Elsevier

Gait & Posture

Volume 84, February 2021, Pages 260-266
Gait & Posture

Full length article
Age-related gait development in children with autism spectrum disorder

https://doi.org/10.1016/j.gaitpost.2020.12.022Get rights and content

Highlights

  • Age-related gait development was observed in children with ASD.

  • Children with ASD may develop gait to a more energy-efficient walking pattern.

  • No age-related difference in gait symmetry was observed.

Abstract

Background

A better understanding of gait development and asymmetries in children with autism spectrum disorder (ASD) may improve the development of treatment programs and thus, patient outcomes.

Research question

Does age affect walking kinematics and symmetry in children with ASD?

Method

Twenty-nine children (aged 6–14 years old) with mild ASD (level one) were recruited and assigned to one of the three groups based on their ages: 6–8 years (U8), 9–11 years (U11) and 12–14 years (U14). Walking kinematics were captured using an inertia measurement unit system placed bilaterally on participants’ foot, lower leg, upper leg, upper arm, pelvis, and thoracic spine. Joint angles were computed and compared among the age groups. Symmetry angles were used to assess the gait symmetry and were compared among the age groups.

Results

Older children exhibited less ankle dorsiflexion and knee flexion angles at heel-strike and greater plantarflexion angles at toe-off compared with younger children. In addition, a decreased pelvis and thorax axial rotation range of motion and increased shoulder flexion/extension range of motion were observed for older children. However, no age-related difference in gait symmetry was observed.

Significance

These findings could suggest that older children with ASD may develop gait kinematics to a more energy-efficient walking pattern.

Introduction

Autism spectrum disorder (ASD) is characterized as a developmental disability that is associated with impaired social, communication, and behavioral skills according to the Centers for Disease Control and Prevention [1]. This condition is commonly diagnosed by either a physician or a psychologist using the Diagnostic and Statistical Manual of Mental Disorder 5th edition (DSM-5; American Psychiatric Association, [2]). Despite numerous studies have found evidence of motor impairments in children with ASD and suggested that movement abnormalities may be an indicator of underlying neurological impairment; motor skill deficits are not considered to be core diagnostic symptoms in the DSM-5. Movement abnormalities have been identified in gait [[3], [4], [5]], balance [6,7], and during reaching tasks [8] for children with ASD when compared to children without ASD. It is important to understand how motor skills are affected by this condition since these abnormalities may impact a child’s activities of daily living and the development of social and communication skills.

Studies have investigated the walking patterns of children with ASD and atypical gait patterns have been reported [[3], [4], [5],[9], [10], [11]]. Compared to age-matched controls, children with ASD have demonstrated altered ankle and hip joint angles [3], increased step width [9], and reduced stride length [10]. However, some findings (e.g., spatiotemporal variables and joint range of motion) were not conclusive among studies [3,4,9,12]. The inconclusive findings could be due to different testing protocols and samples and could also be attributed to the heterogenous nature of ASD [11]. The heterogeneity of ASD walking patterns has been consistently observed in previous research [5,10,11], which may mask their unique individual characteristics when using group analyses. Matched-pair analyses have been proposed to provide a complete interpretation of the ASD heterogeneity [11]. To complement traditional gait analysis, a recent study utilized an innovative nonlinear analysis (i.e., continuous relative phase analysis) to assess inter-segmental coordination variability in children with ASD and observed reduced variability [13]. Children with ASD also demonstrated individualized side to side asymmetries [5]. This study identified significant ankle, knee, and hip joints asymmetries that were unique to each individual [5]. Asymmetry can be problematic since it causes an individual to compensate for one limb by using the other limb which could eventually lead to overuse injuries.

Gait development has also been shown to be impacted by age and walking speeds in healthy children [14,15]. Age has specifically been found to have a significant impact on sagittal plane gait mechanics for the ankle, knee, and hip joints in children between the ages of 7–12 [14]. Several studies have assessed gait in children with ASD, however, to our best knowledge, no research has been conducted to understand age-related gait development in children with ASD. A greater understanding of gait development and asymmetries in children with ASD may improve the development of treatment programs and thus, patient outcomes.

Therefore, the purpose of the present study was to investigate the age effect on gait in children with ASD. Specifically, we compared lower extremity joint kinematics and symmetry during walking in children with ASD among three different age groups: 6–8 years (under 8: U8), 9–11 years (U11), and 12–14 years (U14). We hypothesized that children with ASD would exhibit different joint kinematics among groups and improved symmetry in older age groups.

Section snippets

Participants

In the present study, 29 children (aged 6–14 years old) with mild ASD (level one) were recruited from a local autism summer camp. The inclusionary criteria were: (1) confirmed diagnosis of ASD by a physician or a psychologist using DSM-5 [2], (2) having the ability to understand instructions and communicate with the researchers, and (3) able to walk. The exclusionary criteria included any other chronic medical disorders, current medications, physical impairments and recent injuries that could

Results

The spatiotemporal gait kinematic variables are presented in Table 2. Comparisons of joint kinematics (Figs. 1 & 2 ) and gait symmetry among groups are presented in Table 3, Table 4, respectively. The main effect of group was significant for ankle dorsiflexion (F = 36.00, p = 0.00, partial η2 = 0.78) and knee flexion angle (F = 7.33, p = 0.00, partial η2 = 0.42) at heel-strike, and ankle dorsiflexion angle at toe-off (F = 7.20, p = 0.01, partial η2 = 0.38). The group effect was also significant

Discussion and implications

In the present study, we examined age-related gait development in children with ASD. Specifically, lower extremity joint kinematics and gait symmetry were compared among three different age groups: U8, U11, and U14. It was predicted that children would exhibit different joint kinematics among these age groups and improved symmetry in older age groups. However, these hypotheses were only partially supported by the results.

As expected, differences in joint kinematics were observed among the

Conclusions

In conclusion, some age-related kinematic changes in gait were observed in children with ASD. Older children exhibited less ankle dorsiflexion and knee flexion angles at heel-strike and greater plantarflexion angles at toe-off compared with younger children. In addition, decreased pelvis and thorax range of motion and increased shoulder range of motion were observed in older children. However, no development in gait symmetry was observed. The lack of group differences in gait symmetry could

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

The authors declare that there is no conflict of interest.

References (41)

  • Y. Wu et al.

    Effect of active arm swing to local dynamic stability during walking

    Hum. Mov. Sci.

    (2016)
  • J.L. Stephenson et al.

    The effect of arm movements on the lower limb during gait after a stroke

    Gait Posture

    (2010)
  • S. Viteckova et al.

    Gait symmetry measures: a review of current and prospective methods

    Biomed. Signal Process. Control

    (2018)
  • L. Jorgensen et al.

    Ambulatory level and asymmetrical weight bearing after stroke affects bone loss in the upper and lower part of the femoral neck differently: bone adaptation after decreased mechanical loading

    Bone

    (2000)
  • P.-Y. Lin et al.

    The relation between ankle impairments and gait velocity and symmetry in people with stroke

    Arch. Phys. Med. Rehabil.

    (2006)
  • Center for Disease Control and Prevention, Autism Spectrum Disorder

    (2020)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2013)
  • V.L. Chester et al.

    Gait symmetry in children with autism

    Autism Res. Treat.

    (2012)
  • R. Kohen-Raz et al.

    Postural control in children with autism

    J. Autism Dev. Disord.

    (1992)
  • Y. Li et al.

    Complexity of center of pressure in postural control for children with autism Spectrum disorders was partially compromised

    J. Appl. Biomech.

    (2019)
  • Cited by (5)

    View full text