A synthesis of the characteristics of dance interventions engaging adults with neurodevelopmental disabilities: a scoping review

PURPOSE

Dance can encourage physical activity and promote physical, cognitive, and social development for adults who have neurodevelopmental disabilities (NDD). Dance is defined as a form of expression that may be structured, exploratory, and/or cultural. Current literature supports the benefits of participation in dance for persons with NDD, however less is known about what characteristics support participation in dance.

MATERIALS AND METHODS

A scoping review was conducted to synthesize the characteristics of dance interventions, teaching strategies, and outcome measures used to assess the efficacy of dance interventions. Searches were conducted across six databases and the results were screened according to: i) adults ≥18yrs of age with a diagnosed NDD, and ii) the program incorporated activities that fall within our definition of dance.

RESULTS

A range of dance forms and NDDs were represented across the fourteen studies reviewed. Few provided explicit details of the dance interventions, nor how instruction was adapted. All studies that measured fitness, mobility, balance, posture, and functional activity showed significant improvement. Studies that measured psychosocial and well-being focused on autistic characteristics and showed mixed results.

CONCLUSIONS

Details of interventions, instructions, measures of movement performance, and the relationship between outcomes and the interventions require further development and research.

Motor deficits in autism differ from that of developmental coordination disorder

LAY ABSTRACT

A vast majority of individuals with autism spectrum disorder experience impairments in motor skills. Those are often labelled as additional developmental coordination disorder despite the lack of studies comparing both disorders. Consequently, motor skills rehabilitation programmes in autism are often not specific but rather consist in standard programmes for developmental coordination disorder. Here, we compared motor performance in three groups of children: a control group, an autism spectrum disorder group and a developmental coordination disorder group. Despite similar level of motor skills evaluated by the standard movement assessment battery for children, in a Reach-to-Displace Task, children with autism spectrum disorder and developmental coordination disorder showed specific motor control deficits. Children with autism spectrum disorder failed to anticipate the object properties, but could correct their movement as well as typically developing children. In contrast, children with developmental coordination disorder were atypically slow, but showed a spared anticipation. Our study has important clinical implications as motor skills rehabilitations are crucial to both populations. Specifically, our findings suggest that individuals with autism spectrum disorder would benefit from therapies aiming at improving their anticipation, maybe through the support of their preserved representations and use of sensory information. Conversely, individuals with developmental coordination disorder would benefit from a focus on the use of sensory information in a timely fashion.

Identification and reduction of retained primitive reflexes by sensory stimulation in autism spectrum disorder: effects on qEEG networks and cognitive functions

Several authors have reported finding retained primitive reflexes (RPRs) in individuals with autism spectrum disorders (ASD). This case report describes the reduction of RPRs and changes in cognitive function after transcutaneous electrical nerve stimulation (TENS) of muscle. Three individuals were examined in a study at the Institute for Neurology and Neurosurgery in Havana, Cuba. Two child neurologists, not involved in the study, conducted clinical examinations on each participant and diagnosed each with ASD based on DSM-V criteria and the Autism Diagnostic Interview-Revised (an autism evaluation tool). Each child with ASD possessed a triad of impairments in three domains: social interaction, communication, and repetitive behaviour. Individuals were evaluated by quantitative electroencephalographic measures and tested by standardised cognitive function tests before and after 12 weeks of intervention. These interventions were associated with reduced ASD symptoms in the three domains, significant changes in qEEG network connectivity and significantly improved performance on standardised cognitive tests.

Observational learning of atypical biological kinematics in autism

Observing and voluntarily imitating the biological kinematics displayed by a model underpins the acquisition of new motor skills via sensorimotor processes linking perception with action. Differences in voluntary imitation in autism could be related to sensorimotor processing activity during action-observation of biological motion, as well as how sensorimotor integration processing occurs across imitation attempts. Using an observational practice protocol, which minimized the active contribution of the peripheral sensorimotor system, we examined the contribution of sensorimotor processing during action-observation. The data showed that autistic participants imitated both the temporal duration and atypical kinematic profile of the observed movement with a similar level of accuracy as neurotypical participants. These findings suggest the lower-level perception-action processes responsible for encoding biological kinematics during the action-observation phase of imitation are operational in autism. As there was no task-specific engagement of the peripheral sensorimotor system during observational practice, imitation difficulties in autism are most likely underpinned by sensorimotor integration issues related to the processing of efferent and (re)afferent sensorimotor information during trial-to-trial motor execution.

Kinematic markers of skill in first-person shooter video games

Video games present a unique opportunity to study motor skill. First-person shooter (FPS) games have particular utility because they require visually guided hand movements that are similar to widely studied planar reaching tasks. However, there is a need to ensure the tasks are equivalent if FPS games are to yield their potential as a powerful scientific tool for investigating sensorimotor control. Specifically, research is needed to ensure that differences in visual feedback of a movement do not affect motor learning between the two contexts. In traditional tasks, a movement will translate a cursor across a static background, whereas FPS games use movements to pan and tilt the view of the environment. To this end, we designed an online experiment where participants used their mouse or trackpad to shoot targets in both visual contexts. Kinematic analysis showed player movements were nearly identical between contexts, with highly correlated spatial and temporal metrics. This similarity suggests a shared internal model based on comparing predicted and observed displacement vectors rather than primary sensory feedback. A second experiment, modeled on FPS-style aim-trainer games, found movements exhibited classic invariant features described within the sensorimotor literature. We found the spatial metrics tested were significant predictors of overall task performance. More broadly, these results show that FPS games offer a novel, engaging, and compelling environment to study sensorimotor skill, providing the same precise kinematic metrics as traditional planar reaching tasks.

Functional connectivity of cortical-cerebellar networks in relation to sensorimotor behavior and clinical features in autism spectrum disorder

Sensorimotor issues are present in the majority of individuals with autism spectrum disorder (ASD) and are associated with core symptoms. The neural systems associated with these impairments remain unclear. Using a visually guided precision gripping task during functional magnetic resonance imaging, we characterized task-based connectivity and activation of cortical, subcortical, and cerebellar visuomotor networks. Participants with ASD (n = 19; ages 10-33) and age- and sex-matched neurotypical controls (n = 18) completed a visuomotor task at low and high force levels. Relative to controls, individuals with ASD showed reduced functional connectivity of right primary motor-anterior cingulate cortex and left anterior intraparietal lobule (aIPL)-right Crus I at high force only. At low force, increased caudate, and cerebellar activation each were associated with sensorimotor behavior in controls, but not in ASD. Reduced left aIPL-right Crus I connectivity was associated with more severe clinically rated ASD symptoms. These findings suggest that sensorimotor problems in ASD, particularly at high force levels, involve deficits in the integration of multimodal sensory feedback and reduced reliance on error-monitoring processes. Adding to literature positing that cerebellar dysfunction contributes to multiple developmental issues in ASD, our data implicate parietal-cerebellar connectivity as a key neural marker underlying both core and comorbid features of ASD.

Developmental differences in the prospective organisation of goal-directed movement between children with autism and typically developing children: A smart tablet serious game study

Movement is prospective. It structures self-generated engagement with objects and social partners and is fundamental to children's learning and development. In autistic children, previous reports of differences in movement kinematics compared to neurotypical peers suggest that its prospective organisation might be disrupted. Here, we employed a smart tablet serious game paradigm to assess differences in the feedforward and feedback mechanisms of prospective action organisation, between autistic and neurotypical preschool children. We analysed 3926 goal-directed finger movements made during smart-tablet ecological gameplay, from 28 children with Childhood Autism (ICD-10; ASD) and 43 neurotypical children (TD), aged 3-6 years old. Using linear and generalised linear mixed-effect models, we found the ASD group executed movements with longer movement time (MT) and time to peak velocity (TTPV), lower peak velocity (PV), with PV less likely to occur in the first movement unit (MU) and with a greater number of movement units after peak velocity (MU-APV). Interestingly, compared to the TD group, the ASD group showed smaller increases in PV, TTPV and MT with an increase in age (ASD × age interaction), together with a smaller reduction in MU-APV and an increase in MU-APV at shorter target distances (ASD × Dist interaction). Our results are the first to highlight different developmental trends in anticipatory feedforward and compensatory feedback mechanisms of control, contributing to differences in movement kinematics observed between autistic and neurotypical children. These findings point to differences in integration of prospective perceptuomotor information, with implications for embodied cognition and learning from self-generated action in autism.

Contribution of Retinal Motion to the Impulse Control of Target-Directed Aiming

Contemporary models of sensorimotor control contend that visually regulated movement adjustments may unfold early during a target-directed limb movement through an impulse control process that makes use of anticipatory forward models. To date, evidence surrounding impulse control has involved adjustments to a purported misperception in limb velocity following the unexpected onset of a moving background. That is, the limb is perceived to move faster and undershoots more when there is an incongruent moving background and vice versa. However, this particular behavior may manifest from an independent oculo-manual-following response. The present study aimed to deconstruct these proposals and, with them, the processes that underlie impulse control. Participants had to rapidly reach upward to land their index finger accurately on a target. On 33% of trials, the background, over which the movement was made, moved either up, down, right, or left. Displacements in the primary and perpendicular directions of movement showed spatial trajectories that were consistent with the directions of the moving backgrounds. This behavior was most prevalent in measurements taken at the movements’ peak negative acceleration and endpoints. Moreover, analysis of standardized displacements in the moving background conditions indicated no significant differences in the extent of the movements toward each of the moving backgrounds. These findings indicate that movement adjustments can manifest from an oculo-manual-following response rather than a misperception of limb velocity. We suggest that the anticipatory forward model that comprises impulse control may incorporate features of the environment that surround the vicinity of the limb.

Motor planning and movement execution during goal-directed sequential manual movements in 6-year-old children with autism spectrum disorder: A kinematic analysis

BACKGROUND

Atypical motor functioning is prevalent in children with autism spectrum disorder (ASD). Knowledge of the underlying kinematic properties of these problems is sparse.

AIMS

To investigate characteristics of manual motor planning and performance difficulties/diversity in children with ASD by detailed kinematic measurements. Further, associations between movement parameters and cognitive functions were explored.

METHODS AND PROCEDURES

Six-year-old children with ASD (N = 12) and typically developing (TD) peers (N = 12) performed a sequential manual task comprising grasping and fitting a semi-circular peg into a goal-slot. The goal-slot orientation was manipulated to impose different motor planning constraints. Movements were recorded by an optoelectronic system.

OUTCOMES AND RESULTS

The ASD-group displayed less efficient motor planning than the TD-group, evident in the reach-to-grasp and transport kinematics and less proactive adjustments of the peg to the goal-slot orientations. The intra-individual variation of movement kinematics was higher in the ASD-group compared to the TD-group. Further, in the ASD-group, movement performance associated negatively with cognitive functions.

CONCLUSIONS AND IMPLICATIONS

Planning and execution of sequential manual movements proved challenging for children with ASD, likely contributing to problems in everyday actions. Detailed kinematic investigations contribute to the generation of specific knowledge about the nature of atypical motor performance/diversity in ASD. This is of potential clinical relevance.

Predictive sensorimotor control in autism

Autism spectrum disorder has been characterized by atypicalities in how predictions and sensory information are processed in the brain. To shed light on this relationship in the context of sensorimotor control, we assessed prediction-related measures of cognition, perception, gaze and motor functioning in a large general population (n = 92; Experiment 1) and in clinically diagnosed autistic participants (n = 29; Experiment 2). In both experiments perception and action were strongly driven by prior expectations of object weight, with large items typically predicted to weigh more than equally-weighted smaller ones. Interestingly, these predictive action models were used comparably at a sensorimotor level in both autistic and neurotypical individuals with varying levels of autistic-like traits. Specifically, initial fingertip force profiles and resulting action kinematics were both scaled according to participants' pre-lift heaviness estimates, and generic visual sampling behaviours were notably consistent across groups. These results suggest that the weighting of prior information is not chronically underweighted in autism, as proposed by simple Bayesian accounts of the disorder. Instead, our results cautiously implicate context-sensitive processing mechanisms, such as precision modulation and hierarchical volatility inference. Together, these findings present novel implications for both future scientific investigations and the autism community.

The multiple process model of goal-directed aiming/reaching: insights on limb control from various special populations

Several years ago, our research group forwarded a model of goal-directed reaching and aiming that describes the processes involved in the optimization of speed, accuracy, and energy expenditure Elliott et al. (Psychol Bull 136:1023-1044, 2010). One of the main features of the model is the distinction between early impulse control, which is based on a comparison of expected to perceived sensory consequences, and late limb-target control that involves a spatial comparison of limb and target position. Our model also emphasizes the importance of strategic behaviors that limit the opportunity for worst-case or inefficient outcomes. In the 2010 paper, we included a section on how our model can be used to understand atypical aiming/reaching movements in a number of special populations. In light of a recent empirical and theoretical update of our model Elliott et al. (Neurosci Biobehav Rev 72:95-110, 2017), here we consider contemporary motor control work involving typical aging, Down syndrome, autism spectrum disorder, and tetraplegia with tendon-transfer surgery. We outline how atypical limb control can be viewed within the context of the multiple-process model of goal-directed reaching and aiming, and discuss the underlying perceptual-motor impairment that results in the adaptive solution developed by the specific group.

Perceptual category learning in autism spectrum disorder: Truth and consequences

The ability to categorize is fundamental to cognitive development. Some categories emerge effortlessly and rapidly while others can take years of experience to acquire. Children with autism spectrum disorder (ASD) are often able to name and sort objects, suggesting that their categorization abilities are largely intact. However, recent experimental work shows that the categories formed by individuals with ASD may diverge substantially from those that most people learn. This review considers how atypical perceptual category learning can affect cognitive development in children with ASD and how atypical categorization may contribute to many of the socially problematic symptoms associated with this disorder. Theoretical approaches to understanding perceptual processing and category learning at both the behavioral and neural levels are assessed in relation to known alterations in perceptual category learning associated with ASD. Mismatches between the ways in which children learn to organize perceived events relative to their peers and adults can accumulate over time, leading to difficulties in communication, social interactions, academic performance, and behavioral flexibility.

Comprehensive motor skills assessment in children with autism spectrum disorder yields global deficits

PURPOSE

Although children with autism spectrum disorder (ASD) often display motor deficits, the nature of these motor deficits remains unspecified. The purpose of this study was to establish a robust motor profile in children with ASD across a wider range of motor skills by using two professionally administered standardized motor assessments alongside a parent report measure to capture a comprehensive view of motor performance compared to a group of neurotypical peers.

METHODS

Complex motor skills, balance and global motor performance were compared in twenty-four children, between the ages of 5-12 years, split into two groups: ASD and typically developing. The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) and the Movement Assessment Battery for Children, Second Edition (MABC-2) were used to examine skill performance. Motor proficiency was also collected using the parent/caregiver form of the Vineland Adaptive Behavior Scales, 3^rd edition (Vineland-3).

RESULTS

Children with ASD presented with significant differences in complex motor skills, balance skills, and global motor performance when compared to their neurotypical peers across all three measures.

CONCLUSION

This preliminary study indicated that the children with ASD had greater difficulty with global motor performance, including more difficulty performing complex motor tasks and balance tasks compared to their neurotypical peers. The parents of the children with ASD reported decreased proficiency of motor skills. Overall, the children with ASD demonstrated deficits performing tasks that targeted strength, speed, agility, coordination and both static and dynamic balance. While manifestations of motor skill deficits specific to the ASD population are variable, physical therapists should be included in the ongoing assessment and implementation of comprehensive therapeutic plans for children with ASD.