Existing evidence of RAT for children with ASD have limitations in number of control studies (only 2), focus on preschool aged children (only 3), small sample size (5 to 15 subjects) and separated measurement of social or motor outcomes. The purpose of this study is to investigate the effects of RAT on social-motor functioning in preschool children with ASD in which bigger sample size controlled study design was used.
120 children with ASD social motor function classification category B or C (moderate-low or moderate functioning) were recruited by convenient sampling in community special child care centres of Heep Hong Society in Hong Kong. They were divided into experimental group (n=60) receiving physiotherapy group training with RAT, and control group (n=60) with conventional physiotherapy (CPT). Both groups received 8 weekly groups training designed and led by paediatric physiotherapist in-charge based on the same functional goals of object manipulative skills (overhand strike, catch and kick ball). Imitations of upper limb movements (clap hands, touch head and tap on laps) and social gestures (high five greeting, wave hand goodbye, drinking water, happy and tired) were included in both groups using visual cues to facilitate children’s participation. Humanoid robot NAO and Choregraphe computer programming software were used for RAT. Pre and post tests of 1) Motor Imitation Scales (MIS) total score, 2) PDMS-2 (object manipulation) standard score and single leg standing time, 3) Caregiver questionnaire were measured. Objective measures with pre and post data in each group were evaluated. Variables between groups were compared.
Both groups showed statistical significant difference (p0.001) between pre and post tests of MIS, PDMS-2 object manipulation standard score and single leg standing. Experimental group showed greater significant improvement statistically (p=0.022) in MIS comparing with control group. Both groups showed statistical significant difference (p0.001) between pre and post tests of caregiver questionnaire in attention, social communication, imitation and object manipulation skills.
Both RAT and CPT in community rehabilitation setting are effective to enhance social and motor function in moderate-low functioning ASD children. RAT showed greater improvement in motor imitation than CPT. Caregivers appreciated and recognised the integrated social and motor training for children with ASD.
Integrating RAT into conventional physiotherapy group training for moderate-low functioning ASD preschool children in community rehabilitation setting is proved to be effective. The parallel social-motor developmental approach for children with ASD may be recognized in paediatric physiotherapy clinical practice.
Autism Spectrum Disorder
Social-Motor Function
