Body Constraints on Motor Simulation in Autism Spectrum Disorders

Motor imagery in autism: a systematic review

Introduction

Motor Imagery (MI) is when an individual imagines performing an action without physically executing that action and is thought to involve similar neural processes used for execution of physical movement. As motor coordination difficulties are common in autistic individuals it is possible that these may affect MI ability. The aim of this systematic review was to assess the current knowledge around MI ability in autistic individuals.

Methods

A systematic search was conducted for articles published before September 2023, following PRISMA guidance. Search engines were PsycINFO, PubMed, Web of Science, Scopus, Wiley Online Library and PsyArXiv. Inclusion criteria included: (a) Original peer-reviewed and pre-print publications; (b) Autistic and a non-autistic group (c) Implicit or explicit imagery tasks (d) Behavioral, neurophysiological or self-rating measures, (e) Written in the English language. Exclusion criteria were (a) Articles only about MI or autism (b) Articles where the autism data is not presented separately (c) Articles on action observation, recognition or imitation only (d) Review articles. A narrative synthesis of the evidence was conducted.

Results

Sixteen studies across fourteen articles were included. Tasks were divided into implicit (unconscious) or explicit (conscious) MI. The implicit tasks used either hand (6) or body (4) rotation tasks. Explicit tasks consisted of perspective taking tasks (3), a questionnaire (1) and explicit instructions to imagine performing a movement (2). A MI strategy was apparent for the hand rotation task in autistic children, although may have been more challenging. Evidence was mixed and inconclusive for the remaining task types due to the varied range of different tasks and, measures conducted and design limitations. Further limitations included a sex bias toward males and the hand rotation task only being conducted in children.

Discussion

There is currently an incomplete understanding of MI ability in autistic individuals. The field would benefit from a battery of fully described implicit and explicit MI tasks, conducted across the same groups of autistic children and adults. Improved knowledge around MI in autistic individuals is important for understanding whether MI techniques may benefit motor coordination in some autistic people.

Development of Motor Imagery in School-Aged Children with Autism Spectrum Disorder: A Longitudinal Study

Autism spectrum disorder (ASD) is a diagnosis based on social communication deficits and prevalence of repetitive stereotyped behaviors, but sensorimotor disturbances are commonly exhibited. This longitudinal study aimed at exploring the development of the ability to form mental motor representations (motor imagery; MI) in 14 children with ASD and 17 typically developing (TD) children at 7, 8 and 9 years of age. MI was investigated using a hand laterality paradigm from which response times (RT) and error rates were extracted and compared with performance on a visually based mental rotation task (VI). A criterion task was used to ensure that the children could perform the task. The results showed wide performance variability in the ASD group with more failures than TD in the MI criterion task, especially at 7 years. For all age levels and both the MI and VI tasks, the error rates were significantly higher and RTs longer for the ASD group compared with TD. Signs of MI strategies were however noted in the ASD group as biomechanically constrained orientations had longer RTs than less constrained orientations, a RT pattern that differed from the VI task. The presence of MI in the ASD group was most evident at 9 years, but the error rates remained high at all ages, both in the MI and VI task. In comparison, the TD group showed stable MI strategies at all ages. These findings indicate that MI ability is delayed and/or impaired in children with ASD which may be related to difficulties performing required mental rotations.

Measuring the prediction of observed actions using an occlusion paradigm: Comparing autistic and non-autistic adults

Action prediction involves observing and predicting the actions of others and plays an important role in social cognition and interacting with others. It is thought to use simulation, whereby the observers use their own motor system to predict the observed actions. As individuals diagnosed with autism are characterized by difficulties understanding the actions of others and motor coordination issues, it is possible that action prediction ability is altered in this population. This study compared action prediction ability between 20 autistic and 22 non-autistic adults using an occlusion paradigm. Participants watched different videos of a female actor carrying out everyday actions. During each video, the action was transiently occluded by a gray rectangle for 1000 ms. During occlusions, the video was allowed to continue as normal or was moved forward (i.e., appearing to continue too far ahead) or moved backwards (i.e., appearing to continue too far behind). Participants were asked to indicate after each occlusion whether the action continued with the correct timing or was too far ahead/behind. Autistic individuals were less accurate than non-autistic individuals, particularly when the video was too far behind. A trend analysis suggested that autistic participants were more likely to judge too far behind occlusions as being in time. These preliminary results suggest that prediction ability may be altered in autistic adults, potentially due to slower simulation or a delayed onset of these processes. LAY SUMMARY: When we observe other people performing everyday actions, we use their movements to help us understand and predict what they are doing. In this study, we found that autistic compared to non-autistic adults were slightly less accurate at predicting other people's actions. These findings help to unpick the different ways that social understanding is affected in autism.

Visual Hand Recognition in Hand Laterality and Self-Other Discrimination Tasks: Relationships to Autistic Traits and Positive Body Image

In a study concerning visual body part recognition, a "self-advantage" effect, whereby self-related body stimuli are processed faster and more accurately than other-related body stimuli, was revealed, and the emergence of this effect is assumed to be tightly linked to implicit motor simulation, which is activated when performing a hand laterality judgment task in which hand ownership is not explicitly required. Here, we ran two visual hand recognition tasks, namely, a hand laterality judgment task and a self-other discrimination task, to investigate (i) whether the self-advantage emerged even if implicit motor imagery was assumed to be working less efficiently and (ii) how individual traits [such as autistic traits and the extent of positive self-body image, as assessed via the Autism Spectrum Quotient (AQ) and the Body Appreciation Scale-2 (BAS-2), respectively] modulate performance in these hand recognition tasks. Participants were presented with hand images in two orientations [i.e., upright (egocentric) and upside-down (allocentric)] and asked to judge whether it was a left or right hand (an implicit hand laterality judgment task). They were also asked to determine whether it was their own, or another person's hand (an explicit self-other discrimination task). Data collected from men and women were analyzed separately. The self-advantage effect in the hand laterality judgment task was not revealed, suggesting that only two orientation conditions are not enough to trigger this motor simulation. Furthermore, the men's group showed a significant positive correlation between AQ scores and reaction times (RTs) in the laterality judgment task, while the women's group showed a significant negative correlation between AQ scores and differences in RTs and a significant positive correlation between BAS-2 scores and dprime in the self-other discrimination task. These results suggest that men and women differentially adopt specific strategies and/or execution processes for implicit and explicit hand recognition tasks.

Unique deficit in embodied simulation in autism: An fMRI study comparing autism and developmental coordination disorder

A deficit in pre‐cognitively mirroring other people's actions and experiences may be related to the social impairments observed in autism spectrum disorder (ASD). However, it is unclear whether such embodied simulation deficits are unique to ASD or instead are related to motor impairment, which is commonly comorbid with ASD. Here we aim to disentangle how, neurologically, motor impairments contribute to simulation deficits and identify unique neural signatures of ASD. We compare children with ASD (N = 30) to children with Developmental Coordination Disorder (DCD; N = 23) as well as a typically developing group (N = 33) during fMRI tasks in which children observe, imitate, and mentalize about other people's actions. Results indicate a unique neural signature in ASD: during action observation, only the ASD group shows hypoactivity in a region important for simulation (inferior frontal gyrus, pars opercularis, IFGop). However, during a motor production task (imitation), the IFGop is hypoactive for both ASD and DCD groups. For all tasks, we find correlations across groups with motor ability, even after controlling for age, IQ, and social impairment. Conversely, across groups, mentalizing ability is correlated with activity in the dorsomedial prefrontal cortex when controlling for motor ability. These findings help identify the unique neurobiological basis of ASD for aspects of social processing. Furthermore, as no previous fMRI studies correlated brain activity with motor impairment in ASD, these findings help explain prior conflicting reports in these simulation networks.

The role of mental imagery in pantomimes of actions towards and away from the body

This study aimed to explore the relationship between action execution and mental rotation modalities. To this end, pantomime gesture (i.e. the mime of the use of an object) was used as its execution relies on imagery processes. Specifically, we tried to clarify the role of visuo-spatial or motor and body-related mental imagery processes in pantomime gestures performed away (AB, e.g. drawing on a sheet) and towards the body (TB, e.g. brushing the teeth). We included an "actual use" condition in which participants were asked to use a toothbrush and make 3, 6, or 9 circular movements close to their mouth (as if they were brushing their teeth) or to use a pencil and make 3, 6, or 9 circular movements on a desk (as if they were drawing circles). Afterwards, participants were asked to pantomime the actual use of the same objects ("pantomime" condition). Finally, they were asked to mentally rotate three different stimuli: hands, faces, and abstract lines. Results showed that participants were faster in AB than TB pantomimes. Moreover, the more accurate and faster the mental rotation of body-related stimuli was, the more similar the temporal duration between both kinds of pantomimes and the actual use of the objects appeared. Instead, the temporal similarity between AB pantomimes and pencil actual use, as well as, the duration of AB pantomime and actual use, were associated with the ability to mentally rotate abstract lines. This was not true for TB movements. These results suggest that the execution of AB and TB pantomimes may involve different mental imagery modalities. Specifically, AB pantomimes would not only require to mentally manipulate images of body-parts in movement but also represent the spatial relations of the object with the external world.

An Investigation of Lower Limb Representations Underlying Vision, Touch, and Proprioception in Body Integrity Identity Disorder

Individuals with Body Integrity Identity Disorder (BIID) have a (non-psychotic) longstanding desire to amputate or paralyze one or more fully-functioning limbs, often the legs. This desire presumably arises from experiencing a mismatch between one's perceived mental image of the body and the physical structural and/or functional boundaries of the body itself. While neuroimaging studies suggest a disturbed body representation network in individuals with BIID, few behavioral studies have looked at the manifestation of this disrupted lower limb representations in this population. Specifically, people with BIID feel like they are overcomplete in their current body. Perhaps sensory input, processed normally on and about the limb, cannot communicate with a higher-order model of the leg in the brain (which might be underdeveloped). We asked individuals who desire paralysis or amputation of the lower legs (and a group of age- and sex-matched controls) to make explicit and implicit judgments about the size and shape of their legs while relying on vision, touch, and proprioception. We hypothesized that BIID participants would mis-estimate the size of their affected leg(s) more than the same leg of controls. Using a multiple single-case analysis, we found no global differences in lower limb representations between BIID participants and controls. Thus, while people with BIID feel that part of the body is foreign, they can still make normal sensory-guided implicit and explicit judgments about the limb. Moreover, these results suggest that BIID is not a body image disorder, per se, and that an examination of leg representation does not uncover the disturbed bodily experience that individuals with BIID have.

Difficulties in spontaneously performing level 2 perspective-taking skills in children with autism spectrum disorder

Purpose

The purpose of this paper is to investigate why children with autism spectrum disorder (ASD) tend to respond to tasks from their own perspective. The authors investigated the effects of explicitness of viewpoint on performance of spontaneous level 2 perspective-taking skills in six- to eight-year-old children with ASD.

Design/methodology/approach

The authors conducted visual perspective-taking tasks with explicit and implicit instructions about the viewpoint to be used. Participants operated a toy car on a map while listening to the experimenter’s instructions. In the implicit condition, when the experimenter said “Turn right/left” at each intersection, the participants moved the car accordingly. Subsequently, in the explicit condition, the experimenter said “Look from the driver’s viewpoint and turn right/left” at each intersection.

Findings

In the implicit condition, the authors did not observe a clear developmental change in performance between six- and eight-year-old children in the ASD group. In contrast, performance in the ASD group improved under the explicit condition relative to that under the implicit condition.

Originality/value

The results suggest six- to eight-year-old children with ASD tend not to spontaneously use level 2 perspective-taking skills. Therefore, viewpoints should be explicitly instructed to children with ASD. In addition, it is also important to implement training to encourage spontaneous transitions from self-perspective to other-perspective under the implicit condition.

The sensory school: working with teachers, parents and pupils to create good sensory conditions

Purpose

An alliance of schools and researchers formed a collaborative community of practice in order to understand and improve the sensory school environment for pupils on the autistic spectrum, and incorporate the findings into school improvement planning. The paper aims to discuss this issue.

Design/methodology/approach

Representatives of special and mainstream schools in South London and a team of researchers formed the project team, including an autistic researcher. The researchers and a named staff member from each of the schools met regularly over the course of 18 months in order to work on an iterative process to improve the sensory experience pupils had of the school environment. Each school completed sensory audits and observations, and was visited by members of the research team. Parents were involved via meetings with the research team and two conferences were organised to share findings.

Findings

Useful outcomes included: developing and sharing of good practice between schools; opportunities for parents of autistic pupils to discuss their concerns, particularly with someone with insider perspective; and exploration of creative ways to achieve pupil involvement and the idea that good autism practice has the potential to benefit all pupils. A resource pack was produced for the schools to access. Plans are in place to revisit the initiative in 12 months’ time in order to ascertain whether there have been long-term benefits.

Originality/value

Projects building communities of practice involving autistic people as core team members are rare, yet feedback from those involved in the project showed this to be a key aspect of shared learning.

Inhibition or facilitation? Modulation of corticospinal excitability during motor imagery

Motor imagery (MI) is the mental simulation of an action without any overt movement. Functional evidences show that brain activity during MI and motor execution (ME) largely overlaps. However, the role of the primary motor cortex (M1) during MI is controversial. Effective connectivity techniques show a facilitation on M1 during ME and an inhibition during MI, depending on whether an action should be performed or suppressed. Conversely, Transcranial Magnetic Stimulation (TMS) studies report facilitatory effects during both ME and MI. The present TMS study shed light on MI mechanisms, by manipulating the instructions given to the participants. In both Experimental and Control groups, participants were asked to mentally simulate a finger-thumb opposition task, but only the Experimental group received the explicit instruction to avoid any unwanted fingers movements. The amplitude of motor evoked potentials (MEPs) to TMS during MI was compared between the two groups. If the M1 facilitation actually pertains to MI per se, we should have expected to find it, irrespective of the instructions. Contrariwise, we found opposite results, showing facilitatory effects (increased MEPs amplitude) in the Control group and inhibitory effects (decreased MEPs amplitude) in the Experimental group. Control experiments demonstrated that the inhibitory effect was specific for the M1 contralateral to the hand performing the MI task and that the given instructions did not compromise the subjects' MI abilities. The present findings suggest a crucial role of motor inhibition when a "pure" MI task is performed and the subjects are explicitly instructed to avoid overt movements.

Action simulation and mirroring in children with autism spectrum disorders

Mental imitation, perhaps a precursor to motor imitation, involves visual perspective-taking and motor imagery. Research on mental imitation in autism spectrum disorders (ASD) has been rather limited compared to that on motor imitation. The main objective of this fMRI study is to determine the differences in brain responses underlying mirroring and mentalizing networks during mental imitation in children and adolescents with ASD. Thirteen high-functioning children and adolescents with ASD and 15 age-and- IQ-matched typically developing (TD) control participants took part in this fMRI study. In the MRI scanner, participants were shown cartoon pictures of people performing everyday actions (Transitive actions: e.g., ironing clothes but with the hand missing; and Intransitive actions: e.g., clapping hands with the palms missing) and were asked to identify which hand or palm orientation would best fit the gap. The main findings are: 1) both groups performed equally while processing transitive and intransitive actions; 2) both tasks yielded activation in the bilateral inferior frontal gyrus (IFG) and inferior parietal lobule (IPL) in ASD and TD groups; 3) Increased activation was seen in ASD children, relative to TD, in left ventral premotor and right middle temporal gyrus during intransitive actions; and 4) ASD symptom severity positively correlated with activation in left parietal, right middle temporal, and right premotor regions across all subjects. Overall, our findings suggest that regions mediating mirroring may be recruiting more brain resources in ASD and may have implications for understanding social movement through modeling.

Dissociation between executed and imagined bimanual movements in autism spectrum conditions

Autism spectrum conditions (ASC) are characterized by social-communicative deficits and repetitive stereotyped behaviors. Altered motor coordination is also observed and a dysfunction of motor imagery has been recently reported on implicit tasks. However, no information on explicit motor imagery abilities is available in ASC. Here, we employed a spatial bimanual task to concurrently assess motor coordination and explicit motor imagery in autism. A secondary objective of the study was to evaluate these abilities across two populations of ASC, namely adolescents and adults with ASC. To this aim, we took advantage of the circles-lines task in which where participants were asked to continuously draw: right hand lines (unimanual condition); right hand lines and left hand circles (bimanual condition); right hand lines while imagining to draw left hand circles (imagery condition). For each participant, an Ovalization Index (OI) was calculated as a deviation of the right hand drawing trajectory from an absolute vertical axis. Results showed a significant and similar coupling effect in the bimanual condition (i.e., a significant increase of the OI values with respect to the unimanual condition) in both controls and ASC participants. On the contrary, in the imagery condition, a significant coupling effect was found only in controls. Furthermore, adult controls showed a significantly higher imagery coupling effect in comparison to all the other groups. These results demonstrate that atypical motor imagery processes in ASC are not limited to implicit tasks and suggest that development of neural structures involved in motor imagery are immature in ASC. Autism Res 2018, 11: 376-384. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

Autism spectrum conditions (ASC) are characterized by social-communicative and motor coordination difficulties but in many cases also by an impaired capability to imagine movements. In this study we found that while two handed coordination in ASC can be developed as well as in typically developed persons, the development of motor imagery could still be immature in ASC, leading to difficulties in imagining, understanding as well as programming and coordinating complex movements.

"Like the palm of my hands": Motor imagery enhances implicit and explicit visual recognition of one's own hands

A key point in motor imagery literature is that judging hands in palm view recruits sensory-motor information to a higher extent than judging hands in back view, due to the greater biomechanical complexity implied in rotating hands depicted from palm than from back. We took advantage from this solid evidence to test the nature of a phenomenon known as self-advantage, i.e. the advantage in implicitly recognizing self vs. others' hand images. The self-advantage has been actually found when implicitly but not explicitly judging self-hands, likely due to dissociation between implicit and explicit body representations. However, such a finding might be related to the extent to which motor imagery is recruited during implicit and explicit processing of hand images. We tested this hypothesis in two behavioural experiments. In Experiment 1, right-handed participants judged laterality of either self or others' hands, whereas in Experiment 2, an explicit recognition of one's own hands was required. Crucially, in both experiments participants were randomly presented with hand images viewed from back or from palm. The main result of both experiments was the self-advantage when participants judged hands from palm view. This novel finding demonstrate that increasing the "motor imagery load" during processing of self vs. others' hands can elicit a self-advantage in explicit recognition tasks as well. Future studies testing the possible dissociation between implicit and explicit visual body representations should take into account the modulatory effect of motor imagery load on self-hand processing.

Mental simulation of drawing actions enhances delayed recall of a complex figure

Motor simulation implies that the same motor representations involved in action execution are re-enacted during observation or imagery of actions. Neurofunctional data suggested that observation of letters or abstract paintings can elicit simulation of writing or drawing gestures. We performed four behavioural experiments on right-handed healthy participants to test whether observation of a static and complex geometrical figure implies re-enactment of drawing actions. In Experiment 1, participants had to observe the stimulus without explicit instruction (observation-only condition), while performing irrelevant finger tapping (motor dual task), or while articulating irrelevant verbal material (verbal dual task). Delayed drawing of the stimulus was less accurate in the motor dual-task (interfering with simulation of hand actions) than in verbal dual-task and observation-only conditions. In Experiment 2, delayed drawing in the observation only was as accurate as when participants encoded the stimulus by copying it; in both conditions, accuracy was higher than when participants were instructed to observe the stimulus to recall it later verbally (observe to recall), thus being discouraged from engaging motor simulation. In Experiment 3, delayed drawing was as accurate in the observation-only condition as when participants imagined copying the stimulus; accuracy in both conditions was higher than in the observe-to-recall condition. In Experiment 4, in the observe-only condition participants who observed the stimulus with their right arm hidden behind their back were significantly less accurate than participants who had their left arm hidden. These findings converge in suggesting that mere observation of a geometrical stimulus can activate motor simulation and re-enactment of drawing actions.