Sensory modulation is difficult among children with ASD, and this has been proposed to be related to toe walking. This case study aimed to investigate the effect of sensorimotor training on toe walking in children with ASD.
Two children of ages 4 years and 6 years diagnosed with ASD and with persistent toe walking participated a 4-week sensorimotor exercise program. Each treatment session lasted for 45 minutes and was scheduled twice a week. The participants received no medical or surgical management, or casting.
Assessment was done before and upon completion of the training program. Primary outcomes were collected through walking assessment along a 20-feet distance and mobility items in the Functional Independence Measure (WeeFIM). Secondary outcomes included the clinical tests of tactile sensation, proprioception and ankle joint range of motion, sensory profile evaluated using the Glasgow Sensory Questionnaire (GSQ) adapted for parents, and behaviours during clinical test administration and exposure to various sensory modalities.
The two children demonstrated a proprioceptive-seeking trait. Hence, motor exercises were given with enhanced proprioception. Trainings began with climbing, jumping, or walking together with weight-pushing activities, followed by movement-specific exercises like mini-squatting or manipulation of objects with foot while standing on a vibration machine, standing activities on inflated disc or cloth swing, or obstacle course walking on tilts. Joint compression to lower limbs was given at the end of each session.
Toe walking in 20 feet reduced from 100% to 5.67% and 47.14% to 0% in child one and two respectively. For the mobility items of WeeFIM, child one achieved ceiling at baseline while the raw score improved from 21/35 to 30/35 in child two.
Static proprioception improved over the ankle of more severe side in child one and bilateral ankles in child two. Improvement in dynamic proprioception was evident over the ankle of worse side in child two. Upon initial assessment, child one demonstrated behaviours, like walking on hands and feet on soft mat and sliding on floor in sitting, which no longer appeared in final assessment. Surprisingly, improvement in sensory profile reflected by GSQ was noticed with raw scores decreased from 40/168 to 27/168 in child one and from 71/168 to 58/168 in child two.
We observed reduced toe walking and improved secondary outcomes in the two children with ASD following sensorimotor training.
The apparent improved outcomes suggest the potential importance of investigating individual sensory profiles when managing motor deficits of children with ASD. Addressing sensory needs within motor contexts may help enhance desired movement patterns. The cases reported here may serve as bases for further studies that can test effects following robust study designs.
Toe walking
Autism
