A sensory-motor integration programme for boys with autism spectrum disorder : two case studies

Hagemann, Carla-Rae (2014-12)

Thesis (MScSportSc)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Autism Spectrum Disorder (ASD) has been described as a neuro-developmental disorder influencing the social interaction and communication skills of individuals. Those with ASD have been observed to experience sensory input challenges, which could result in motor delays. Descriptive research was conducted with two case studies, who were boys aged 6- and 8-years, diagnosed with ASD. The purpose of the study was to design and implement a Sensory-Motor Integration (SMI) programme for each boy and to assess the effect it had on the sensory motor skills of the boys over time. At the start of the intervention, the boys were assessed with three neuro-developmental and diagnostic evaluations (Social Communication Questionnaire, Autism Diagnostic Interview Revised and Autism Diagnostic Observation Schedule-2nd Edition) conducted by a psychiatrist to re-affirm their previous ASD diagnoses. The two boys (Subject A and Subject G) participated in individualised sessions of 30 minutes each, twice a week for seven months. The SMI programme focused on vestibular and somato-sensory (proprioceptor) variables. The Quick Neurological Screening Test-3 (QNST III) and the Sensory Input Systems Screening Test (SISST) were used to evaluate the latter at baseline. These were repeated regularly, every 4 to 5 weeks, over the 7-month period and included a retention test of 5 weeks. Based on the results from the subtests of the motor skill tests, a self-designed SMI programme was integrated into the planning of the intervention programme for each boy according to their sensory-motor needs. Subject A showed improvement in the following vestibular subtests in the QNST-III: Stand on one leg (67%) and Tandem walk (83%) and retaining his standard from the Post-test to the Retention test. For muscle tone ability and proprioception, the Arm and leg extension subtest also demonstrated improvement (67%) from the Pre-to the Post-test. The results of the subtest were not retained over the retention period and increased only slightly being 33% from the baseline score. The proprioceptive function of Subject A showed great improvement in the following QNSTIII subtests: Finger to nose (67%), Rapidly reversing repetitive hand movements (88%) and Left and right discrimination (67%). The results of vestibular-related subtests for Subject G showed improvement in the following: Stand on one leg (33%) and the Arm and leg extension task (33%). Some of the scores of Subject G started in the functional category of “severe discrepancy”; however there was improvement in the following proprioceptionrelated subtests: Finger to nose (43%), Thumb and finger circles (20%), and Reversing repetitive hand movements (86%). Although Subject G showed gradual improvement over time, his two sensory systems struggled to integrate with the more complex tasks. The outcome of the individualised SMI programmes showed that the sensory-motor skills improved by enhancing the stimulation of their vestibular and somato-sensory (proprioception) function. Regarding the SISST, Subject A progressed from a ‘fail’ to ‘pass’, in the following test items: the Tonic Labyrinthine Supine (TLS), Tonic Labyrinthine Prone (TLP), Positive Support Reflex (PSR) and the Ocular Alignment test items. Results from the Vestibular test for both Subject A and Subject G appeared to be ‘hypo-vestibular’ (under-stimulated) according to the Post- Rotary Nystagmus test (PRN) score at baseline. These scores were inconsistent during the intervention. The only test item to show positive improvement for Subject G was the Equilibrium Reactions. Lastly, both Subject A and Subject G remained in the ‘fail’ category for Kinaesthesis, which may indicate their ongoing poor proprioception and spatial orientation. There is a need for further research in the area of sensory-motor individualised programmes for children with ASD. Suggestions for future research interventions are to conduct the individualised programmes either over a longer period of time and more frequently at three times a week.

AFRIKAANSE OPSOMMING: Outisme Spektrum Versteuring (OSV) word beskryf as 'n neuro-ontwikkelingsversteuring wat die sosiale interaksie en kommunikasie van individue beïnvloed. Daar is waargeneem dat diegene met OSV, uitdagings met betrekking tot sensoriese insette ervaar, wat kan lei tot motoriese agterstande. Beskrywende navorsing is toegepas met twee gevalle-studies. Die ouderdom van die twee seuns wat met outisme gediagnoseer was, was 6- en 8-jaar oud. Die doel van die studie was om ʼn Sensories-Motoriese Integrasie (SMI) program te ontwikkel en te implementeer as intervensie wat op elk van die seuns spesifiek toegespits is. Die intervensie-program het voorsiening gemaak om aan die uitvoering van bepaalde motoriese vaardighede aandag te skenk en om die uitwerking daarvan oor die 7-maande tydperk te assesseer. Die twee seuns (Geval A en Geval G) het individuele sessies van 30 minute elk twee keer per week bygewoon. Die SMI program het op die vestibulêre en somato-sensoriese (proprioseptor) sisteme gefokus om hul vermoë en vordering waar te neem. Aan die begin van die studie is drie neuro-ontwikkelings- en diagnostiese meetinstrumente (SCQ, ADIR-R en ADOS) deur 'n psigiater gelei om die vorige OSV diagnose van die seuns te bevestig. Die “Quick Neurological Screening Test” (QNST III) en die “Sensory Input Systems Screening Test“ (SISST) is benut om hul aanvangsvermoë as basislyn te bepaal. Hierdie toetse was gereeld herhaal, elke 4 tot 5 weke oor ʼn tydperk van 7 maande en het ʼn retensie toets van 5 weke ingesluit. Op grond van die resultate van die sub-toetse van die vermelde motoriese vaardigheidstoetse, is die self-ontwerpte SMI intervensie-program vir elke seun, volgens sy persoonlike sensoriese-motoriese behoeftes, beplan. Geval A het verbetering getoon in die volgende QNST-III sub-toets: Staan op een been (67%) en Tandemloop (83%), en handhaaf sy standaard vanaf die na-toets tot en met die retensie toets. Vir spiertonus en propriosepsie, het die Arm- en been-ekstensie sub-toets ook ʼn verbetering (67%) van die voor-toets tot die na-toets getoon. Die resultaat van hierdie subtoets is nie oor die hele tydperk gehandhaaf nie, en het net effens verhoog (33%) van die basislyn telling. Die proprioseptiewe funksie van Geval A het 'n groot verbetering in die volgende QNST-III sub-toetse getoon: Vinger na neus (67%), Vinnige omkeer, herhalende hand bewegings (88%) en Links en regs diskriminasie (67%). Geval G se resultate vir die vestibulêre-verwante sub-toetse het verbetering in die volgende getoon: Een been staan (33%) en Arm- en Been-ekstensie (33%). Sommige van die resultate van Geval G het op 'n ernstige diskripansie begin, maar daar was verbetering in die volgende proprioseptiewe verwante sub-toetse: Vinger na neus (43%), Duim en vinger sirkels (20%) en Vinnige omkeer, herhalende hand bewegings (86%). Ten spyte daarvan dat Geval G ʼn geleidelike verbetering oor tyd getoon het, het sy twee sensoriese stelsels gesukkel om met die meer komplekse take met mekaar te integreer. Die uitkoms van die geïndividualiseerde SMI programme het getoon dat die sensoriesemotoriese vaardighede by beide seuns verbeter as gevolg van die verbeterde stimulering van hul vestibulêre en somato-sensoriese (proprioseptiewe) funksie. Die SSIST resultate toon dat Geval A van ‘druip’ na ‘slaag’ in die volgende toetsitems gevorder het: Tonic Labyrinthine Supine (TLS), Tonic Labyrinthine Prone (TLP), Positive Support Reflex (PSR) en die Ocular Alignment toetsitems. Resultate van die vestibulêre toets, blyk dit dat sowel Geval A as Geval G ‘hipo-vestibulêr’ (onder-gestimuleer) was volgens die “Post-Rotary Nystagmus toets” (PRN) meting wat by die basislyn toetsing behaal is. Hierdie tellings was veranderlik tydens die intervensie. Die enigste toetsitem wat ʼn positiewe verbetering by Geval G getoon het, was die Ekwilibriumsreaksie. Laastens, beide Geval A en Geval G het in die ‘druip’ kategorie vir Kinestese gebly wat daarop dui dat hul swak propriosepsie en ruimtelike oriëntasie steeds teenwoordig was. Daar is 'n behoefte aan verdere navorsing op die gebied van sensoriese-motoriese individuele programme vir kinders met OSV. Toekomstige navorsing wat individuele programme benut, moet oorweeg om die intervensie oor ʼn langer tydperk (bv. een jaar) te laat geskied met meer sessies per week (bv. drie sessies).

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/96084
This item appears in the following collections: