Postural control processes during standing and step initiation in autism spectrum disorder
Postural control processes during standing and step initiation in autism spectrum disorder
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DOI：
10.1186/s11689-019-9305-x
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发表时间：
2020-01-06
影响因子：
4.9
通讯作者：
Mosconi, Matthew W.
中科院分区：
文献类型：
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作者：
Bojanek, Erin K.;Wang, Zheng;Mosconi, Matthew W.
背景：患有自闭症谱系障碍（ASD）的个体表现出维持姿势稳定性的能力下降，尽管导致这些问题的运动控制机制以及它们与其他大运动活动（如走路）的关联程度尚不清楚。方法17例ASD患者和20例正常发育（TD）对照（6 ~ 19岁）完成3项站立姿势控制测试。在中性站立时，受试者双脚分开与肩同宽。在隆伯格一站的时候，他们两脚紧紧地站在一起。在环形摇摆中，参与者双脚分开与肩同宽站立，并以圆周运动摇摆。检测各站立位压力中心（COP）在中外侧（ML）和正后方（AP）方向的标准差（SD）和COP轨迹长度。我们还评估了相互信息（MI），或ML和AP方向上COP之间的共享依赖关系。参与者还完成了一项跨步任务，他们从一个力平台向前走到相邻的平台。研究了预期体位调整（APAs）的幅度和持续时间，以及初始步骤后COP调整的最大横向摆动、持续时间和速度。我们使用单独的单向ancova以高度作为协变量来检查步进变量。采用Spearman相关性与《自闭症诊断观察表-第二版》（ADOS-2）和《自闭症诊断访谈-修订版》（ADI-R）评分评估体位控制和步进措施与ASD症状严重程度之间的关系。结果与TD对照组相比，ASD个体在不同姿态条件下COP轨迹长度增加（p = 0.05），圆周摇摆时MI降低（p = 0.02）。在迈步过程中，各组在APA振幅（p = 0.97）和持续时间（p = 0.41）上没有差异，但在迈步初始阶段，ASD个体与对照组相比，ML摆动减少（p = 0.06），身体转移持续时间缩短（p < 0.01），身体转移速度增加（p = 0.02）。在ASD参与者中，当行走时，更大的中性姿态COPML变异性（r = 0.55, p = 0.02）和更少的侧倾（r = - 0.55, p = 0.02）与更严重的限制性和重复性行为相关。结论：我们发现ASD患者在旋转时心肌梗死减少，这表明在动态姿势调整过程中有效协调关节运动的能力降低。此外，ASD患者在行走时表现出减少的侧向摆动，这表明运动僵硬可能会干扰平衡和步态。ASD患者的姿势控制和行走缺陷与重复性行为有关，这表明运动僵硬和ASD的关键临床问题可能代表了重叠的病理过程。
Background Individuals with autism spectrum disorder (ASD) show a reduced ability to maintain postural stability, though motor control mechanisms contributing to these issues and the extent to which they are associated with other gross motor activities (e.g., stepping) are not yet known. Methods Seventeen individuals with ASD and 20 typically developing (TD) controls (ages 6-19 years) completed three tests of postural control during standing. During the neutral stance, individuals stood with their feet shoulder width apart. During the Romberg one stance, they stood with feet close together. During the circular sway, participants stood with feet shoulder width apart and swayed in a circular motion. The standard deviation (SD) of their center of pressure (COP) in the mediolateral (ML) and anteroposterior (AP) directions and the COP trajectory length were examined for each stance. We also assessed mutual information (MI), or the shared dependencies between COP in the ML and AP directions. Participants also completed a stepping task in which they stepped forward from one force platform to an adjacent platform. The amplitude and duration of anticipatory postural adjustments (APAs) were examined, as were the maximum lateral sway, duration, and velocity of COP adjustments following the initial step. We examined stepping variables using separate one-way ANCOVAs with height as a covariate. The relationships between postural control and stepping measures and ASD symptom severity were assessed using Spearman correlations with scores on the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and the Autism Diagnostic Interview-Revised (ADI-R). Results Individuals with ASD showed increased COP trajectory length across stance conditions (p = 0.05) and reduced MI during circular sway relative to TD controls (p = 0.02). During stepping, groups did not differ on APA amplitude (p = 0.97) or duration (p = 0.41), but during their initial step, individuals with ASD showed reduced ML sway (p = 0.06), reduced body transfer duration (p < 0.01), and increased body transfer velocity (p = 0.02) compared to controls. Greater neutral stance COPML variability (r = 0.55, p = 0.02) and decreased lateral sway (r = - 0.55, p = 0.02) when stepping were associated with more severe restricted and repetitive behaviors in participants with ASD. Conclusions We found that individuals with ASD showed reduced MI during circular sway suggesting a reduced ability to effectively coordinate joint movements during dynamic postural adjustments. Additionally, individuals with ASD showed reduced lateral sway when stepping indicating that motor rigidity may interfere with balance and gait. Postural control and stepping deficits were related to repetitive behaviors in individuals with ASD indicating that motor rigidity and key clinical issues in ASD may represent overlapping pathological processes.