Examining the Effects of Group Versus Individual Based Exercise Program on Balance and Coordination in Children With Autism

Primary outcomes

1. Pediatric Balance Scale (PBS)

   Time frame: Assessed at Baseline (Week 0) and Post-intervention (Week 6).

   It is a comprehensive and effective scale evaluating the balance in the following three dimensions: static balance, anticipatory balance, and functional movement transitions. The scale comprises 14 items including sitting balance, standing balance, sitting to standing/standing to sitting, transfers, stepping, reaching forward with outstretched arm, reaching the floor, turning, and placing foot on stool items. Each item ranked from 0 to 4. 0 shows inability to perform the instruction, while 4 shows the ability to perform without any difficulty. Maximum total score is 56. The intraobserver agreement of the PBS total score was high, perfectly (ICC=0.927).(15, 16) PBS can be considered a simple, valid scale for examining functional balance capacity in children with neurological disorders.

2. Finger-to-Nose Test

   Time frame: Assessed at Baseline and Week 6

   A widely used neurological test for evaluating cerebellar function and upper limb coordination, the finger-to-nose test involves the patient alternately touching the examiner's finger and their nose in a smooth, controlled manner. Its reliability is generally moderate to good. Its validity is thought to be good for detecting gross cerebellar dysfunction, coordination, intention tremor, and dysmetria. Sensitivity roughly 60-85% and specificity around 70-90, while its reliability is usually moderate to good, with inter-rater reliability coefficients (ICC or kappa) commonly reported in the range of 0.60-0.85.

3. Heel-to-Shin Test

   Time frame: Assessed at Baseline and Week 6

   The heel-to-shin test is a neurological examination used to evaluate lower-limb coordination and cerebellar function. The patient is asked to place the heel of one foot on the opposite knee and smoothly slide it down the shin to the ankle. Normal performance is smooth and accurate; abnormal findings, such as irregular movement, side-to-side wavering, inability to maintain contact, or intention tremor, suggest cerebellar dysfunction, sensory ataxia. Studies report sensitivity ranging approximately from 65-90% and specificity around 70-95% for detecting significant cerebellar dysfunction, depending on standardization and patient population, while its reliability is generally moderate to good, with reported inter-rater and intra-rater reliability coefficients (ICC or kappa) typically between 0.60 and 0.85.

4. Past-Pointing Test

   Time frame: Assessed at Baseline and Week 6

   When a person consistently overshoots or undershoots a target during voluntary, goal-directed movements, it is a sign of impaired cerebellar coordination. It reflects defective error correction and timing of agonist-antagonist muscle activity normally regulated by the cerebellum, leading to dysmetria. It becomes more pronounced when visual guidance is removed, which worsens primarily with eyes closed, multiple sclerosis, and autism. Sensitivity (~60-80%) and good specificity (~70-90%).