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Chapek M, Kessler J. The Prevalence of Persistent Toe Walking in Children with and without Autism Spectrum Disorder and the Odds of Subsequent Surgery. J Foot Ankle Surg 2024:S1067-2516(24)00176-5. [PMID: 39147358 DOI: 10.1053/j.jfas.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/04/2024] [Indexed: 08/17/2024]
Abstract
Persistent toe walking is associated with autism spectrum disorder. The true prevalence of persistent toe walking and odds of progression to surgery in children with and without autism remains unclear. This retrospective descriptive study identified patients ages 3 - 17 years who were enrolled in our healthcare system over a two-year period. Using international classification of disease codes, we identified all children with autism and persistent toe walking, and excluded children with conditions that may independently cause toe walking. Data on Achilles lengthening surgeries, sex, race and body mass index was gathered. The toe walking prevalence amongst children with and without autism was calculated. Multivariable logistic regression analysis controlling for sex, race and body mass index was used to determine independent risk factors for persistent toe walking and surgery. Of the children who met inclusion criteria (N = 284,925), 4,622 (1.6%) had persistent toe walking. Prevalence of persistent toe walking was higher amongst children with autism (6.3% versus 1.5%, p < 0.01), as were odds of persistent toe walking (OR 4.13, 95% CI 3.74 - 4.56, p < 0.01). Males and White patients had higher odds of persistent toe walking compared to females and patients of any other race, respectively (p < 0.01 for all). Although children with autism and toe walking had higher rates of surgery than their counterparts without autism (4.3% versus 2.6%, p = 0.04), this difference was not significant after controlling for sex, race and BMI (OR 1.59, 95% CI 0.95 - 2.69, p > 0.05). LEVEL OF CLINICAL EVIDENCE: III.
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Affiliation(s)
- Michael Chapek
- Kaiser Permanente Bernard J Tyson School of Medicine, 98 S Los Robles Ave. Pasadena, CA 91101 USA.
| | - Jeffrey Kessler
- Kaiser Permanente Bernard J Tyson School of Medicine, 98 S Los Robles Ave. Pasadena, CA 91101 USA; Kaiser Los Angeles Medical Center, Department of Orthopedics, 4760 Sunset Blvd. Los Angeles, CA, 90027 USA.
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2
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Smith G, McCoy K, Di Prisco GV, Kuklish A, Grant E, Bhat M, Patel S, Mackie K, Atwood B, Kalinovsky A. Deletion of endocannabinoid synthesizing enzyme DAGLα from cerebellar Purkinje cells decreases social preference and elevates anxiety. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.08.08.607068. [PMID: 39211155 PMCID: PMC11361171 DOI: 10.1101/2024.08.08.607068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The endocannabinoid (eCB) signaling system is robustly expressed in the cerebellum starting from the embryonic developmental stages to adulthood. There it plays a key role in regulating cerebellar synaptic plasticity and excitability, suggesting that impaired eCB signaling will lead to deficits in cerebellar adjustments of ongoing behaviors and cerebellar learning. Indeed, human mutations in DAGLα are associated with neurodevelopmental disorders. In this study, we show that selective deletion of the eCB synthesizing enzyme diacylglycerol lipase alpha (Daglα) from mouse cerebellar Purkinje cells (PCs) alters motor and social behaviors, disrupts short-term synaptic plasticity in both excitatory and inhibitory synapses, and reduces Purkinje cell activity during social exploration. Our results provide the first evidence for cerebellar-specific eCB regulation of social behaviors and implicate eCB regulation of synaptic plasticity and PC activity as the neural substrates contributing to these deficits. Abstract Figure
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Morrow EM, Kothari A. In Reply: Letter to the Editor Regarding Health-related Quality of Life in Idiopathic Toe Walkers: A Multicenter Prospective Cross-sectional Study. J Pediatr Orthop 2024; 44:e571-e572. [PMID: 38770679 DOI: 10.1097/bpo.0000000000002717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Eileen Mairi Morrow
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre University of Oxford, Oxford, UK
| | - Alpesh Kothari
- Paediatric Orthopaedic Department Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Hines D, Armstrong-Heimsoth A, Schoen SA. A Pilot Study of Idiopathic Toe Walking: Measures and Outcomes. Occup Ther Health Care 2024; 38:723-749. [PMID: 37598376 DOI: 10.1080/07380577.2023.2246552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
This pilot study sought to determine the feasibility of quantifying sensory processing, postural control, motor skill development and participation in daily life in children with idiopathic toe walking (ITW) compared to children without ITW. A nonrandomized, prospective case-control design was employed. Twenty participants were recruited. Computerized weight bearing and postural control data was successfully collected. Differences were found in forefoot/rearfoot weight bearing, balance, sensory-motor abilities and parent reported participation challenges. Sensory processing results were inconclusive. Findings can inform standardized assessment and treatment of ITW.
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Affiliation(s)
- Debra Hines
- Northern Arizona University, Phoenix, Arizona, USA
| | | | - Sarah A Schoen
- Rocky Mountain University of Health Professions, Provo, Utah, USA
- STAR Institute, Centennial, Colorado, USA
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Rehm A, Elerian S, Shehata R, Newton AC, Linardatou Novak P, Hatzantoni K. Health-Related Quality of Life in Idiopathic Toe Walkers: A Multicenter Prospective Cross-sectional Study. J Pediatr Orthop 2024; 44:e572-e573. [PMID: 38686948 DOI: 10.1097/bpo.0000000000002713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Andreas Rehm
- Department of Paediatric Orthopaedics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Valagussa G, Purpura G, Balatti V, Trentin L, Signori A, Grossi E. Quantitative assessment of tip-toe behavior in individuals with autism spectrum disorder and intellectual disability: A cross-sectional study. Autism Res 2024; 17:311-323. [PMID: 38108559 DOI: 10.1002/aur.3072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
The term "toe walking" describes walking on the toes with a lack of heel strike upon initiation of the stance phase of gait. In individuals with autism spectrum disorder (ASD), this phenomenon, or "tip-toe behavior" (TTB), can be present in a substantial proportion of subjects even during standing. In this study, we investigated TTB in 50 persons with ASD (age range 4-26 years). We evaluated TTB through an observational/report-based assessment protocol. Subsequently, we employed a new structured video-based coding protocol based on standardized video recordings, focusing on static and dynamic conditions. Finally, the findings of the two protocols were compared. Twenty-four subjects with TTB were identified and classified according to three functional groups: TTB1, present only during running (6 subjects); TTB2, present during walking and running (11 subjects); and TTB3, present during standing, walking, and running (7 subjects). Moreover, we found that TTB3 subjects exhibited a significantly higher quantity of TTB compared with subjects in the TTB1 and TTB2 groups during both standing and walking tests. Additionally, a high quantity of TTB in the static test was found to be related to a high quantity of TTB in the dynamic test. Variables such as age, autism severity, intellectual disability, and gender were not significantly associated with the mean percent of TTB both in static and dynamic tests in multivariate analysis. This structured video-based coding approach appears feasible and useful for assessing TTB in individuals with ASD and it has the potential to provide insights into TTB trajectories and aid in designing possible interventions.
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Affiliation(s)
- Giulio Valagussa
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Autism Research Unit, Villa S. Maria Foundation, Tavernerio (CO), Italy
| | - Giulia Purpura
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Valeria Balatti
- Autism Research Unit, Villa S. Maria Foundation, Tavernerio (CO), Italy
| | - Luca Trentin
- Autism Research Unit, Villa S. Maria Foundation, Tavernerio (CO), Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Enzo Grossi
- Autism Research Unit, Villa S. Maria Foundation, Tavernerio (CO), Italy
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Orland K, Harvey K, Klinkerman LN, Corrales A, Jamnik A, Zale C, Jo CH, Rathjen K, McIntosh A, Petrasic J, Sucato DJ, Ramo B, Johnson M, Brooks JT. An Analysis of Scoliosis in Autism Spectrum Disorder. J Pediatr Orthop 2023; 43:e804-e808. [PMID: 37609890 DOI: 10.1097/bpo.0000000000002497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Children with autism/Asperger are grouped into the diagnosis of autism spectrum disorder (ASD). It remains uncertain whether children with ASD and scoliosis have radiographic and clinical outcomes similar to idiopathic scoliosis (IS) patients. METHODS A single-center, retrospective review of a prospective scoliosis registry evaluated patients who had a posterior spinal fusion±Anterior Spinal Fusion and an underlying diagnosis of ASD between 1990 and 2021. A 2:1 match with AIS patients by age and sex was compared using demographic, radiographic, intraoperative, and SRS-22/30 variables. RESULTS Thirty patients with ASD (63% male, mean age at surgery 14.6±2.5 y) met inclusion criteria, with a follow-up of 2.46±1.00 years. Despite no differences in curve magnitude preoperatively, patients with ASD had a higher percent correction at 2-year follow-up (66% vs. 57%, P =0.01) and improved mean curve magnitude (20±10 degrees) at 2-year follow-up compared with IS patients (27±11 degrees, P <0.01). ASD patients had less lumbar lordosis preoperatively (40±12 vs. 53±14, P <0.01), but there were no significant differences in sagittal parameters at 2-year follow-up. There were no significant differences in the rate of complications at 2-year follow-up between ASD and AIS cohorts. CONCLUSIONS Although patients with ASD exhibited decreased lordosis compared with IS patients preoperatively, their radiographic outcomes at 2-year follow-up were the same. In addition, ASD patients maintained greater curve correction than IS patients at 2 years follow-up. LEVEL OF EVIDENCE Prognostic retrospective study.
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Affiliation(s)
| | | | | | | | | | - Connor Zale
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, HI
| | | | - Karl Rathjen
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Amy McIntosh
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Jason Petrasic
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Daniel J Sucato
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Brandon Ramo
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Megan Johnson
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Jaysson T Brooks
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
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Luginsland LA, Haegele JA, Bennett HJ. Lower extremity joint stiffness of autistic adolescents during running at dual speeds. J Biomech 2023; 149:111478. [PMID: 36780731 DOI: 10.1016/j.jbiomech.2023.111478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/13/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
Running is one of the most common forms of physical activity for autistic adolescents. However, research examining their lower extremity dynamics is sparse. In particular, no information exists regarding lower extremity joint stiffness in autistic adolescents. This study compared knee and ankle joint stiffness during the absorption phase of running between autistic adolescents and non-autistic controls. Motion capture and ground reaction forces were recorded for 22 autistic adolescents and 17 non-autistic age, sex, and BMI matched peers who ran at self-selected and standardized (3.0 m/s) speeds. Group × speed knee and ankle joint stiffness, change in moment, and range of motion were compared using mixed-model ANOVAs. There were no group × speed interactions for any variable. Autistic adolescents presented with significant (12 % and 19 %) reduced knee and ankle joint stiffness, respectively. In addition, autistic adolescents had significant reduced changes in knee and ankle joint moments by 11 % and 21 %, respectively, compared to their non-autistic peers. Only knee joint stiffness and knee joint moments were sensitive to running speed, each significantly increasing with speed by 6 %. Current literature suggests joint stiffness is an important mechanism for stability and usage of the stretch shortening cycle (or elastic recoil); as such, it is possible that the reduced ankle plantar flexor and knee extensor stiffness found in autistic adolescents in this study could be indicative of reduced efficiency during running. As group differences existed across both speeds, autistic adolescents may benefit from therapeutic and/or educational interventions targeting efficient running mechanics.
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Affiliation(s)
- Lauren A Luginsland
- Department of Human Movement Sciences, 2016 Student Recreation Center, Old Dominion University, Norfolk, VA 23529, United States.
| | - Justin A Haegele
- Department of Human Movement Sciences, 2016 Student Recreation Center, Old Dominion University, Norfolk, VA 23529, United States.
| | - Hunter J Bennett
- Department of Human Movement Sciences, 2016 Student Recreation Center, Old Dominion University, Norfolk, VA 23529, United States.
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Loubersac J, Michelon C, Ferrando L, Picot MC, Baghdadli A. Predictors of an earlier diagnosis of Autism Spectrum Disorder in children and adolescents: a systematic review (1987-2017). Eur Child Adolesc Psychiatry 2023; 32:375-393. [PMID: 33909143 DOI: 10.1007/s00787-021-01792-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/19/2021] [Indexed: 01/11/2023]
Abstract
Autism Spectrum Disorder (ASD) is an early onset neurodevelopmental disorder in which the first signs generally emerge at approximately 12 months of age but its diagnosis is feasible only from the age of 18 months. According to the literature, the average age of diagnosis ranges from 2.7 to 7.2 years, which raises the question of factors associated with early diagnosis as a condition for early intervention. In this systematic review, we aim to identify clinical, social, and environmental factors associated with the age at which the diagnosis of ASD is confirmed in children. A literature search was performed in the Pubmed, Web of Sciences, PsycInfo, and Cochrane databases. Among the 530 publications identified, 50 were selected according to the inclusion criteria. This review focuses on studies conducted in 21 countries using data collected over a period from 1987 to 2017. These studies were published before December 31st, 2019. The results suggest that the diagnosis of ASD occurs earlier if there is a delay in social communication or the presence of intellectual disability. There is a low level of evidence concerning associations between the age at diagnosis and sex, race, parental education, or socioeconomic status and accessibility to health care. Further studies using large and well-characterized data sets are needed to simultaneously explore clinical and socio-environmental factors involved in early diagnosis.
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Affiliation(s)
- Julie Loubersac
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Cécile Michelon
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
| | - Laetitia Ferrando
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France
| | - Marie-Christine Picot
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
- Department of Medical Information, University Hospital, Montpellier, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-Développementaux (CeAND), CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier Cedex 05, France.
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
- Faculté de Médecine, Université de Montpellier, Montpellier, France.
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Melnikov EY, Khodasevich LS, Polyakova AV, Legkaya EF. [Motor impairments in children with autism spectrum disorders: causes and possibilities for correction]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:54-61. [PMID: 37735796 DOI: 10.17116/kurort202310004154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Autism spectrum disorder (ASD) is characterized by triad of abnormalities in the form of developmental distortion with a lack of communicative abilities, behavioral and motor stereotypies. Etiology and pathogenesis of disease currently are unknown, but multifactorial causes of this pathology have been suggested. Although social disorders are considered a defining characteristic, motor disorders are a key feature of ASD. They are based on a postural control impairment, which is accompanied by delayed psychomotor development, reduced ability to motor synchronism in early childhood, modified arrangement of muscles, problems with balance and gait, postural instability, coordination deficiency, presence of motor dyspraxia and other abnormalities. OBJECTIVE To analyze current scientific data about motor disorders in ASD and their correction possibilities in children with this pathology. MATERIAL AND METHODS Analysis of publications, contained in PubMed and Google Scholar databases, which give consideration to motor disorders in children with ASD, was carried out. The search was done by keywords: motor disorders, children, autism spectrum disorder, causes, correction. RESULTS AND CONCLUSION Adaptive physical culture during individual training is one of the available and effective methods of physical rehabilitation in patients with ASD. Children with ASD need three levels of psychological support, each of which offers individual exercises, depending on the nature and severity of speech and cognitive impairment.
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Affiliation(s)
- E Yu Melnikov
- Research Center of Health Resort and Rehabilitation - branch of Federal Scientific and Clinical Center of Medical Rehabilitation and Health Resort of Federal Medical-Biological Agency in Sochi, Sochi, Russia
| | - L S Khodasevich
- Research Center of Health Resort and Rehabilitation - branch of Federal Scientific and Clinical Center of Medical Rehabilitation and Health Resort of Federal Medical-Biological Agency in Sochi, Sochi, Russia
- Kuban State Medical University, Krasnodar, Russia
| | | | - E F Legkaya
- Sochi Institute - branch of Peoples' Friendship University of Russia, Sochi, Russia
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The Management of Toe Walking in Children with Autism Spectrum Disorder: "Cast and Go". CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101477. [PMID: 36291413 PMCID: PMC9600566 DOI: 10.3390/children9101477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/25/2022]
Abstract
Background: Toe walking is associated with autism spectrum disorders (ASD). Correction of this “behavior” is a health challenge. The toe walker is affected by the contact refusal with the outside world: touching the ground as little as possible, trying to avoid any contact. A structured equines foot is a possible consequence. Method: We present the “Cast and Go” protocol, used in 22 idiopathic toe walker children with ASD treated from 2015 to 2020. The treatment was performed by a single senior experienced doctor with botulinum injection, ankle casts and rehabilitative therapies. All patients underwent pre- and post-treatment clinical evaluation using ankle dorsiflexion angle and casting number as treatment. We aimed to identify the intervention with the shortest acquisition time for the management of toe walking. Results: Our findings demonstrated the baseline ankle dorsiflexion angle influenced the casting number (p < 0.01) and male patients had a higher baseline ankle dorsiflexion angle than female patients (p < 0.01). No adverse events were observed. Conclusions: These findings suggested that the “Cast and Go” protocol could be a promising, dynamic and effective practice for toe walking disease in ASD patients.
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Valagussa G, Purpura G, Nale A, Pirovano R, Mazzucchelli M, Grossi E, Perin C. Sensory Profile of Children and Adolescents with Autism Spectrum Disorder and Tip-Toe Behavior: Results of an Observational Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091336. [PMID: 36138645 PMCID: PMC9497722 DOI: 10.3390/children9091336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023]
Abstract
Atypical sensory processing is frequently reported in persons with autism spectrum disorders (ASD), and it is one of the described diagnostic criteria for ASD. There is also mounting literature supporting the presence of motor impairments in individuals with ASD. Among these motor signs, tip-toe behavior (TTB) is a possible clinical finding, but its etiology is not clearly understood. It is suggested that TTB in ASD could be a sign of a sensory modulation impairment, but evidence is lacking and controversial. The main aim of this pilot study is to explore sensory features in a sample (4 females; 28 males) of children and adolescents with ASD (age range: 7-18). All participants also presented Intellectual Disability. Participants were divided in two groups, matched for age and gender, on the basis of the presence or absence of TTB (16 ASD TTB group vs. 16 ASD NO-TTB group) and then evaluated by using the Short Sensory Profile. We found that both ASD groups tend to significantly present sensory-related behavioral symptoms, but ASD TTB individuals more frequently showed the specific pattern of "under responsive/seeks sensation" than ASD NO-TTB individuals. These preliminary findings support that sensory-motor features might be taken into consideration when rehabilitation for TTB in children and adolescents with ASD is necessary.
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Affiliation(s)
- Giulio Valagussa
- Autism Research Unit, Villa S. Maria Foundation, Tavernerio, 22100 Como, Italy
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Giulia Purpura
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Alessandra Nale
- Autism Research Unit, Villa S. Maria Foundation, Tavernerio, 22100 Como, Italy
| | - Rita Pirovano
- Autism Research Unit, Villa S. Maria Foundation, Tavernerio, 22100 Como, Italy
| | - Miryam Mazzucchelli
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
| | - Enzo Grossi
- Autism Research Unit, Villa S. Maria Foundation, Tavernerio, 22100 Como, Italy
| | - Cecilia Perin
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy
- Correspondence:
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13
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Valagussa G, Piscitelli D, Baruffini S, Panzeri V, Perin C, Mazzucchelli M, Cornaggia CM, Pellicciari L, Grossi E. Little Evidence for Conservative Toe Walking Interventions in Autism Spectrum Disorders: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00329-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AbstractThis systematic review summarizes the evidence about toe walking (TW) interventions in persons with autism. Following the PRISMA guidelines, a systematic search of MEDLINE, CINAHL, PsycINFO, The Cochrane Library, Google Scholar, and Opengrey was performed. Nine articles (all case reports or case series) were included. Methodological quality was assessed using the Mayo Evidence-Based Practice Centre tool. The included studies considered 17 subjects (16 males; age range: 4–15 years). All studies reported a reduction of TW frequency, but the follow-up was lacking in seven studies. There is a lack of high-quality studies with a sufficiently large and well-characterized sample to assess the effectiveness of TW interventions in autistic persons. These findings strongly support the need for further research in this area.
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Abstract
BACKGROUND This paper aims to report on the last 5 years of relevant research on pediatric foot and ankle pathology with specific focus on clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. METHODS The Browzine platform was used to review the table of contents for all papers published in the following target journals related to the treatment of pediatric foot and ankle conditions. Search results were further refined to include clinical trials and randomized controlled trials published from March 1, 2015 to November 15, 2021. RESULTS A total of 73 papers were selected for review based on new findings and significant contributions in treatment of clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. Also included were several papers that did not fit into any of these categories but provided new insight into specific foot and ankle pathologies. CONCLUSIONS Treatment strategies for children with foot and ankle pathology are continually evolving. We review many of the most recent publications with the goal of improving understanding of these pathologies and highlighting current best practices. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kali Tileston
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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15
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Freiman HD, Mensah C, Codrington J, Frick SL. Idiopathic Toe-Walking in Children and Adolescents: Diagnosis, Natural History, and Treatment Options. JBJS Rev 2022; 10:01874474-202202000-00012. [PMID: 35180146 DOI: 10.2106/jbjs.rvw.21.00193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Idiopathic toe-walking is a diagnosis of exclusion. » The natural history of idiopathic toe-walking has not been studied in many children; we identified only 1 prospective study. Of children without equinus contractures who were toe-walking before the age of 5.5 years, 59% had spontaneous resolution of toe-walking by 5.5 years of age, and 79%, by the age of 10 years. » Adverse consequences of toe-walking into adulthood have not been reported, but may exist, and further research is needed to define and clarify. » If parents desire treatment to resolve their child's toe-walking, surgical lengthening of the Achilles tendon is the treatment with the highest chance of success and lowest relapse rate, and thus far, no complications have been reported in any surgical series.
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Affiliation(s)
- Halle D Freiman
- Stanford University School of Medicine, Palo Alto, California
| | | | | | - Steven L Frick
- Stanford University School of Medicine, Palo Alto, California
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16
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Wilder DA, Ingram G, Hodges AC. Evaluation of shoe inserts to reduce toe walking in young children with autism. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- David A. Wilder
- The Scott Center for Autism Treatment Florida Institute of Technology Melbourne Florida USA
| | - Grant Ingram
- The Scott Center for Autism Treatment Florida Institute of Technology Melbourne Florida USA
| | - Ansley C. Hodges
- Department of Applied Behavior Analysis Nemours Children's Hospital Orlando Florida USA
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Bennett HJ, Jones T, Valenzuela KA, Haegele JA. Coordination variability during running in adolescents with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1201-1215. [PMID: 34519564 DOI: 10.1177/13623613211044395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Walking and running are popular forms of physical activity that involve the whole body (pelvis/legs and arms/torso) and are coordinated by the neuromuscular system, generally without much conscious effort. However, autistic persons tend not to engage in sufficient amounts of these activities to enjoy their health benefits. Recent reports indicate that autistic individuals tend to experience altered coordination patterns and increased variability during walking tasks when compared to non-autistic controls. Greater stride-to-stride coordination variability, when the task has not changed (i.e. walking at same speed and on same surface), is likely indicative of motor control issues and is more metabolically wasteful. To date, although, research examining running is unavailable in any form for this population. This study aimed to determine if coordination variability during running differs between autistic adolescents and age, sex, and body mass index matched non-autistic controls. This study found that increased variability exists throughout the many different areas of the body (foot-leg, left/right thighs, and opposite arm-opposite thigh) for autistic adolescents compared to controls. Along with previous research, these findings indicate autistic persons exhibit motor control issues across both forms of locomotion (walking and running) and at multiple speeds. These findings highlight issues with motor control that can be addressed by therapeutic/rehabilitative programming. Reducing coordination variability, inherently lessening metabolic inefficiency, may be an important step toward encouraging autistic youth to engage in sufficient physical activity (i.e. running) to enjoy physiological and psychological benefits.
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Chiropractic management of toe-walking in an eight-year-old male diagnosed with autism spectrum disorder utilizing a functional approach: A case study. J Bodyw Mov Ther 2021; 26:538-541. [PMID: 33992294 DOI: 10.1016/j.jbmt.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 12/10/2020] [Accepted: 03/13/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this paper is to discuss the treatment of idiopathic toe-walking utilizing cognitive-motor dual-tasking and primitive reflex integration exercises. METHODS An eight-year-old child with the previous diagnosis of autism spectrum disorder and idiopathic toe-walking presents for chiropractic care. The patient had previously received eight months of physical therapy in which his results plateaued after three months of care. RESULTS On the initial visit, the child was evaluated for primitive reflexes. The patient retained the asymmetrical tonic neck reflex and palmer grasp. He was prescribed exercises to integrate these reflexes. In the second visit and onwards, the patient was tasked with walking while performing a cognitive or motor task. The patient's performance of primitive reflex attenuation exercises significantly improved in form and timing, and the patient achieved proper gait mechanics with most interventions used. CONCLUSION Due to the limited number of visits, the patient was prescribed a cognitive task to help facilitate the retention of proper gait mechanics; however, these findings suggest that chiropractic management may prove useful in children who toe walk and that further investigation into treatment utilizing primitive reflex integration exercises for children with psychomotor delays is warranted. We suggest that the integration of primitive reflex testing for the chiropractor can yield many answers and serve as a valuable rehabilitation approach.
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Mawson AR, Croft AM. Multiple Vaccinations and the Enigma of Vaccine Injury. Vaccines (Basel) 2020; 8:E676. [PMID: 33198395 PMCID: PMC7712358 DOI: 10.3390/vaccines8040676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022] Open
Abstract
A growing number of vaccines are administered at the same time or in close succession, increasing the complexity of assessing vaccine safety. Individual vaccines are assumed to have no other effect than protection against the targeted pathogen, but vaccines also have nonspecific and interactive effects, the outcomes of which can be beneficial or harmful. To date, no controlled trials and very few observational studies have determined the impact of vaccination schedules on overall health. The balance of the risks and benefits from mass vaccination therefore remains uncertain. Recent studies worryingly suggest links between multiple vaccinations and increased risks of diverse multisystem health problems, including allergies, infections, and neuropsychiatric or neurodevelopmental disorders. Here, we propose that, in susceptible persons, multiple vaccinations activate the retinoid cascade and trigger apoptotic hepatitis, leading to cholestatic liver dysfunction, in which stored vitamin A compounds (retinyl esters and retinoic acid) enter the circulation in toxic concentrations; this induces endogenous forms of hypervitaminosis A, with the severity of adverse outcomes being directly proportional to the concentration of circulating retinoids. In very low concentrations, vitamin A and its major metabolite retinoic acid contribute to immune function and to the process of immunization, whereas excess vitamin A increases the risk of adverse events, including common "side-effects" as well as chronic adverse outcomes. The increasing rates of allergy, ear infections, and neurodevelopmental disorders (NDDs) in countries with high rates of vaccination could be related to mass vaccination and to its impact on liver function and vitamin A metabolism, collectively representing endogenous manifestations of hypervitaminosis A. Further studies of health outcomes in vaccinated and unvaccinated groups are urgently needed, to increase understanding of the pathophysiology and treatment of vaccine injury, to identify the risk factors and screen for vaccine injury, to inform public health policy on potential hazards related to vaccination schedules, and to optimize the safety and benefits of vaccines.
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Affiliation(s)
- Anthony R. Mawson
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Jackson State University, Jackson, MS 39213, USA
| | - Ashley M. Croft
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, White Swan Road, Portsmouth PO1 2DT, UK;
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20
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Valagussa G, Balatti V, Trentin L, Piscitelli D, Yamagata M, Grossi E. Relationship between tip-toe behavior and soleus - gastrocnemius muscle lengths in individuals with autism spectrum disorders. J Orthop 2020; 21:444-448. [PMID: 32982098 PMCID: PMC7493131 DOI: 10.1016/j.jor.2020.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND About 20% of individuals with autism spectrum disorders (ASD) showed tip-toe behavior (TTB). This behavior may be related to a decreased ankle joint range of motion (ROM) in dorsiflexion. Physiologically, gastrocnemius (GM) and soleus (SM) muscles influence ankle ROM independently. However, no studies investigated the relationship between the amount of time individuals with ASD spend in TTB and GM and SM muscle lengths. OBJECTIVE To evaluate the relationship between three mutually exclusive clinical patterns of TTB i.e., during standing, walking and running (TTB Class 1), or during walking and running (TTB Class 2), or only when running (TTB Class 3), and GM and SM muscle lengths. METHODS Sixty-nine individuals with ASD (average age: 14.1 ± 3.6 years, 56 males) were enrolled. In a clinical setting, SM and GM muscle lengths of both legs were assessed through a manual goniometer. Measurements were performed by two trained assessors blinded to TTB classifications. RESULTS Individuals with ASD classified as TTB Class 1 demonstrated a shortening of both GM and SM compared with NO-TTB and TTB Class 3 individuals. CONCLUSIONS Our results support the relationship between TTB severity and GM and SM shortening assessed by a decreased ankle joint ROM in dorsiflexion. Further studies are needed to determine the factors associated with TTB and decreased ankle ROM.
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Affiliation(s)
- Giulio Valagussa
- Autism Research Unit, Villa Santa Maria Foundation, Via IV Novembre 15, Tavernerio, CO, Italy
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
- Corresponding author. Autism Research Unit, Villa Santa Maria Foundation, Tavernerio, CO, Italy.
| | - Valeria Balatti
- Autism Research Unit, Villa Santa Maria Foundation, Via IV Novembre 15, Tavernerio, CO, Italy
| | - Luca Trentin
- Autism Research Unit, Villa Santa Maria Foundation, Via IV Novembre 15, Tavernerio, CO, Italy
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada
| | - Momoko Yamagata
- Faculty of Human Development, Graduate School of Human Development and Environment, Kobe University, Japan
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Japan
| | - Enzo Grossi
- Autism Research Unit, Villa Santa Maria Foundation, Via IV Novembre 15, Tavernerio, CO, Italy
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