Combined Effects of Sensorimotor Integration and Post-facilitation Stretch in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a complex neurodevelopmental disease that involves communication, social interaction and language in different ways. The autism toe walker is affected by outside world contact refusal: touching the ground as little as possible, trying to avoid any contact. The pathological walking caused by myotendinous retraction of the sural muscles bilaterally, succeeding in transforming an equine "attitude" into structured clubfoot walking. Many therapy options have been described: no treatment, physical therapy or casting to stretch the gastrocnemius, soleus, and Achilles' tendon, surgical lengthening of the gastrocnemius, soleus and Achilles tendon, blocking plantar flexion.

Sensorimotor integration is the process by which motor behaviors and sensory system processing take place together, with motor actions being continuously guided by sensory information.

Inclusion criteria

• Children with diagnosed Mild Autism Spectrum Disorder
• Presenting with toe walk as a prominent feature of Autism Spectrum Disorder (e.g., more than 50% of steps observed during a gait assessment). Toe walking should be entirely because of Achilles tightness.
• Able to follow simple verbal commands.
• Sufficient gross motor skills present.

Exclusion criteria

• Toe walking due to neurological (e.g., cerebral palsy, spina bifida, peripheral neuropathy) or orthopedic disorders (e.g., clubfoot, leg length discrepancy > 1 cm, hip dysplasia, contractures not related to idiopathic toe walking) and other behavioral factors that could be the primary cause of toe walking will be excluded.
• History of Achilles tendon surgery or lower limb surgery.
• Current participation in another physical therapy intervention targeting gait or posture
• Severe behavioral/sensory issues that would interfere with treatment sessions i.e. severe Autism Spectrum Disorder with Attention Deficit Hyperactivity Disorder as well as mental retardation.
• Non-ambulatory children.