Effectiveness of Vestibular and Proprioceptive exercises for hyperactivity, balance and quality of life in children with Autism Spectrum Disorder: A randomized controlled trial

Introduction

Background

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and restricted, repetitive behaviors (American Psychiatric Association, 2013). A substantial proportion of children with ASD exhibit sensory processing dysfunction, particularly involving the vestibular and proprioceptive systems (Ben-Sasson et al., 2009; Tomcheck & Dunn, 2007). These sensory-motor impairments contribute to poor balance, motor incoordination, and behavioral dysregulation, often manifesting as hyperactivity (Jansiewicz et al., 2006; Minshew et al., 2004). Vestibular dysfunction affects postural control and arousal regulation, while proprioceptive deficits impair motor planning and body awareness, thereby limiting participation in daily activities and negatively influencing quality of life (Williams, 2019; Davis, 2018). Although conventional interventions primarily target behavioral and communication skills, emerging evidence suggests that vestibular and proprioceptive-based physiotherapy interventions may improve motor performance and reduce hyperactive behaviors. However, their combined effects on hyperactivity, balance, and quality of life require further systematic evaluation.

Procedure and Protocol

The study will be conducted after the approval from Departmental Research Committee and the Institutional Ethical Committee of the University. A sample of 32 Autism Spectrum Disorder subjects who met the inclusion and exclusion criteria will be recruited. Their guardians were given a detailed explanation about the motive and procedure of the study. An informed consent was duly obtained from all the subject’s guardians who voluntarily agreed to participate in the study. Demographic details and pre-intervention assessment will be taken.

Group allocation:- Participants will be randomized into two groups using chit pattern.

Group A:- Interventional group (16 participants)

Group B:- Control group. (16 participants)

For conventional group:-

Vestibular and Proprioceptive exercises

Week 1 & 2:-

Standing still with legs apart on both feet .

Holding an object (toy stick) with legs apart.

Trying to stand still with legs together.

Holding an object (toy stick) with legs together.

Standing up from sitting position on wobble board with the help of a physiotherapist.

Dribbling a swiss ball with both hands while looking without looking at it.

Jumping on a trampoline while holding the physiotherapist’s hand.

Trying to jump higher on a trampoline while holding the physiotherapist’s hand.

Put rings from one end to another while walking on blocks placed closely.

Walking on sensory pads.

Rotational and linear swinging in a Svava swing.

Sit to stand and vice versa while Rotational and linear swinging in a Svava swing

Applying whole body pressure with a Bobath ball after wrapping with a Pilates mat.

Put the rings from one place to another while walking on blocks.

Put the rings back in holder from right to left side and vice versa while sitting on the Swiss ball.

Climbing on climbing board.

Week 3&4 :-

Trying to stand on one leg (separately for left and right legs).

Trying to stand on a Bosu ball with both feet with the help of the physiotherapist.

Standing up from sitting position without the help of physiotherapist.

Trying to toss and catch a swiss ball while jumping on a trampoline.

Put the rings from one end to another while walking on blocks place slightly apart .

Animal walking while crossing the hurdles.

Walking on sensory pads spaced further apart than in previous weeks.

Trying to climb higher while holding the physiotherapist’s hand with one hand.

Climbing a climbing board and put soft balls on top part.

Put soft balls in basket while Rotational and linear swinging in a Svava swing Applying whole body pressure with a Bobath ball after wrapping with a Pilates mat.

For control group:-

General physiotherapy intervention

The program included structured exercises targeting both fine and gross motor skills.

WEEK 1–2

(Basic Functional Activities)

Simple walking on flat surface (short distance).

Slow stepping forward–backward.

Sit-to-stand with support.

Gentle trunk rotation & side reaching.

Soft ball rolling to therapist (10–12 repetitions).

Light arm and leg mobility tasks with slow pace.

Simple stepping over line drawn on floor.

All tasks done slowly to ensure familiarization.

WEEK 3–4

(Moderate Progression)

Increase repetitions of all tasks by 20–30%.

Introduce mildly longer walking pathway.

Add soft-surface stepping (soft blocks/cushion).

Controlled stepping over small obstacles (1–2 cm height).

Walking with direction changes.

Introduce low-resistance theraband for simple arm and leg movements.

Replace ball rolling with throwing/catching (short distance).

Increase stepping speed slightly while maintaining safety.

Longer walking paths with 2–3 obstacles.

Walking fast with head-turns (left–right).

Stepping on and off on blocks (height increases).

Ball bouncing or catching while standing.

Introduce slightly challenging step patterns (side–step, cross step).

Improve coordination using simple dual-task activities (e.g., holding ball while walking).

Mostafa, M. et. al. (2014).Anderson-Hanley et. al. (2011). Pan, C.-Y. (2008),Fournier, K. A., et al. (2010).

A post intervention assessment was carried out at the end of 4 weeks (20th session) with the repeated outcome measures of both groups (intervention and control).

Outcome measures

VADPRS

The VADPRS was used as the primary outcome measure, specifically focusing on the Hyperactive/Impulsive subscale (questions 10–18). This subscale was selected due to its relevance in capturing hyperactivity-related behaviors in children with ASD, despite not being explicitly validated for this population (Wolraich, 2013). Each item is rated on a scale from 0 (never) to 3 (very often), with higher scores indicating greater symptom severity (Wolraich, 2003; Küçük Dogaroglu et al., 2012).

It is a parent rated scale so all the questions will be asked from subject’s mother or father and according to their answer we will score each question.

PBS

The Pediatric Balance Scale is a modified version of the Berg Balance Scale that is used to assess functional balance skills during tasks that mimic experiences of everyday living in school-aged children. The scale consists of 14 balance-related test items that are scored from 0 points (lowest function) to 4 points (highest function) with a maximum score of 56 points. (Franjoine MR, et. al.).

ASQoL

Nine autism-specific (ASQoL) items are listed. Three of the items are negatively phrased, hence are reverse-scored. One of the items was intended as a ‘global’ QoL item about autistic identity. The WHOQoL measures along with the newly developed ASQoL show promise for use with autistic people in clinical settings to elucidate some of the challenging issues they may be experiencing in their lives. (Helen mcConachie et. al. 2017).

It is a also parent rated scale so all the questions will be asked from subject’s mother or father and according to their answer we will score each question.