Efeitos do exergaming sobre a marcha e o risco de queda em crianças com transtorno do espectro autista (TEA): ensaio clínico randomizado controlado

Abstract

Background: Autism Spectrum Disorder (ASD) is characterized by neurodevelopmental disorders, presenting motor symptoms that may predispose to falls and gait disorders. Exergaming has shown promising results in children with ASD, but few studies evaluated the effects of exergaming on gait and the risk of falls. Objective: To assess the effects of exergaming compared with telemonitoring on motor performance during gait and the risk of falls in children with ASD. Methods: Randomized controlled clinical trial. 22 participants, diagnosed with ASD, level I or II; age: 5 to 9 years; without continuous use of medications that interfere with balance and falls; without physical therapy for 2 months. Randomized into Exergaming Group (EG, n=11) and Telemonitoring Group (TG, n=11). The EG followed the exergaming protocol: 2 weekly sessions of 30-35 min each (10 min initial, 20-25 min exergaming, 5 min cooldown) for 3 months, while the TG received a booklet of activities to be done at home, with the guardians, and were telemonitored biweekly. A blind evaluation wawas done through validated questionnaires, a fall diary, and a gait assessment in the gait laboratory. Parametric tests were used to compare independent and paired variables. For categorical variables, Fisher's exact test or Chi-square test was used for comparisons between groups, and McNemar's test for intragroup comparisons. A significant level of 5% (p <0.05) was considered. Results: The results were presented in three articles format. The first article described the protocol of the clinical trial. The second article presented the central adaptations made during the exergaming treatment and the main criteria for children with ASD to benefit with this therapy. The central adaptations were single mat, sound, adequacy of sensory stimuli, and acoustic and spatial isolation. The main criteria for the use of exergaming in children with ASD are imitation ability, triangulation of attention, and obeying simple commands. The third article presented the results of the intervention carricarried out in the clinical trial. There was a change in the pelvic symmetry indices, with a moderate effect size in pelvic obliquity for the EG (d=0.660) and in inclination and rotation in the TG (d=0.605; d=0.823, respectively). There were no significant changes in the other kinematic gait parameters. There was a reduction in the number of falls for all children, with a moderate effect size (d=0.747) only in those in the EG and a statistically significant improvement in the balance scale score for the TG (p=0.011). However, the groups had no significant differences for any of the parameters evaluated. Conclusion: There was no difference between the groups regarding motor performance during gait and the risk of falls in children with ASD. However, the results in the intragroup demonstrated a reduction in the number of falls in EG and an improvement in the balance in TG. Both groups demonstrated to be viable resources to be used in the motor rehabilitation of children with ASD, as long as both are adapted, as additional therapeutic tools for gait control, balance, and fall prevention. Registered: Clinical Trial, ID number NCT05908357. CAAE: 66594723.2.0000.5543.