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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Battisti N, Cozzaglio M, Faccioli S, Perazza S, Groppi A, Menta L, Motta M, Piovesan R, Digennaro GL, Rodocanachi M, Ronchetti AB, Sarno C, Saviola D, Valagussa G, Cersosimo A. Prevention of hip dislocation in severe cerebral palsy (GMFCS III-IV-V): an interdisciplinary and multi-professional Care Pathway for clinical best practice implementation. Eur J Phys Rehabil Med 2023; 59:714-723. [PMID: 37796120 PMCID: PMC10795071 DOI: 10.23736/s1973-9087.23.07978-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/28/2023] [Accepted: 09/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Hip displacement (HD) and dislocation in severe Cerebral Palsy (CP) (GMFCS III, IV, V) are important causes of worsening disability and quality of life. Prevention must be started from the first months of life through screening programs and early treatments, both conservative and surgical. Evidence from Clinical Practice Guidelines also suggests the development of Care Pathways for good clinical practice. At the beginning of 2020 an interdisciplinary, multi-professional working group, composed of 26 members (including Physiatrists, Physiotherapist, Neuro-psychomotor Therapists and Orthopedists representing the respective Italian Scientific Societies) with the involvement of the FightTheStroke Foundation families' association, was set up. AIM The aim of the multi-professional panel was the production of evidence-based recommendations for the Care Pathway "Prevention of Hip Displacement in children and adolescents with severe CP" for best clinical practice implementation in our national context. DESIGN Clinical Care Pathway (Clinical Practice Guideline). SETTING Inpatient and outpatient. POPULATION Children with severe CP (GMFCS III-IV-V). METHODS The recommendations of this Care Pathway were developed using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines for Care Pathways development and the Grading of Recommendations Assessment Development and Evaluation (GRADE ADOLOPMENT) working group for adoption or adaption or de novo development of recommendations from high-quality guidelines. In 2020 a multidisciplinary working group (WG) developed four research questions on the prevention of HD on the following topics: screening, botulinum toxin treatment, postural management and preventive soft tissue surgery. A comprehensive review of the biomedical literature was performed on each question. Guidelines, Systematic Reviews and Primary studies were retrieved through a top-down approach. References were screened according to inclusion criteria and quality was assessed by means of specific tools. A list of recommendations was then produced divided by intervention (screening programs, postural management, botulinum toxin, preventive surgery). In a series of meetings, the panel graduated recommendations using the GRADE evidence to decision frameworks. RESULTS Fifteen recommendations were developed: seven on screening programs, four on postural management strategies, one on botulinum toxin, and three on preventive surgery. Evidence quality was variable (from very low to moderate) and only a few strong recommendations were made. CONCLUSIONS In severe CP at high risk of hip dislocation, it is strongly recommended to start early hip surveillance programs. In our national context, there is a need to implement Screening programs and dedicated Network teams. We also strongly recommend a comprehensive approach shared with the families and goal-oriented by integrating the different therapeutic interventions, both conservative and not, within Screening programs. CLINICAL REHABILITATION IMPACT Implementing a comprehensive multi-professional approach for the prevention of hip dislocation in severe CP.
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Affiliation(s)
- Nicoletta Battisti
- Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy -
| | - Massimo Cozzaglio
- Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Ca' Granda Ospedale Maggiore Polyclinic Hospital, Milan, Italy
| | - Silvia Faccioli
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Postgraduate Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Perazza
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Lorena Menta
- Pediatric Rehabilitation Area, AUSL Parma, Parma, Italy
| | - Matteo Motta
- Child and Adolescent Neurology and Psychiatry Unit, ASST Lecco, Lecco, Italy
| | | | - Giovanni L Digennaro
- Pediatric Orthopedics and Traumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Claudia Sarno
- UFSMIA Service of Rehabilitation, Azienda Usl Toscana Centro, Florence, Italy
| | - Donatella Saviola
- Cardinal Ferrari Santo Stefano Rehabilitation Center, KOS Care, Fontanellato, Parma, Italy
| | - Giulio Valagussa
- Villa Santa Maria Foundation, Tavernerio, Como, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonella Cersosimo
- Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy
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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) 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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. Rev J Autism Dev Disord 2022. [DOI: 10.1007/s40489-022-00329-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Grossi E, Caminada E, Goffredo M, Vescovo B, Castrignano T, Piscitelli D, Valagussa G, Franceschini M, Vanzulli F. Patterns of Restricted and Repetitive Behaviors in Autism Spectrum Disorders: A Cross-Sectional Video Recording Study. Preliminary Report. Brain Sci 2021; 11:678. [PMID: 34064245 PMCID: PMC8224357 DOI: 10.3390/brainsci11060678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several instruments have been proposed to investigate restricted, repetitive behaviors (RRBs) in individuals with Autism Spectrum Disorder (ASD). Systematic video observations may overcome questionnaire and interview limitations to investigate RRBs. This study aimed to analyze stereotypic patterns through video recordings and to determine the correlation between the number and appearance of RRBs to ASD severity. METHODS Twenty health professionals wearing a body cam recorded 780 specific RRBs during everyday activities of 67 individuals with ASD (mean age: 14.2 ± 3.72 years) for three months. Each stereotypy was classified according to its complexity pattern (i.e., simple or complex) based on body parts and sensory channels involved. RESULTS The RRBs spectrum for each subject ranged from one to 33 different patterns (mean: 11.6 ± 6.82). Individuals with a lower number of stereotypies shown a lower ASD severity compared to subjects with a higher number of stereotypies (p = 0.044). No significant differences were observed between individuals exhibiting simple (n = 40) and complex patterns (n = 27) of stereotypies on ASD severity, age, sex, and the number of stereotypes. CONCLUSIONS This study represents the first attempt to systematically document expression patterns of RRBs with a data-driven approach. This may provide a better understanding of the pathophysiology and management of RRBs.
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Affiliation(s)
- Enzo Grossi
- Autism Research Unit, “Villa Santa Maria” Foundation, 22038 Tavernerio, Italy; (E.G.); (E.C.); (B.V.); (T.C.); (G.V.); (F.V.)
| | - Elisa Caminada
- Autism Research Unit, “Villa Santa Maria” Foundation, 22038 Tavernerio, Italy; (E.G.); (E.C.); (B.V.); (T.C.); (G.V.); (F.V.)
| | - Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCSS San Raffaele Pisana, 00163 Rome, Italy;
| | - Beatrice Vescovo
- Autism Research Unit, “Villa Santa Maria” Foundation, 22038 Tavernerio, Italy; (E.G.); (E.C.); (B.V.); (T.C.); (G.V.); (F.V.)
| | - Tristana Castrignano
- Autism Research Unit, “Villa Santa Maria” Foundation, 22038 Tavernerio, Italy; (E.G.); (E.C.); (B.V.); (T.C.); (G.V.); (F.V.)
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy;
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
| | - Giulio Valagussa
- Autism Research Unit, “Villa Santa Maria” Foundation, 22038 Tavernerio, Italy; (E.G.); (E.C.); (B.V.); (T.C.); (G.V.); (F.V.)
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy;
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCSS San Raffaele Pisana, 00163 Rome, Italy;
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00163 Rome, Italy
| | - Franco Vanzulli
- Autism Research Unit, “Villa Santa Maria” Foundation, 22038 Tavernerio, Italy; (E.G.); (E.C.); (B.V.); (T.C.); (G.V.); (F.V.)
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Perin C, Valagussa G, Mazzucchelli M, Gariboldi V, Cerri CG, Meroni R, Grossi E, Cornaggia CM, Menant J, Piscitelli D. Physiological Profile Assessment of Posture in Children and Adolescents with Autism Spectrum Disorder and Typically Developing Peers. Brain Sci 2020; 10:brainsci10100681. [PMID: 32992546 PMCID: PMC7601261 DOI: 10.3390/brainsci10100681] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023] Open
Abstract
A sound postural system requires sensorimotor integration. Evidence suggests that individuals with Autism Spectrum Disorder (ASD) present sensorimotor integration impairments. The Physiological Profile Assessment (PPA) can be used to evaluate postural capacity assessing five physiological subsets (i.e., vision, reaction time, peripheral sensation, lower limb strength, balance); however, no studies applied the PPA in young individuals. Therefore, this study aimed to investigate the PPA in children and adolescents with ASD compared with age-matched typically developing (TD) individuals and examine the relationship between the PPA subset within the ASD and TD participants according to different age groups. Percentiles from the PPA were obtained from the TD children and adolescents (n = 135) for each test. Performances of the individuals with ASD (n = 18) were examined relative to the TD percentiles. ASD participants' scores were above the 90th percentile (i.e., poor performance) in most sensory, motor and balance parameters. Performance in most of the PPA tests significantly improved with older age in the TD group but not in the ASD group. The study findings support the use of the PPA in TD children and adolescents while further research should investigate postural capacity in a larger ASD sample to enhance the understanding of sensorimotor systems contributing to compromised postural control.
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Affiliation(s)
- Cecilia Perin
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy; (G.V.); (M.M.); (V.G.); (C.G.C.); (C.M.C.); (D.P.)
- Correspondence: ; Tel.: +39-0362-986-446; Fax: +39-0362-986-439
| | - Giulio Valagussa
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy; (G.V.); (M.M.); (V.G.); (C.G.C.); (C.M.C.); (D.P.)
- Autism Research Unit, “Villa Santa Maria” Foundation, 22038 Como, Italy;
| | - Miryam Mazzucchelli
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy; (G.V.); (M.M.); (V.G.); (C.G.C.); (C.M.C.); (D.P.)
| | - Valentina Gariboldi
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy; (G.V.); (M.M.); (V.G.); (C.G.C.); (C.M.C.); (D.P.)
- ASST Rhodense, Ospedale “G. Salvini”, 20024 Milan, Italy
| | - Cesare Giuseppe Cerri
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy; (G.V.); (M.M.); (V.G.); (C.G.C.); (C.M.C.); (D.P.)
| | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, 4671 Luxembourg, Luxembourg;
| | - Enzo Grossi
- Autism Research Unit, “Villa Santa Maria” Foundation, 22038 Como, Italy;
| | - Cesare Maria Cornaggia
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy; (G.V.); (M.M.); (V.G.); (C.G.C.); (C.M.C.); (D.P.)
| | - Jasmine Menant
- Neuroscience Research Australia and School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy; (G.V.); (M.M.); (V.G.); (C.G.C.); (C.M.C.); (D.P.)
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
- School of Physical Therapy and Athletic Training, Pacific University, Hillsboro, OR 97123, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Valagussa G, Trentin L, Signori A, Grossi E. Toe Walking Assessment in Autism Spectrum Disorder Subjects: A Systematic Review. Autism Res 2018; 11:1404-1415. [PMID: 30199607 DOI: 10.1002/aur.2009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/16/2018] [Indexed: 02/05/2023]
Abstract
There is increasing evidence that autism spectrum disorder (ASD) subjects have also motor impairments. Toe walking (TW) is a phenomenon that can be found in ASD subjects during gait, even if this condition was found not to be necessarily related only to walking, since these children often also stand and run on their tiptoes. Since persistent TW in ASD subjects may contribute to secondary shortening of the Achilles's tendon, it becomes important to have an assessment tool and/or outcome measure for both the clinical and rehabilitative settings. The aim of this systematic review is to critically evaluate and describe the methods employed to assess toe walking in ASD subjects. The systematic review protocol was previously registered on PROSPERO. We conducted an extensive literature search in PubMed, CINAHL, PsycINFO, The Cochrane Library, and Scopus databases. There were no restrictions on the types of study design eligible for inclusion. Ten studies were included in the systematic review. Risk of bias of the included studies was conducted using the following instruments depending on the study types: STROBE Statement, Cochrane risk of bias tool, and CARE checklist. Almost all the included studies (8/10) proposed a tip-toe behavior (TTB) assessment only during walking. Nine out of ten of the included studies assessed TTB using a qualitative methodology. The results evidenced the heterogeneity of qualitative methods and a lack of a structured quantitative test to assess toe walking in ASD subjects. Autism Res 2018, 11: 1404-1415. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY ABSTRACT: Toe walking (TW) is a phenomenon that can be found during ASD subject's gait. The persistence of this behavior may contribute to secondary Achilles's tendon shortening. In this perspective it becomes important to have an assessment tool and/or outcome measure for both the clinical and rehabilitative settings. The current systematic review aimed to describe the methods employed to assess TW. The results evidenced the lack and the need of a structured quantitative test to assess TW in ASD subjects.
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Affiliation(s)
- Giulio Valagussa
- Autism Research Unit, Villa Santa Maria Foundation, Tavernerio, CO, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luca Trentin
- Autism Research Unit, Villa Santa Maria Foundation, Tavernerio, CO, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Enzo Grossi
- Autism Research Unit, Villa Santa Maria Foundation, Tavernerio, CO, Italy
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Valagussa G, Trentin L, Balatti V, Grossi E. Assessment of presentation patterns, clinical severity, and sensorial mechanism of tip-toe behavior in severe ASD subjects with intellectual disability: A cohort observational study. Autism Res 2017; 10:1547-1557. [PMID: 28383150 DOI: 10.1002/aur.1796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 02/07/2017] [Accepted: 03/20/2017] [Indexed: 02/05/2023]
Abstract
We assessed presentation patterns and characteristics of tip-toe behavior (TTB), more commonly known as toe walking, in a cohort of severe autism spectrum disorder (ASD) subjects with intellectual disability in two studies. The first study included 69 consecutive ASD subjects (57 males, mean age = 14 years-3.7 SD) under observation at our institute. A therapist assessed the presence of TTB during standing, walking, and running through direct observation and an interview with the subjects main caregiver. The prevalence of TTB was 32%. We found three clinical presentation patterns of TTB: (1) present when standing, walking and running (45.5%), (2) present when walking and running (18.4%), or (3) present only when running (36.4%). TTB subjects were more frequently nonverbal than those without TTB (72.7% vs. 44.6%-P = 0.03). On the other hand, no significant difference in ASD severity according to the ADOS scale was found between TTB and non-TTB subjects. In the second study, carried out in a subgroup of 14 ASD subjects (7 TTB and 7 non-TTB), we evidenced that a soft floor surface (foam mats) made a substantial difference in reducing the TTB phenomenon. TTB is frequently present in ASD individuals and may occur in three mutually exclusive modalities, which ultimately defines what is commonly known as toe walking. The presence of TTB seems correlated to the severity of language delay. Foot contact on soft surfaces reduces TTB both during static and/or dynamic tasks. Further evaluation is needed to clarify the potential pathophysiological implications of this phenomenon. Autism Res 2017, 10: 1547-1557. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Giulio Valagussa
- Autism Research Unit, Villa Santa Maria Institute, Tavernerio, (CO), Italy
- School of Medicine and Surgery - University of Milano Bicocca, Milan, Italy
| | - Luca Trentin
- Autism Research Unit, Villa Santa Maria Institute, Tavernerio, (CO), Italy
| | - Valeria Balatti
- Autism Research Unit, Villa Santa Maria Institute, Tavernerio, (CO), Italy
| | - Enzo Grossi
- Autism Research Unit, Villa Santa Maria Institute, Tavernerio, (CO), Italy
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Aina A, Barbero M, Cagnie B, Castelli E, Cook C, Ferrari S, Foglia A, Bizzarri P, Giraudo D, Littlewood C, Pillastrini P, Piscitelli D, Romano M, Tettamanti A, Vanti C, Vercelli S, Voogt L, Maria A, Emanuele S, Paolo P, Francesco S, Antonio C, Ilaria C, Giuseppe O, Raffaele B, Serena F, Alessandro A, Bonfanti M, Pasquetti M, Arianna B, Paolo P, Carla V, Brioschi D, Vitali M, Pedretti A, Fraschini G, Tettamanti A, Castellini G, Gianola S, Bonovas S, Banfi G, Moja L, Castellini G, Gianola S, Frigerio P, Agostini M, Bolotta R, Corbetta D, Gasparini M, Gozzer P, Guariento E, Li L, Pecoraro V, Sirtori V, Turolla A, Andreano A, Moja L, Castellini G, Gianola S, Bonovas S, Moja L, Chiarotto A, Terwee CB, Boers M, Ostelo RW, Chiarotto A, Maxwell LJ, Terwee CB, Wells GA, Tugwell P, Ostelo RW, Chiarotto A, Clijsen R, Fernandez-de-las-Penas C, Barbero M, Matteo C, Sara R, Stefano V, Cislaghi M, Penone G, Marinelli G, Rezzan G, Melegati G, Gatti R, Claudio C, Francesca T, Moriondo A, Stefano V, Doronzio S, Paci M, Ferrari S, Vanti C, Monticone M, Ferrari S, Vanti C, Monticone M, Fabiola G, Anna Z, Serena B, Giorgia C, Francesco S, Ghirlanda F, Schneebeli A, Cescon C, Barbero M, Gioia G, Faccendini S, Aina A, Tettamanti A, Granzotto G, Coppola L, Gava I, Frassinelli M, Gattinoni F, Guidotti L, Postiglione M, Lombardi B, Paci M, Leoni D, Storer D, Gatti R, Egloff M, Barbero M, Tiziano M, Andrea T, Maremmani D, Cencini S, Plebani G, Moresi F, Barbero M, Isnardi M, Gallace A, Cescon C, Gatti R, Moretti N, Maselli, Testa M, Negrini S, Donzelli S, Saveri F, Negrini A, Parzini S, Romano M, Zaina F, Nesi L, Ferrarello F, Bianchi VAM, Paci M, Paci M, Nannetti L, Lombardi B, Mini G, Marchettini M, Ferrarello F, Paci M, Piccolo F, Agosta F, Sarasso E, Adamo P, Temporiti F, Falini A, Gatti R, Filippi M, Piscitelli D, Meroni R, Pellicciari L, Mondelli MA, Favaron T, Cerri CG, Tallarita EA, Elisa R, Stefano V, Sara R, Matteo C, Stefano V, Sarasso E, Agosta F, Tomić A, Basaia S, Dragašević N, Svetel M, Copetti M, Kostic VS, Filippi M, Saveri F, Romano M, Mastrantonio M, Negrini A, Zaina F, Stefano N, Schneebeli A, Castellini G, Redaelli V, Soldini E, Barbero M, Segat M, Casonato O, Margelli M, Pillon S, Spunton V, Fenini R, Garofalo R, Conti M, Valagussa G, Balatti V, Trentin L, Melli S, Norsi M, Grossi E, Vanossi M, Saveri F, Romano M, Vanti C, Taioli S, Gardenghi I, Bertozzi L, Rosso A, Romeo A, Pillastrini P, Vanti C, Ferrari S, Ruggeri M, Monticone M, Vanti C, Filippo B, Conti C, Faresin F, Ruggeri M, Piccarreta R, Ferrari S, Luca V, Stefano V, Claudia V, Joseph CM, Carmen D, Fabrizio P, Youssef S, Montesano M, Picardi M, De Giampaulis P, Corbo M, Pisani L, Anna Z, Fabiola G, Carolina R, Francesco S. 5th National Congress of the Italian Society of Physiotherapy. Arch Physiother 2016. [DOI: 10.1186/s40945-016-0022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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