Biofeedback-Based, Videogame Balance Training in Autism
- 894 Downloads
The present study examined the effects of a visual-based biofeedback training on improving balance challenges in autism spectrum disorder (ASD). Twenty-nine youth with ASD (7–17 years) completed an intensive 6-week biofeedback-based videogame balance training. Participants exhibited training-related balance improvements that significantly accounted for postural-sway improvements outside of training. Participants perceived the training as beneficial and enjoyable. Significant moderators of training included milder stereotyped and ritualistic behaviors and better starting balance. Neither IQ nor BMI moderated training. These results suggest that biofeedback-based balance training is associated with balance improvements in youth with ASD, most robustly in those with less severe repetitive behaviors and better starting balance. The training was perceived as motivating, further suggesting its efficacy and likelihood of use.
KeywordsPostural stability Motor Video game Technology-based interventions
This work was supported by the Brain and Behavior Research Foundation’s NARSAD Young Investigator Award [to BGT], the Hartwell Foundation’s Individual Biomedical Award [to BGT], the University of Wisconsin System’s WiSys Technology Foundation [to LM], and the Eunice Kennedy Shriver National Institute of Child Health and Human Development [P30 HD003352 and U54 HD090256 to the Waisman Center and T32 HD007489]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health & Development or the National Institutes of Health. We thank those at Prentice Technologies for designing the video game. We thank Sarah Crook, Nikki Erickson, Aubrey Fisher, Isabelle Gallagher, Robyn Geist, Larissa Hacker, Lauren Hoover, Sarah Jacquot, Jenna Lent, Kristin Lillie, Sagui Lutman, Nicole Marczak, Claire Melin, Molly Pearcy, Carli Peters, Kirstin Peters, Kailey Sabel, Sean Sekelsky, Elise Suttner, Josh Tarnoff, Desiree Taylor, Jake Tenaglia, David Turner, Amin Tmimi, and Catie Van Sloun for their contributions to this project. We sincerely thank all the families who spent the 6 weeks participating in this study.
BGT conceived of the study. BGT, AHM, AE, and LAM designed the game and participated in the design of the study. BGT coordinated and drafted the manuscript. BGT, DD, AHM, and LAM participated in the design, analysis, and interpretation of the data. KM, OD, AG, and CE participated in the design and coordination of the study, performed the measurements, and assisted in drafting the manuscript. All authors read and approved the final manuscript.
Compliance with Ethical Standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This project was approved the University of Wisconsin-Madison Education and Social/Behavioral Science Institutional Review Board (protocol #2014-1248) and Health Sciences Institutional Review Board (protocol #1014-1499).
Informed consent was obtained from all individual participants included in the study.
- Ajzenman, H. F., Standeven, J. W., & Shurtleff, T. L. (2013). Effect of hippotherapy on motor control, adaptive behaviors, and participation in children with autism spectrum disorder: A pilot study. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 67(6), 653–663. doi: 10.5014/ajot.2013.008383.CrossRefGoogle Scholar
- Bruininks, R. H., & Bruininks, B. B. (2005). Bruininks-Oseretsky test of motor proficiency (2edn.). Minneapolis, MN: Pearson Assessment.Google Scholar
- Constantino, J. (2002). The social responsiveness scale. Los Angeles, CA: Western Psychological Services.Google Scholar
- Constantino, J., Davis, S. A., Todd, R. D., Schindler, M. K., Gross, M. M., Brophy, S. L., et al. (2003). Validation of a brief quantitative measure of autistic traits: Comparison of the social responsiveness scale with the autism diagnostic interview-revised. Journal of Autism and Developmental Disorders, 33(4), 427–433CrossRefPubMedGoogle Scholar
- Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule–2nd edition. (ADOS-2). Los Angeles, CA: Western Psychological Corporation.Google Scholar
- Mazurek, M. O., Shattuck, P. T., Wagner, M., & Cooper, B. P. (2012). Prevalence and correlates of screen-based media use among youths with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(8), 1757–1767. doi: 10.1007/s10803-011-1413-8.CrossRefPubMedPubMedCentralGoogle Scholar
- Monteiro-Junior, R. S., Ferreira, A. S., Puell, V. N., Lattari, E., Machado, S., Vaghetti, C. A. O., & Silva, E. B. (2015). Wii Balance Board: Reliability and clinical use in assessment of balance in healthy elderly women. CNS & Neurological Disorders- Drug Targets, 14(9), 1165–1170.CrossRefGoogle Scholar
- R Core Team. (2015). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing. https://www.R-project.org/.
- Smoot Reinert, S., Jackson, K., & Bigelow, K. (2015). Using posturography to examine the immediate effects of vestibular therapy for children with Autism Spectrum Disorders: A feasibility study. Physical & Occupational Therapy in Pediatrics, 35(4), 365–380. doi: 10.3109/01942638.2014.975313.CrossRefGoogle Scholar
- Tarakci, D., Ersoz Huseyinsinoglu, B., Tarakci, E., & Razak Ozdincler, A. (2016). Effects of Nintendo Wii-Fit(®) video games on balance in children with mild cerebral palsy. Pediatrics International: Official Journal of the Japan Pediatric Society, 58(10), 1042–1050. doi: 10.1111/ped.12942.CrossRefGoogle Scholar
- Tarakci, D., Ozdincler, A. R., Tarakci, E., Tutuncuoglu, F., & Ozmen, M. (2013). Wii-based balance therapy to improve balance function of children with cerebral palsy: A pilot study. Journal of Physical Therapy Science, 25(9), 1123–1127. doi: 10.1589/jpts.25.1123.CrossRefPubMedPubMedCentralGoogle Scholar
- Wechsler, D., & Hsiao-pin, C. (2011). WASI-II: Wechsler abbreviated scale of intelligence. San Antonio, TX: Pearson.Google Scholar