Biofeedback-Based, Videogame Balance Training in Autism

Abstract

The present study examined the effects of a visual-based biofeedback training on improving balance challenges in autism spectrum disorder (ASD). Twenty-nine youth with ASD (7-17 years) completed an intensive 6-week biofeedback-based videogame balance training. Participants exhibited training-related balance improvements that significantly accounted for postural-sway improvements outside of training. Participants perceived the training as beneficial and enjoyable. Significant moderators of training included milder stereotyped and ritualistic behaviors and better starting balance. Neither IQ nor BMI moderated training. These results suggest that biofeedback-based balance training is associated with balance improvements in youth with ASD, most robustly in those with less severe repetitive behaviors and better starting balance. The training was perceived as motivating, further suggesting its efficacy and likelihood of use.

Keywords: Motor; Postural stability; Technology-based interventions; Video game.

Conflict of interest statement

Conflict of Interest: Brittany G. Travers declares that she has no conflict of interest. Andrea Mason declares that she has no conflict of interest. Leigh Ann Mrotek declares that she has no conflict of interest. Anthony Ellertson is a founding partner of Prentice Technologies. Douglas C. Dean declares that he has no conflict of interest. Courtney Engel declares that she has no conflict of interest. Andres Gomez declares that he has no conflict of interest. Kristine McLaughlin declares that she has no conflict of interest.

Figures

Figure 1

Schematic of the in-lab videogame setup. The Kinect camera connected to the computer via a USB cord. The Wii balance board connected to the computer via Bluetooth. Participants trained one-at-a-time on the six poses shown. There were three two-footed poses (Standing Side Bend [gray], Energy Ball [red], and Hug the Tree [brown]), and there were three one-footed poses (Tree [green], Karate Kid [orange], and Arm to Knee [blue]). For the one-footed poses, participants completed the pose with the right and left feet separately Using the software designed in Adobe Air, participants saw themselves on the screen with joint dots projected onto their image. Joint dots were yellow when within the shadow but red when outside the shadow. When all joint dots were within the shadow, the background would slowly come into view with each passing second that the participant held the pose correctly. The force data from the Wii balance board and the Kinect camera joint data were synchronized and output to a .csv file.

Figure 2

Fitted linear smoothed lines for balance improvements over the course of the training sessions at both the level of the individual participants (dashed lines) and at the level of the group (black solid lines). Overall, the participants demonstrated significant training progress in both two-footed and one-footed poses (p’s

Figure 3

Pre- and post-training postural sway area data for a participant who made substantial balance improvement during the training (“Training Responder”) compared to a similarly aged participant who did not make substantial balance improvements during the training (“Training Non-Responder”). Importantly, the postural sway area measures were taken outside of the game context, and these poses were not explicitly trained during the game. The blue dots represent the center of pressure over the course of the trial. The green ellipse represents the 95% confidence ellipse for the blue dots, from which postural sway area was calculated.