Development of postural stability in children with autism spectrum disorder: a cross-sectional study

Postural Control in Children with Autism Spectrum Disorders: What are the Most Striking Specificities and How Can They be Quantified?

Autistic children (AT) are known to exhibit distinct postural control patterns compared to neurotypical (NT) children. However, identifying and interpreting these differences can be complex due to the wide range of variables used to analyse Centre of Pressure (CoP) trajectories. This study aims to elucidate the specific characteristics of postural control in AT children by identifying the most discriminative CoP variables that distinguish them from NT children. The study evaluated 24 AT and 24 NT children while they stood on a force plate for 30 s under three conditions: eyes open (EO), eyes closed (EC), and the feet on a foam pad with eyes open (EOF). A total of 75 variables-including frequential, linear, and non-linear variables-were extracted from the CoP trajectory. These variables, expressed as the rate of change between the EC and EOF conditions relative to the EO condition, were compared between the AT and NT groups. A best-subsets approach was used to identify the most discriminative variables, and Pearson correlations were calculated to assess their relationship with age and Social Responsiveness Scale (SRS) scores. Of the 75 variables analysed, 15 showed significant differences between the AT and NT groups. The best-subsets analysis and the correlations revealed that variables such as the rate of change between the EOF and EO conditions, and the root mean square of the trembling component of the CoP trajectory, were particularly discriminative. Autistic children demonstrated a more rigid and regular CoP trajectory, particularly in the EO condition, compared to NT children. These findings suggest that AT children have greater difficulty integrating multisensory information and an increased reliance on supraspinal processes for postural control.

Atypical Postural Control Variability and Coordination Persist Into Middle and Older Adulthood in Autism Spectrum Disorder

Postural control deviations remain largely unexplored in middle aged and older autistic adults. With the increased prevalence of neurodegenerative conditions and heightened fall risk, precise quantification of postural variability and coordination may provide valuable insights into aging associated neuromotor deviations in autistic adults. Forty-seven autistic and 48 non-autistic individuals completed static stance, anterior-posterior (AP), and mediolateral (ML) postural sway on a force platform. Center of pressure (COP) metrics were derived and interpreted using ANCOVAs for between-group comparisons and multilinear regressions for group ×  age interaction. Correlations between clinical measures and COP variables that differentiated groups were explored. Compared to non-autistic individuals, autistic adults exhibited greater COP standard deviation (COPSD) and COP trajectory length during static stance and demonstrated significant COPSD-AP reductions in older age. Autistic adults also exhibited decreased COP range of motion (ROM) but increased ROM variability in the target direction during dynamic stance. Autistic adults' postural sway was jerkier during dynamic stance, and increased ROM variability during dynamic AP sway was moderately associated with lower verbal IQ in autistic adults. Our findings highlight persistent postural control deviations in middle aged and older autistic adults. Static and dynamic stance are differentially associated with unique profiles of postural control in ASD. Specifically, autistic adults demonstrated pronounced increases in postural sway variability during static stance, while reducing coordination during dynamic conditions. The extent to which postural control deviations found in autistic adults are predictive to the onset of neurodegenerative conditions and the severity of falls warrants future longitudinal research.

Effects of Horseback Riding on the Postural Control of Autistic Children: A Multiple Baseline Across-subjects Design

The aim of this research was to study the effect of a horseback-riding programme on postural control in a group of autistic children (ASD). Nine children aged 9 to 12 years participated in this study through a multiple baseline across subjects design. The whole programme took place over nine months. Participants followed a previously developed specific horseback-riding programme, consisting of 45-minute sessions held twice a week for at least three months. To evaluate postural control, the average velocity of the centre of pressure displacement was measured by means of a posturographic platform. Results indicated that this intervention with horses had a positive effect on the postural control in children with ASDs.

Postural Differences in Speaking Versus Non-Speaking Children with Autism Spectrum Disorder

Background/Objectives: Autism spectrum disorder (ASD) is a heterogeneous condition with diverse symptoms influenced by factors like gender, severity and the involvement of family and therapists. While many risk factors that contribute to ASD development are known, the exact etiology remains unclear. The relationship between speech ability and postural/gait patterns in ASD has not been extensively studied. This study aimed to verify if the ability to speak can affect body posture and gait patterns. Methods: The study involved 28 boys aged 6-17. The postural assessment used the Adams test, Bunnell scoliometer, goniometer, and inclinometer to measure trunk rotation, joint range of motion, and spinal curvature. Trunk muscle strength was assessed via a flexion test measuring position maintenance time. This study compare body posture parameters in speaking and non-speaking children with Autism Spectrum Disorders. Moreover the parameters were compared to the general norms. Results: The study observed a tendency for speaking children to deviate more from normative body posture. They presented shoulder protraction more often, increased lumbar lordosis angle, and anterior pelvic tilt. Additionally, non-speaking children were more prone to toe-walking, which, according to other studies, is present in approximately 8-9% of all children with autism spectrum disorders. Both groups presented a decreased angle of dorsal flexion in the ankle joint. Conclusions: This study suggests that speaking children with ASD exhibit greater anterior-posterior postural deviations (increased lumbar lordosis, shoulder protraction, anterior pelvic tilt) than non-speaking children. ASD did not affect scoliosis or trunk rotation. Non-speaking children showed a higher incidence of toe-walking. However, the small sample size limits the generalizability of these findings.

Postural balance control interventions in autism spectrum disorder (ASD): A systematic review

BACKGROUND

Postural control (PC) disturbances in autism spectrum disorder (ASD) are associated with its severity. Varied sensorimotor interventions have been used for the management of these symptoms. However, there is a lack of a review elucidating all the available postural control interventions in ASD.

RESEARCH QUESTION

To comprehensively present the variety of interventions targeted at improving PC in ASD and to provide future research recommendations.

METHODS

PubMed, SCOPUS, Embase, Cochrane, ScienceDirect and Web of Science databases were searched for publications examining the effects of PC targeting interventions in those with ASD. Included articles were in English, published after 2000 in the peer-reviewed journals with full text available and used intervention targeted at improving PC or balance with a predefined objective outcome measure for accessing PC or balance. Initial database search yielded 1022 studies and 21 articles were included in this review after screening.

RESULTS

We identified diverse PC interventions including animal assisted therapies, karate/martial arts, aquatic exercises, virtual reality-based training, standard and customized exercises, and physical activity programs. The effect of long- and short-term interventions on PC improvement in children and adults with ASD is mixed. Future research should focus on undertaking randomized controlled trials with large sample size and participants with varying severity of ASD to improve generalizability of the study findings. The lack of population-specific, reliable, and validated motor outcome measures including neuro-imaging techniques should be addressed.

SIGNIFICANCE

While many of the interventions improved PC in those with ASD, the sample size and methodological quality of the studies was highly variable. There are limited studies exploring the long-term effects of the interventions. Rigorous study methods with population-specific objective outcome measures are warranted to draw generalizable conclusions regarding the PC interventions in individuals with ASD.

Modulation of center-of-pressure signal in children on the autism spectrum: A case-control study

BACKGROUND

Proper postural and motor control plays a fundamental role in the child's ontogenetic development. So far, the postural control in children on the autism spectrum has mainly been assessed with standard posturographic measurements of center of pressure (COP) displacements.

RESEARCH QUESTION

What are the differences in postural control between autistic and typically developing children?

METHODS

The study group comprised 16 autistic children aged 6-10 years, identified by a psychiatrist. The control group consisted of 16 typically developing children aged 6-10 years with no posture deformities, no pervasive developmental disorder and no history of postural control or movement deficits. The data were collected during quiet standing with eyes open using a force plate. To gain a better insight into the postural control processes, the rambling-trembling and sample entropy analyses were used in COP data processing.

RESULTS

Compared to typically developing children, those with autism spectrum had significantly higher values of COP and rambling trajectory parameters in the antero-posterior direction during quiet standing. The variables of the trembling trajectory did not differ significantly between the groups. The autistic children had significantly lower values of sample entropy in the antero-posterior direction compared to typically developing children.

SIGNIFICANCE

More advanced measures of COP displacements including the rambling-trembling method and sample entropy revealed differences in postural control between autistic and typically developing children. These methods may therefore contribute to functional assessment of postural control deficits in children on the autism spectrum.

Assessment of postural control in children

The relevance of the study is due to the high incidence of postural control impairment in patients with neurological diseases and lack of common approaches to their diagnosing in children. In this article we show the main stages in the formation of postural control and mechanisms of balance maintaining in childhood. We assessed the information content of existing clinical scales used to study components of postural balance in children in clinical practice. Also, we studied the diagnostic significance of functional methods for assessing postural control. Particular attention we paid to the study of the diagnostic significance of computer posturography (stabilometry) and accelerometry. We identified the main clinical and functional diagnostic markers of postural imbalance in children of different age and nosological groups. Further research in this area will make it possible to develop the most objective criteria for impaired postural control in childhood, which will increase the effectiveness of treatment and rehabilitation measures. 

Quantitative Assessment of Sensory Integration and Balance in Children with Autism Spectrum Disorders: Cross-Sectional Study

Postural stability is dependent on the interpretation of external inputs acquired by sensory information processes, such as visual, vestibular, and proprioceptive systems, in order to accomplish neuromuscular control, balance maintenance, and appropriate motor response. A defect in any of these systems, or in the integration of information given by these systems, might threaten their capacity to maintain balance. Therefore, the purpose of this study was to investigate the sensory integration and balance using the Biodex balance system (BBS) in children with autism spectrum disorder (ASD) during the static posture. Seventy-four children from both sexes, 38 with ASD matched with 36 typically developed (TD) children as a control group, were included in the study. Using the Biodex balance system, the postural sway was evaluated through the modified Clinical Test of Sensory Integration and Balance (m-CTSIB) during quiet standing. In this test, four different situations were considered from standing position: eyes open/firm surface, eyes closed/firm surface, eyes open/foam surface, and eyes closed/foam surface. ASD children showed a significant increase in postural sway under all tested conditions when compared to the TD children group, especially for the conditions in which visual and somatosensory inputs were disrupted (p-value < 0.05). These results provide evidence that postural stability decreased in ASD children. Under static postural challenges, the current study’s findings imply that children diagnosed with ASD have postural control deficiencies, especially for the conditions in which visual and somatosensory input was disrupted. Further research must be conducted to find the best balance training program for ASD cases using the Biodex balance system and considering its impact on motor skills.