr. Ahmad Ghotbi vazane, Mr. Rouhola fatemi, and Dr. Maryam Alsadat Shetab Boshehri.

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