Wearable Sensors Approach to quantify Tip Toe Behaviour in Individuals with Severe Autism Spectrum Disorder: Preliminary Results about Feasability, Acceptability and Comparison with a Quantitative Assessment Approach using Video-Recording

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Giulio Valagussa1,2 , Luca Emanuele Molteni1, Martina Boccotti1, Giuseppe Andreoni3,4, Enzo Grossi1

Wearable Sensors Approach to quantify Tip Toe Behaviour in Individuals with Severe Autism Spectrum Disorder: Preliminary Results about Feasability, Acceptability and Comparison with a Quantitative Assessment Approach using Video-Recording (2023)

Israeli Meeting for Autism Research, Ben Gurion University of the Negev, Be

BACKGROUND:

Toe walking is a clinical sign present in 20% of individuals with autism spectrum disorder (ASD). Because this behavior is also found during standing or running, the term tip-toe behavior (TTB) seems to be more appropriate. TTB is poorly quantified with structured methods. Previously, we proposed a standardized method to quantify TTB during static and dynamic tasks using a video-recording approach (VRA) in an ecological setting. The most used and reliable instrumental tool to quantify motor deficit during standing and walking is the gait analysis, but this approach requests the positioning of a large number of markers on the skin of the patient, a long time to prepare the patient for the execution of the test and is conducted in a non-ecological setting. Thus, gait analysis could be difficult to use with individuals with severe ASD because of their clinical condition. To overcome these limitations, a simpler instrumental approach that uses wearable sensors (WS) usable in an ecological setting could be a useful resource.

OBJECTIVES:

The aims of this pilot study are: 1) to verify the feasibility and acceptability of WS in individuals with severe ASD; 2) to quantify TTB using VRA and WS during structured standing and walking tasks; 3) comparing the quantitative assessment of TTB using a WS-based protocol with the VRA.

METHODS:

Subjects with ASD diagnosed according to DSM-5 criteria and confirmed using the Autism Diagnostic Observation Schedule (ADOS) were involved to the pilot study. TTB was quantified using a VRA and WS approach during a structured static and dynamic tasks, previously described. All the tests were performed without shoes albeit with “Sensoria® Smart Socks” (SSS), a validated commercially available wireless gait monitoring technology (Figure 1). The static test consisted in playing while standing in front of a table for 3 minutes. The dynamic test consisted in transporting 1 object (puzzle, Lego®, …) from the therapist to the playing table situated 2 meters away and back again 15 times. The same person was tested three times on three different days (9 acquisitions). In this way, we were able to collect data obtained from video-recording and WS approaches at the same time. The result of the video-recording and WS approaches were analyzed. The intraclass correlation coefficient (ICC) was used to assess the reliability between the video-recording and WS approaches in quantifying the mean percentage of toe steps and the mean percentage of the time spent in TTB.

RESULTS:

We assessed 3 individuals with ASD and TTB. The age was 10.9yrs, 12.8yrs and 13yrs (3/3 males) and their ADOS CSS was 9, 10 and 8, respectively. SSS was feasible and acceptable in the three individuals with severe ASD and TTB in all three trials. We were also able to quantify TTB during both the static and the dynamic tests using the SSS tool in 9/9 of the acquisition (100%) (Figure 2). The normal distribution of data was confirmed (Shapiro-Wilk test p > 0.05). The ICC values of the mean percentage of toe steps and the mean percentage of the time spent in TTB were 0.778 (excellent) and 0.731 (good), respectively.

CONCLUSION:

SSS seems to be a feasible and acceptable WS approach for quantifying TTB in individuals with severe ASD and TTB. SSS used for the quantitative assessment of TTB in individuals with ASD showed good-to-excellent reliability in comparison with the VRA both during a static and dynamic tests. Further research is required to confirm the results of this preliminary study.
Notes: 1) Villa Santa Maria Foundation Autism Research Unit, Tavernerio (Como), Italy 2) University of Milano Bicocca School of Medicine and Surgery, Milano, Italy 3) Politecnico di Milano Department of Design, Milano, Italy 4) Scientific Institute IRCCS “E. Medea” Bioengineering Laboratory, Bosisio Parini (Lecco), Italy

Notes:

1) Villa Santa Maria Foundation Autism Research Unit, Tavernerio (Como), Italy
2) University of Milano Bicocca School of Medicine and Surgery, Milano, Italy
3) Politecnico di Milano Department of Design, Milano, Italy
4) Scientific Institute IRCCS “E. Medea” Bioengineering Laboratory, Bosisio Parini (Lecco), Italy