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Gait analysis to identify autism

Discussion in 'Pediatrics' started by NewsBot, May 8, 2008.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Analysis of toddlers' gait after six months of independent walking to identify autism: a preliminary study.
    Esposito G, Venuti P.
    Percept Mot Skills. 2008 Feb;106(1):259-69.
  2. Admin2

    Admin2 Administrator Staff Member

  3. drsarbes

    drsarbes Well-Known Member

    "Walking Observation Scale"

    Where can I view this?

  4. NewsBot

    NewsBot The Admin that posts the news.

    Was looking for the "Walking Observation Scale" and found another similar study:
    GAIT analysis in children with autism spectrum disorder and in children with typical development
    Gait & Posture Volume 24, Supplement 2, December 2006, Pages S270-S271
  5. drsarbes

    drsarbes Well-Known Member

    " the results were quite interesting............."

    I second this!
    This is very interesting stuff indeed.

  6. DawnPT

    DawnPT Member

    This has definitely caught my eye- I am requesting full text copies of both of those articles from our medical library at the hospital. I have many children that I am "screening" for autism/ developmental delay. I have been administring the Sensory Profile, but I had never heard of this Walking Observation Scale. (if this turns out to be fake, I'm gonna be mad!) I did find another reference while I was researching. I am still looking for a copy of the Scale.

    Walking observation scale: a useful tool for early diagnosis of autism
    Gianluca Esposito1, Paola Venuti

    Gait disorders in the autistic syndrome have already been acknowledged and widely discussed in many studies (Hallett e al., 1993; Rinehart e al., 2001; Mari e al., 2003). Teitelbaum e al. (1998) have shown that movement analysis is a useful indicator to consider in order to obtain an early diagnosis of autism. The anomalies in walking seem to be the most clear and permanent of all gait alterations that can be found in autistic subjects. Many researchers indeed refer to the autistic way of walking as “parkinsonian mode” and ascribe it to a dysfunction of the dopaminergic system (Damasio e Maurer, 1978; Vilensky e al., 1981). Starting from Teitelbaum’s studies by home-video of autistic subjects, the aim of this research has been to verify through observational tools the difference between autistic and non-autistic children. According to this purpose we have built an observational scale to study the way of walking (WOS: walking Observational Scale). This scale analyses movements through three axis: fluidity, symmetry and activity-passivity. Normal performances in these three levels are reached within 15-18 months.

    WOS has been applied to the home-videos of a 40 subjects sample by two observers (agreement by Cohen’s K=0.815). The sample was made up of a group (A) of 20 autistic subjects (with a DSM IV diagnosis, and sorted out in two subgroups: A1, subjects of 18-48 months; A2, subjects of 48-84 months) and a matched group (B) made up of non pathological subjects. Inferential data analysis and cluster analysis indicate differences between the A and B groups. The data derived from subgroups A1 and A2 show that performance improves with ages.

    Considered data reveal from the analysis of the sample that there are differences between group A (autistic subject) and B (matched group). These results are in agreement with the recent evidence in the diagnostic field, which acknowledged the importance of movement as an early indicator for the diagnosis of autism. These results demonstrate that the WOS can be useful for the movement analysis and if they are included in a wider diagnostic protocol, they may represent a useful tool for early diagnosis of autism.

    1Discof , Università di Trento, Via Matteo del Ben, 5 – 338068 Rovereto (Tn). Tel: 0464–483578 – Fax: 0464–483554
  7. drsarbes

    drsarbes Well-Known Member

    Hi Dawn:
    PLEASE let us know what you find out and I also would like to see the WOS.
    Subjectivity is always the problem with this type of interpretational testing.

  8. DawnPT

    DawnPT Member

    I have received the research articles I requested regarding the Walking Observation Scale. There was not a reference for reliability for the scale. I contacted my pediatric therapy professor (who works at a gait lab), and she said she had not heard of the scale. She said the other reference by the author was an Italian article, so she couldn't research it that way. I can't find out where to purchase the scale to even look at it, but I contacted the authors, so hopefully I will hear something from them.

    However, this has spawned a search for autism & cerebellar dysfunction. I will keep you posted if I find anything that is relevant.
  9. DawnPT

    DawnPT Member

    There is not a way to purchase this scale. I have summarized what I found out about it.

    Walking Observation Scale- comprised of 11 items that analyze gait through 3 axes: (F) foot movements- 3 items (A) arm movements- 5 items (M) global movements- 3 items

    Foot movements
    1) Heel to toe pattern
    2) Tip-toe pattern
    3) Out-toeing pattern (at least 1 foot)

    Arm movements
    1) While walking, forearms held parallel to ground pointing forward
    2) The arms are not held in a symmetrical position
    3) At least one elbow is not held alongside the body, but in an irregular position
    4) The arms are not fully extended downwards alongside the body, in particular the forearms are held rigidly
    5) Arm & hand flapping

    Global movements
    1) Myopathic gait or "waddling walk"- general body movement in not fluid and continuative but progresses by waddling from side to side
    2) Lack of opposition movement pattern- lack of reciprocal arm swing
    3) Sterotyped general movement- excessive repetition or lack of variation in movements

    The scoring procedure for the Walking Observation scale evaluates each item with a scale from 1 to 100 based on the percentage of time the participant performs a specific item: the higher the number, the more atypical the pattern of walking. (i.e. assessing m1- myopathic gait- the amount of time is calculated for the child to perform the myopathic gait and the amount of time is divided by the total amount of time the child walks in seconds ....if a child performs 300 seconds of myopathic gait in 5 minutes, the scores will be 50% --> 300 sec/ 600 sec, which means 50% of the time he is performing an atypical gait)

    The study was done taking home videos from children's first birthday and editing out all footage except where the child's whole body was visible when walking. The total time was 5 minutes for each subject. The videos were analyzed in slow motion at a speed of 4 frames per second.

    Differences listed in Gait & Posture (2006) S270-271 showed slight differences in each category between typically developing children and high functioning autism spectrum disorder. There were major differences in each category between typically developing children and low functioning ASD.

    The largest difference between typically developing children & high functioning ASD was seen in the arms then general movement then foot. This was the same between typical development and low functioning ASD, just on a greater scale.

    Just thought you'd want to read a summary of what I found....
  10. Bug

    Bug Well-Known Member

    There is currently a large study being conducted in Melbourne: children with diagnosed Asperger's and their gait. If you know anyone that may be interested can you pm me. They are currently in the stage of recruitment.

    Thanks for that Dawn, would be interesting to see if anyone else is using it.
    Last edited: Jun 14, 2008
  11. Boots n all

    Boots n all Well-Known Member

    ABC Catalyst

    Did any of you get to see this last night?

    "Children with Autism have difficulties with communication and social interaction. Around two thirds have an intellectual disability with an IQ below 70. Others can be high functioning and have average or even above average intelligence. But the majority of people with Autism have problems with movement control. Chris has been diagnosed with Asperger’s Syndrome - which has long been considered a milder form of autism. To analyse how his brain is processing automatic walking, the positions of reflective markers placed on his joints are recorded as he walks at various speeds. The information is processed to create a 3D model of his gait. This can be compared to the gait of children who don’t have Asperger’s."

    it was interesting here is a link for you

  12. MelbPod

    MelbPod Active Member

    Re: ABC Catalyst

    Thanks Boots. Great link, very interesting.
  13. Lorraine Munro

    Lorraine Munro Active Member

    Awesome link David,
    For a while I've been interested in gait in children with attention disorders and how so many children travel through their school life under the radar. It has been my understanding that Aspergers, autism and wrestless brain all present with signs in gait. I didn't know that Aspergers presented with a more stable pelvis. many thanks.
  14. Boots n all

    Boots n all Well-Known Member

    Does anyone here know the two Doctors and are they doing any workshop / lectures regarding their study?

    Dr. Nicole J. Rinehart & Dr Anna Murphy
  15. Bug

    Bug Well-Known Member

    Hi David,

    I know Anna, she heads up the Gait lab at Kingston Rehab Hospital. She doesn't do workshops etc but does show people around the lab and how it works.

    As far as I know Nicole mainly lectures and does the conference/publication circuit.

    That is the study I was previously discussing. They are still low on number because of the amount of testing they are doing, they are having a good number drop out due to difficulty. However their results are fascinating!

    I have both of their contact details though if you want?
  16. Boots n all

    Boots n all Well-Known Member

  17. NewsBot

    NewsBot The Admin that posts the news.

    Postural and gait performance in children with attention deficit/hyperactivity disorderPaul Buderatha, Kristina Gärtnera, Markus Fringsa, Hanna Christiansenb, Beate Schochc, Jürgen Konczake, Elke R. Gizewskid, Johannes Hebebrandb, Dagmar Timmanna
    Gait & Posture (in press)
  18. Sally_Smillie

    Sally_Smillie Member

    Hi all, thanks for a very interesting discussion.
    Just o introduce myself, I am full-time podopaeds in a Child Development Centre in an area of the UK where we have an ASD rate of 40%. Thirty percent of my caseload are on the spectrum. I thought I'd pop a few of my obs:

    Do not forget that often children with ASD have severe Sensory Integration disorder: this has big implications on gait - particularly failure to integrate visual information, poor proprioception and tactile defensiveness / sensory avoidance. This relates to poor core stability, which along with tactile defensiveness, leads to a high percentage of these children toe-walking.

    They also tend to be hypermobile and fatigue quickly, so require advice on gross motor conditioning and may need specific strengthening.

    There is a lot of overlap with other disorders such as DCD (formerly known as dyspraxia). Common features tend to be hypermobility, impaired motor corodination, ideation and motor planning

    They can be very difficult to examine! Actually, I have just finished a draft on an article with a sensory specialist OT on how to conduct/survive an examination for a child with ASD/ADHD. The draft is at the stage where we are sending it out to people who don't work in our context to test it for clarity, helpfulness etc. prior to submission for publication. Would anyone like to volunteer to be a test reader and priovide some feedback and comments??? Please email me for more info: sal_smillie@yahoo.co.uk
  19. Sally_Smillie

    Sally_Smillie Member

    [Check4SPAM] RE: URL Attempt

    It may be of interest that I am at recruitment stage of a study looking at balance, stability, temporal and spatial parameters of gait in children with Developmental Coordination Disorder, with and without UCBL style orthoses. You may have noted my earlier post with regard to the large overlap with all these conditions, including ADHD.
    Last edited by a moderator: Nov 8, 2008
  20. Bug

    Bug Well-Known Member

    Hi Sally,

    Great to hear from you. I work in Melbourne, Aust with a similar case load and would love to give you some feed back on your article. If you want to fling it to cyliebug@gmail.com

    I'm currently doing my PhD on idiopathic toe walking and it's link with sensory modulation/sensory seeking or sensory avoiding behaviours.

    Would love to have a chat sometime.
  21. Sally Smillie

    Sally Smillie Active Member

    Hi Cylie,

    Your PhD sounds very inteteresting! The main way we deal with it here is sensory OT techniques of progressive desensitisation with patting and brushing, using singing to bring an anticipated close to the activity. I can send the parent into sheet if you like it. I can probably find references too if you don't have them already. I am looking at doing a toe walking study too, with our local paed.orthopod using Botox for certain sub-types of ideopathic TW's. In the pipeline...

    For everyone who isn't doing their PhD in ideo / sensory toe walking: you might suspect it if when questioned you find that they only toe-walk barefoot or certain situations, hate having feet touched or nails cut (this has obvious complications), hate particular textures: grass, sand, carpet etc. I've got 1 patient who can't even touch his own feet - he takes his socks off by pulling his hand into his sleeve to pull his sock on. Daily dressing is very traumatic!

    Re: ASD article - I will email the draft to you. It's intended purpose is as a general introduction to the wonderful world of ASD, and to help make consultations a little more productive than the child diving under the chair and therapist just chatting to parent. Our article does not include de-sensitisation programs, but I can send that to you too

    Seems like there is some interesting things happening!
  22. Bug

    Bug Well-Known Member

    Thanks Sally, the parent sheet would be great. Flinging through any references too if you get a chance would also be much appreciated in case there is something new.

    I'm looking more at the cause at the moment rather than the treatment. I, like you and many others, are sure there is a link with idiopathic toe walking however there is no solid research linking sensory integration/modulation and idiopathic toe walking.

    I think that the treatment options are great however until we have proof of this link we then can't do some solid research into validated treatment protocols for these kids. For kids without ASD, we use triplanar wedges, vestibular stimulation, brushing, tapping, plates/long orthotics in boots, casting. Some of those also used with kids with ASD.

    For your Botox study - you might want to contact a physio at the Royal Children's hospital here in Melbourne: Chris Blackburn. She is currently in the middle of doing exactly this. However the argument still stands - are you treating the equinus or the toe walking habit. I would argue the equinus. There are a number of studies that show even after long term "normal" ankle ROM is achieved a child, adolecence, adult will still toe walk at times.
  23. Sally_Smillie

    Sally_Smillie Member

    Hi Cylie, I've emailed the ASD article to you. I haven't got the parent sheet on patting/brushing in electronic form, but I've requested from our OT babe and I'm sure I'll have that soon enough. I don'k think it is particularly ground breaking, but can be useful - especially as parents tend to look at you as if aliens have abducted you and playing a joke on them, they can take the sheet home and realise you were perfectly serious.

    Regarding toe walking after attaining sufficient ankle ROM: admittedly I am quite clinically oriented, but how I address it is to break it into two stages firstly making it physically possible (ie. gain ankle ROM) and secondly breaking the habitual element (heel-toe walking along a 'tightrope', and heel walking as daily activities). My thinking here is to re-train motor planning and normalise heel-toe pattern. I also use these activities as a stepping stone to strengthen tib ant and frequently add tib post strengthening as these key players have never experienced normal movement patterns. I would be interested to see what you and others think of this.
  24. Bug

    Bug Well-Known Member

    Nothing wrong with clinical orientated. I treat with a similar process. My research is hopefully going to help that, if we have a clearer idea of what causes the habit then it is easier to break, especially if it also involves brushing, tapping, stomping and spinning.
  25. NewsBot

    NewsBot The Admin that posts the news.

    Analysis of unsupported gait in toddlers with autism.
    Esposito G, Venuti P, Apicella F, Muratori F.
    Brain Dev. 2010 Aug 12. [Epub ahead of print]
  26. NewsBot

    NewsBot The Admin that posts the news.

  27. NewsBot

    NewsBot The Admin that posts the news.

    Persistent toe walking in autism.
    Barrow WJ, Jaworski M, Accardo PJ.
    J Child Neurol. 2011 May;26(5):619-21
  28. NewsBot

    NewsBot The Admin that posts the news.

    Gait analysis of teenagers and young adults diagnosed with autism and severe verbal communication disorders.
    Weiss MJ, Moran MF, Parker ME, Foley JT.
    Front Integr Neurosci. 2013 May 20;7:33.
  29. NewsBot

    NewsBot The Admin that posts the news.

    Addressing Toe Walking in Children with Autism Spectrum Disorder
  30. Admin2

    Admin2 Administrator Staff Member

    Decreased dynamical complexity during quiet stance in children with Autism Spectrum Disorders
    Kimberly A. Fournieremail address, Shinichi Amano, Krestin J. Radonovich, Tana M. Bleser, Chris J. Hass
    Gait & Posture; Article in Press
  31. wdd

    wdd Well-Known Member

    Do you think that the above research will have any effect upon the profession of podiatry?

    Have podiatrists initiated any of the research in this area?

    Do you envisage that podiatrists will become involved in the diagnosis and management of these conditions?

  32. NewsBot

    NewsBot The Admin that posts the news.

    Gait analysis in autistic young adults indicates motor dysregulation
    Michael J. Weiss, Matthew F. Moran, Mary Elizabeth Parker and John T. Foley
    Frontiers in Integrative Neuroscience
  33. Admin2

    Admin2 Administrator Staff Member

    Toe Walking in Autism
    Further Observations

    Pasquale J. Accardo, William Barrow, BS
    J Child Neurol February 21, 2014
  34. NewsBot

    NewsBot The Admin that posts the news.

    Chang-Soo Yang, Gye-San Lee, Young-Tae Lim, Bee-Oh Lim
    International Conference of Biomechanics in Sports (2014)
  35. NewsBot

    NewsBot The Admin that posts the news.

    Gait Deviations in Children with Autism Spectrum
    Disorders: A Review

    Deirdre Kindregan, Louise Gallagher, and John Gormley
    Autism Research and Treatment Volume 2015
  36. NewsBot

    NewsBot The Admin that posts the news.

    Comparative gait analysis between children with autism and age-matched controls: analysis with temporal-spatial and foot pressure variables
    Bee-Oh Lim
    Journal of Physical Therapy Science; Vol. 28 (2016) No. 1 January p. 286-292
  37. NewsBot

    NewsBot The Admin that posts the news.

    Automated Classification of Autism Spectrum Disorders Gait Patterns
    Using Discriminant Analysis Based on Kinematic and
    Kinetic Gait Features

    Che Zawiyah Che Hasan et al
    J. Appl. Environ. Biol. Sci., 7(1)150-156, 2017
  38. NewsBot

    NewsBot The Admin that posts the news.

    Analysis of gait symmetry during over-ground walking in children with autism spectrum disorder
    Jeffrey D. Eggleston et al
    Gait and Posture; Article in Press
  39. Cyrilg

    Cyrilg Member

    This is certainly true about gait. A few years ago I had a youngster with a bad gait. He is now 21yrs and full blown autism. Much improved in himself ( he teaches guitar but autism was there to see in his gait at a very early age).
  40. NewsBot

    NewsBot The Admin that posts the news.

    A Comparative Evaluation of Gait between Children with Autism and Typically Developing Matched Controls
    Janet S. Dufek et al
    Med Sci (Basel). 2017 Mar; 5(1): 1.

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