5~7岁孤独症谱系障碍儿童跨越高度障碍步态特征

doi:10.11852/zgetbjzz2024-1419

摘要/Abstract

摘要： 目的观察孤独症谱系障碍(ASD)儿童跨越不同高度障碍物时步态的时空参数特征,为制定早期运动干预方案和护理措施提供参考,以期降低ASD儿童跌倒风险。方法 2023年11—12月,招募5~7岁ASD儿童和典型发育儿童各30例,使用Footscan^®足底压力测试系统,采集无障碍行走以及跨越5cm、15cm高度障碍时足底各区域初始着地时相、触地时间百分比、离地时相以及整足压力中心位移。采用重复测量方差分析比较实验组与对照组在三次测试中各步态指标差异。结果无障碍行走时,ASD儿童趾骨区域初始着地时相、趾骨和跖骨区域离地时相与典型发育儿童差异有统计学意义(P<0.05);跨越高度障碍时,典型发育儿童相较于无障碍行走,引导腿跖骨和足跟区域的初始着地时相差异有统计学意义(P<0.05),但ASD儿童引导腿足跟区域的初始着地时相在三次测试中不存在显著差异(P>0.05),仅在15cm高度障碍时跖骨区域的初始着地时相变化具有差异(P<0.05)。结论 ASD儿童行走时,在承重反应期表现为跖屈不足,在支撑相末期表现为背屈不足;跨越障碍时表现出更谨慎的动作模式。与典型发育儿童对障碍物的“有无”更敏感不同,ASD儿童对障碍物的“高度”更为敏感。

关键词: 孤独症谱系障碍, 步态, 跨越高度障碍, 时空参数, 儿童

Abstract: Objective To observe the spatiotemporal gait parameters of children with autism spectrum disorder (ASD) when crossing obstacles of different heights, in order to provide reference for developing early motor intervention programs and nursing strategies to reduce the risk of falls in ASD children. Methods From November to December 2023,thirty children with ASD (aged 5 - 7 years) and thirty typically developed children were recruited.The Footscan^® plantar pressure system was used to collect the initial contact time, duration of contact, final contact time, and whole-foot center of pressure displacement during unobstructed walking and when crossing 5 cm and 15 cm obstacles.Repeated measures ANOVA was used to compare gait parameters between the two groups under the three test conditions. Results During unobstructed walking, significant differences were observed between ASD and TD children in the initial contact phase of the toe region, the final contact phase of the toe and metatarsal regions, and COP-X (P<0.05).When crossing obstacles, typically developed children showed significant differences in the initial contact phase of the metatarsal and heel regions of the leading limb compared to unobstructed walking (P<0.05), whereas ASD children showed no significant differences in the heel region across the three trials (P>0.05), with changes only in the metatarsal region when crossing the 15 cm obstacle (P<0.05). Conclusions Children with ASD exhibit insufficient plantar flexion during the loading response phase and insufficient dorsiflexion at the terminal stance during walking.They adopt a more cautious movement pattern when crossing obstacles.Unlike TD children, who are more sensitive to the presence of obstacles, ASD children are more sensitive to obstacle height.

Key words: autism spectrum disorder, gait, crossing height obstacles, spatiotemporal parameters, children

中图分类号:

刘天鹭, 段晓琴, 裴晶晶, 邹晓峰. 5~7岁孤独症谱系障碍儿童跨越高度障碍步态特征[J]. 中国儿童保健杂志, 2026, 34(1): 76-81.

LIU Tianlu, DUAN Xiaoqin, PEI Jingjing, ZOU Xiaofeng. Gait characteristics of 5- to 7-year-old children with autism spectrum disorder while crossing height obstacles[J]. Chinese Journal of Child Health Care, 2026, 34(1): 76-81.

参考文献

[1] 陈为玮, 朱小烽, 张虹雷.自闭症谱系障碍儿童运动功能评估与干预研究进展[J].中国体育科技, 2022,58(6):3-9.
Chen WW, Zhu XF, Zhang HL.Research progress of motor function evaluationand intervention in children with autism spectrum disorders[J].China Sport Science and Technology, 2022,58(6):3-9.(in Chinese)
[2] Weiss MJ, Moran MF, Parker ME, et al.Gait analysis of teenagers and young adults diagnosed with autism and severe verbal communication disorders[J].Front Integr Neurosci, 2013,7:33.
[3] 王琳, 王志丹, 王泓婧.孤独症儿童动作发展障碍的神经机制[J].心理科学进展, 2021,29(7):1239-1250.
Wang L, Wang ZD, Wang HJ.The neural mechanisms of developmental motor disorders in children withautism spectrum disorder[J].Advances in Psychological Science, 2021,29(7):1239-1250.(in Chinese)
[4] Sparrow WA, Shinkfield AJ, Chow S, et al.Characteristics of gait in stepping over obstacles[J].Hum Mov Sci, 1996,15(4):605-622.
[5] Austin GP, Garrett GE, Bohannon RW.Kinematic analysis of obstacle clearance during locomotion[J].Gait posture, 1999,10(2):109-120.
[6] Lee SM, Lee HS.Correlation between executive function and walk while crossing over an obstacle under different gait phases[J].Demen Neurocogn Disord, 2023,22(4):139-147.
[7] Zhang C, Mao D, Riskowski JL, et al.Strategies of stepping over obstacles: The effects of long-term exercise in older adults[J].Gait Posture, 2011,34(2):191-196.
[8] Mohd Nor MN, Jailani R, Tahir NM, et al.EMG signals analysis of BF and RF muscles in autism spectrum disorder (ASD) during walking[J].Int J Adv Sci Eng Inf Technol, 2016,6(5):793.
[9] Eggleston JD, Harry JR, Cereceres PA, et al.Lesser magnitudes of lower extremity variability during terminal swing characterizes walking patterns in children with autism[J].Clin Biomech, 2020,76:105031.
[10] Li Y, Koldenhoven RM, Liu T, et al.Age-related gait development in children with autism spectrum disorder[J].Gait & Posture, 2021,84:260-266.
[11] Hasan C, Jailani R, Md TN, et al.The analysis of three-dimensional ground reaction forces during gait in children with autism spectrum disorders[J].Res Dev Disabil, 2017,66:55-63.
[12] Mohd Nor MNI, Jailani R, Nooritawati MT.Feature selection of electromyography signals for autism spectrum disorder children during gait using mann-whitney test(Article)[J].Jurnal Teknologi-Sciences & Engineering, 2020,82(2):113-120.
[13] Calhoun M, Longworth M, Chester V L.Gait patterns in children with autism[J].Clin Biomech, 2011,26(2):200-206.
[14] Yamagata M, Tateuchi H, Pataky T, et al.Relation between frontal plane center of mass position stability and foot elevation during obstacle crossing[J].J Biomech, 2021,116:110219.
[15] Rathore R, Tucker CA, Jeka JJ.Effect of increasing obstacle distances task on postural stability variables during gait initiation in older non-fallers and fallers[J].Arch Phys Med Rehabil, 2022(12):2303-2310.
[16] Auml B, Ouml C, MA, et al.Motor planning and movement execution during goal-directed sequential manual movements in 6-year-old children with autism spectrum disorder: A kinematic analysis.[J].Res Dev Disabil, 2021(Suppl C):104014.
[17] Pieruccini-Faria F, Jones JA, Almeida QJ.Motor planning in Parkinson's disease patients experiencing freezing of gait: The influence of cognitive load when approaching obstacles[J].Brain Cogn, 2014:76-85.
[18] 史姗姗, 汪杰, 王颖鹏, 等.基于功能性近红外光谱的孤独症谱系障碍儿童可视音乐任务下大脑前额叶激活程度的研究[J].中国康复医学杂志, 2023,38(8):1050-1055.
Shi SS, Wang J, Wang YP, et al.Prefrontal cortex activation in children with autism spectrum disorder under visual music task based onfunctional near-infrared spectroscopy[J].Chinese Journal of Rehabilitation Medicine, 2023,38(8):1050-1055.(in Chinese)
[19] Bass MM, Duchowny CA, Llabre MM.The effect of therapeutic horseback riding on social functioning in children with autism[J].J Autism Dev Disord, 2009,39(9):1261-1267.
[20] Bremer E, Lloyd M.School-based fundamental-motor-skill intervention for children with autism-like characteristics: An exploratory study.[J].Adapted Physical Activity Quarterly, 2016,33(1):66.
[21] 黎梦晗, 李廷玉.孤独症谱系障碍儿童感觉异常的研究进展[J].中国儿童保健杂志, 2023,31(6):650-655.
Li MH, Li TY.Progress in sensory abnormalities in children with autism spectrum disorder[J].Chin J Health Care, 2023,31(6):650-655.(in Chinese)
[22] Clowes DP.Sensorimotor planning, integration, and execution processes in autism spectrum disorders[D].Liverpool:United Kingdom Liverpool John Moores University, 2022.
[23] Brieber S, Herpertz-Dahlmann B, Fink G, et al.Coherent motion processing in autism spectrum disorder (ASD): An fMRI study[J].Neuropsychologia, 2010(6):1644-1651.
[24] Marko MK, Crocetti D, Hulst T, et al.Behavioural and neural basis of anomalous motor learning in children with autism[J].Brain, 2015,138(Pt 3):784-797.
[25] Patla AE, Greig M.Any way you look at it, successful obstacle negotiation needs visually guided on-line foot placement regulation during the approach phase[J].Neurosci Lett, 2006,397(1-2):110-114.