Postural control deficits, also referred to as balance deficits, are a noted example of
impaired motor-skills and are increasingly considered as one of the primary markers for
autism spectrum disorder (ASD)1-5. However, there are very few controlled clinical trials
examining effects of balance interventions in individuals with ASD. Moreover, to date
there exist few effective interventions based on well-designed research that address
balance deficits in youth with ASD and are home-implemented, cost-effective,
generalizable, and enjoyable and that promote adherence. Virtual reality (VR) active
gaming is one such intervention that incorporates scientific mechanisms for improving
balance. But, there exist few, evidence-based best practices that use this method to
address balance in youth with ASD. In addition to being based on principles of motor
learning/control, commercially available VR active gaming can be affordable, enjoyable,
at-home intervention. Thus, the aim of this study is to assess the effect of short-term
(3 days/week for 2 weeks) Virtual Reality (VR) active video gaming intervention on static
and dynamic balance, versus traditional balance training exercises, in youth with ASD.
This study will take place at the Physical Activity and Biomechanics Labs at School of
Public Health, Indiana University, Bloomington, and participants home for total of 9
sessions occurring over 7-8 weeks.
Before participants come to the lab:
Participants' parent/guardian will complete a couple of questionnaires that will ask
questions about any medications that participant takes and about participants' physical
health to make sure it is safe for the participant to participate in the study. They will
also answer questions that are used to determine if someone might have ASD.
Participants will be shown a video which will give them information about the lab they
will be coming to do some of the study activities, and information about the people that
will be working with them during the study. Participants will then be randomly assigned
(like flipping a coin) to one of two groups: the Virtual Reality Group, or the Exercise
Group. This will determine what activities or exercise they will do for the upcoming
sessions.
Session #1, about 90 minutes:
Researchers measure participants height, weight, and length of arm and leg. Researchers
will also measure which hand participants prefer to perform daily activities using
Edinburgh Handedness Inventory- short form (EHI-SF). Participants will also stand on a
large mat containing sensors that will measure how much their body moves back and forth
while they are standing. Participants will stand on the mat for 30 seconds with their
eyes open, and then for 30 seconds with their eyes closed.
Then, researchers will measure how well participants are able to balance by having them
do some activities like sitting and standing without help, standing with their eyes
closed, reaching forward with their arms stretched in front, placing their right then
left foot on a stool, standing with alternating foot in front, and standing on one foot,
alternating right and left. The researcher will show the participants how to do each of
these, and they can practice a couple of times before the test begins.
Participants will then do some walking in the lab with special sensors that are attached
to their lower back and feet. This will measure how participants walk. The sensors are
attached with special tape to the cloths and shoes, and are not painful. A special camera
will take pictures as the participants walk, and video recording will be done as well.
Participants will do this several times and will be reminded to walk at a normal pace.
Lastly, if the participants are in the Virtual Reality Group, their parent/guardian will
receive the Nintendo switch™ console and the sports game to take home.
At home, 3 times a week for two weeks for 30-40 minutes (Sessions 2-7):
If participants are in the Virtual Reality Group, they will choose 2 video games on
the Nintendo Switch from golf, Frisbee, beach tennis, soccer, Volleyball, badminton,
bowling, and Chambara. Games will be played for 10 minutes each with a 5-minute
break in-between. The same 2 games will be played at each session in the same
sequence. Researchers will provide verbal prompts and encouragement during the games
as they watch participants via Zoom. Each session will take approximately 30-40
minutes. Ideally, each session will occur with an off day in between, however this
may not be realistic depending on participants schedules and so sessions will occur
at their convenience.
If participants are in the Exercise Group, they will perform balance exercises for
15 minutes with 5 minutes of warm and cool down each. Some of the exercises are
standing with one foot in front of the other for 10 seconds, standing on 1 foot for
10 seconds, standing with feet together etc. Breaks will be given, and they will be
given instructions and encouragement by the researcher who will be watching via
Zoom.
Sessions 8 and 9 (in the lab), about an hour:
Session #8: 3-5 days after session 7, Participants will complete all the balance and
walking measurements that they did in session #1 excluding parameters such as EHI-SF, leg
and arm length, weight, height. It will take approximately 1 hour.
On session #9: 4 weeks after session #7, participants will once again complete all the
same activities they completed during visit #8. It will take approximately 1 hour.
