Controle postural em crianças com transtorno do espectro autista: influência de diferentes demandas na regularidade do controle postural

Abstract

Background: Impairments in postural control (PC) in individuals with autism spectrum disorder (ASD) are well-documented, often characterized by inefficiency and difficulty adapting to different conditions. PC is a prerequisite for effectively performing motor tasks and is crucial for maintaining balance, performing daily activities, and engaging in school tasks. Therefore, PC can impact other developmental domains. Research indicates that adding motor tasks can exacerbate PC difficulties in ASD, emphasizing the need to examine PC across various contexts to understand better how different demands affect it. Discrete and linear measures may inadequately capture the complexity of PC, so analyzing movement regularity has been used to understand PC better. A system with highly regular behavior tends to have lower adaptability to contextual demands, with greater regularity in PC being linked to reduced effectiveness. Objective: This study aimed to investigate the regularity of PC in children with ASD in different task conditions. Methods: 24 children with ASD, matched with typically developing (TD) children by sex and age, were assessed for PC under three conditions: standing, sitting, and sitting while performing a fine motor task. The regularity of PC was evaluated using Multiscale Entropy. A linear mixed-effects model was employed to compare PC regularity between ASD and TD children across each task. Results: Significant group differences (p=0.032) indicated that children with ASD had more regular PC than TD children across all tasks. Additionally, a significant task effect (p<0.001) indicated varying PC regularity by task, but no significant group-by-task interaction (p=0.697) was found, suggesting consistent group differences across different tasks. Planned contrasts showed significant differences between the ASD and TD groups in each task. Conclusion: Children with ASD exhibited more regular behavior compared to TD children, indicating reduced adaptive capacity. The significant main effect observed between tasks demonstrated that each task's demands modulated the PC response. Our results align with the three constraints influencing this motor ability: the organism's properties, the characteristics of the base of support, and the goal of the task. Additionally, the results suggest that pediatric physical therapy interventions for children with ASD could include demands in various contexts to enhance the adaptability of these individuals.