While balance training may not necessarily sound fun to most adolescents, video games typically do. And for adolescents with autism spectrum disorder, video games that improve their balance by teaching them yoga and tai chi poses also improves their posture, reduces the severity of their autism symptoms and influences the structure of their brains.
Those were the findings of a study published in the journal Brain Communications by researchers at the University of Wisconsin–Madison Waisman Center, in which autistic adolescents aged 13 to 17 used Nintendo Wii balance boards to mimic tai chi and yoga poses in an on-screen game.
“So many adolescents love video games, right? And there’s been research in autistic youth to show that there’s even more interest in video games sometimes,” says graduate student Olivia Surgent, first author of the study. “It might not be traditionally super fun for an adolescent to do some tai chi, but it might be good for them. So, we’re kind of masking it.”
For autistic individuals, balance control seems to plateau in early adolescence — earlier than their non-autistic peers — which may lead to challenges with posture and balance. Difficulties with motor control, says Brittany Travers, occupational therapy professor and a Waisman Center investigator, are highly predictive of more severe autism symptoms and poorer execution of daily living skills.
Why this happens is not entirely clear, but Travers is determined to find out. “I’m really interested in trying to better understand if there is some type of third variable that explains the relationship that every (study) kept finding in terms of motor and core autism features,” she says.
For the recent study, adolescents with and without autism were encouraged to hold yoga and tai chi poses on the balance board in her laboratory for as long as they could. An image, faded into the white screen, would become increasingly brighter the longer they held a pose correctly, providing them instant feedback of their performance. Halfway through the training session, participants got to play other fun video games. They practiced for one hour three times a week for six weeks.
By the end of training, the participants increased the time they were able to hold a pose by an average of 36 seconds. “If we think about what it takes to brace yourself, if you’re starting to slip on ice or stepping into a tub, that extra 36 seconds could be something that prevents you from actually falling,” says Travers.
Off the balance board, the adolescents also showed improvement in postural sway, or their ability to maintain posture, indicating that the benefits of the training extended outside of the video game context. Autistic youths typically show less stability in their posture than youths without autism.
Autistic adolescents who did the balance training also reported significant decreases in autism symptom severity in areas of social communication, repetitive behavior and restricted interests — or strong interest in specific topics or objects. Their symptoms, as reported by their caregivers, went from severe to moderate. Importantly, the researchers say, the goal of the training was not to attempt to eliminate autistic traits, but to better understand the connection between motor functions and core autism symptoms.
“Autism symptom severity unto itself may be a measure that, while interesting to the research community, may not be that meaningful to the autistic community,” says Travers, since for adolescents with autism, some symptoms such as stimming — or repetitive movements — may help them feel better.
The adolescents who took part in balance training did not demonstrate improvements in their daily living skills, such as showering, preparing basic foods, and crossing a street safely, despite earlier studies linking motor control and improvements in these skills. Travers believes it might take longer before daily living skills begin to improve.
Meanwhile, adolescents randomly assigned to control groups that played sedentary video games did not show significant improvement in motor control or symptom severity.
Travers was also interested in understanding whether balance training would change key features of the brain, especially white matter tracts — fibers that connect and send signals across different brain regions — and whether these changes would be related to improvements in autism symptoms.
The researchers used magnetic resonance imaging (MRI) to get images of the adolescents’ brains before and after the six-week training. To their surprise, balance training did not result in changes in the corticospinal tract, which connects motor and sensory regions of the brain to the spinal cord. However, they did observe changes in white matter tracts involved in both motor ability and autism symptoms, including the superior cerebellar peduncle.
“The SCP is a particularly interesting tract because it’s sending a lot of information from the cerebellum to the cortex and the cerebellum is really important for motor feedback and regulating motor behavior in different contexts,” Surgent explains, though further studies are needed to understand how motor behaviors regulated by regions connected to this structure may be tied to autism severity.
Additionally, changes in brain structure following balance training differed between adolescents with and without autism. Travers believes this may be due to differences in the sensory experiences and motor outcomes experienced by autistic youths relative to their non-autistic peers.
“It’s very likely that our brains are going to adapt (differently) to those experiences, because that’s what our amazing brains do,” says Travers, who hopes to continue to disentangle these differences throughout her career.
She also hopes to identify outcomes of balance training that will be meaningful to autistic adolescents and further study how to use video games to both help with motor control and contribute to their quality of life.
All the study participants showed overwhelming support of the video games and reported they enjoyed the experience. And all learned the video games at the same rate, whether they did or did not have autism, and regardless of IQ. For Travers, this was a huge success.
“We’re seeing that this video game world might be a place where autistic individuals may excel, and where these cognitive differences that we’re measuring in an IQ test just simply don’t seem to apply,” she says.
Note: Brittany Travers and her lab use identity-first language based on the expressed majority preference of autistic adults.
This study was funded by the Brain and Behavior Research Foundation’s NARSAD Young Investigator Award, the Hartwell Foundation’s Individual Biomedical Award, the University of Wisconsin System’s WiSys Technology Foundation, the Carla and Mike Austin Faculty Fellowship and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.