Visual feedback increases postural stability in children with autism spectrum disorder

Autism spectrum disorders (ASD) are often associated with poor motor control, which depends greatly on postural stability. Firstly, this study examined postural stability in young children with ASD, as little is known about early postural skills in this population. Children with ASD are known to depend considerably on visual cues when maintaining balance. We therefore wished to explore whether visual stimuli would in turn improve postural stability. We recruited 18 children with ASD (aged 6–11) and also 12 age-matched typically developing (TD) children. We measured their baseline postural stability and their ability to maintain balance when provided contingent visual feedback of the movements of their center of pressure. Postural performances were measured with a force platform. Baseline postural stability of children with ASD was significantly reduced compared to TD children, as indicated by higher sway scores. When provided visual feedback, children with ASD improved their balance significantly. We conclude that although deficient postural control in ASD is present in childhood, this may be improved in facilitating settings where children with ASD can rely on visual cues.     

Cognitive demands and cortical control of human balance-recovery reactions

Summary A traditional view has been that balance control occurs at a very automatic level, primarily involving the spinal cord and brainstem; however, there is growing evidence that the cerebral cortex and cognitive processing are involved in controlling specific aspects of balance. The purpose of this review is to summarize recent literature pertaining to the cognitive demands and cortical control of balance-recovery reactions, focussing on five emerging sources of evidence: 1) dual-task studies demonstrating that concurrent performance of cognitive and balance-recovery tasks leads to interference effects; 2) dual-task studies that have examined the temporal dynamics associated with the reallocation of cognitive resources to the balance-recovery task; 3) visual attention studies that have inferred contributions of visual attention based on gaze measurements and/or manipulations to occlude vision; 4) measurements of brain potentials evoked by postural perturbation; and 5) use of transcranial magnetic stimulation to alter contributions from specific cortical areas.     

Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) Modulates Evoked-Gamma Frequency Oscillations in Autism Spectrum Disorder (ASD)

INTRODUCTION: It has been reported that individuals with Autism Spectrum Disorder (ASD) have abnormal reactions to the sensory environment and visuo-perceptual abnormalities. Electrophysiological research has provided evidence that gamma band activity (30-80 Hz) is a physiological indicator of the co-activation of cortical cells engaged in processing visual stimuli and integrating different features of a stimulus. A number of studies have found augmented and indiscriminative gamma band power at early stages of visual processing in ASD; this may be related to decreased inhibitory processing and an increase in the ratio of cortical excitation to inhibition. Low frequency or 'slow' (≤1HZ) repetitive transcranial magnetic stimulation (rTMS) has been shown to increase inhibition of stimulated cortex by the activation of inhibitory circuits. METHODS: We wanted to test the hypothesis of gamma band abnormalities at early stages of visual processing in ASD by investigating relative evoked (i.e. ~ 100 ms) gamma power in 25 subjects with ASD and 20 age-matched controls using Kanizsa illusory figures. Additionally, we wanted to assess the effects of 12 sessions of bilateral 'slow' rTMS to the dorsolateral prefrontal cortex (DLPFC) on evoked gamma activity using a randomized controlled design. RESULTS: In individuals with ASD evoked gamma activity was not discriminative of stimulus type, whereas in controls early gamma power differences between target and non-target stimuli were highly significant. Following rTMS individuals with ASD showed significant improvement in discriminatory gamma activity between relevant and irrelevant visual stimuli. We also found significant improvement in the responses on behavioral questionnaires (i.e., irritability, repetitive behavior) as a result of rTMS. CONCLUSION: We proposed that 'slow' rTMS may have increased cortical inhibitory tone which improved discriminatory gamma activity at early stages of visual processing. rTMS has the potential to become an important therapeutic tool in ASD treatment and has shown significant benefits in treating core symptoms of ASD with few, if any side effects.     

Sensory Symptoms and Processing of Nonverbal Auditory and Visual Stimuli in Children with Autism Spectrum Disorder

Atypical sensory responses are common in autism spectrum disorder (ASD). While evidence suggests impaired auditory–visual integration for verbal information, findings for nonverbal stimuli are inconsistent. We tested for sensory symptoms in children with ASD (using the Adolescent/Adult Sensory Profile) and examined unisensory and bisensory processing with a nonverbal auditory–visual paradigm, for which neurotypical adults show bisensory facilitation. ASD participants reported more atypical sensory symptoms overall, most prominently in the auditory modality. On the experimental task, reduced response times for bisensory compared to unisensory trials were seen in both ASD and control groups, but neither group showed significant race model violation (evidence of intermodal integration). Findings do not support impaired bisensory processing for simple nonverbal stimuli in high-functioning children with ASD.     

Low-Frequency Repetitive Transcranial Magnetic Stimulation Modulates Evoked-Gamma Frequency Oscillations in Autism Spectrum Disorder

Introduction. It has been reported that individuals with Autism Spectrum Disorder (ASD) have abnormal reactions to the sensory environment and visuo-perceptual abnormalities. Electrophysiological research has provided evidence that gamma band activity (30–80 Hz) is a physiological indicator of the coactivation of cortical cells engaged in processing visual stimuli and integrating different features of a stimulus. A number of studies have found augmented and indiscriminative gamma band power at early stages of visual processing in ASD; this may be related to decreased inhibitory processing and an increase in the ratio of cortical excitation to inhibition. Low frequency or “slow” (≤1HZ) repetitive transcranial magnetic stimulation (rTMS) has been shown to increase inhibition of stimulated cortex by the activation of inhibitory circuits.

Method. We wanted to test the hypothesis of gamma band abnormalities at early stages of visual processing in ASD by investigating relative evoked (i.e., ～100 ms) gamma power in 25 participants with ASD and 20 age-matched controls using Kanizsa illusory figures. In addition, we wanted to assess the effects of 12 sessions of bilateral “slow” rTMS to the dorsolateral prefrontal cortex on evoked gamma activity using a randomized controlled design.

Results. In individuals with ASD evoked gamma activity was not discriminative of stimulus type, whereas in controls early gamma power differences between target and nontarget stimuli were highly significant. Following rTMS individuals with ASD showed significant improvement in discriminatory gamma activity between relevant and irrelevant visual stimuli. We also found significant improvement in the responses on behavioral questionnaires (i.e., irritability, repetitive behavior) as a result of rTMS.

Conclusion. We propose that slow rTMS may have increased cortical inhibitory tone, which improved discriminatory gamma activity at early stages of visual processing. rTMS has the potential to become an important therapeutic tool in ASD treatment and has shown significant benefits in treating core symptoms of ASD with few, if any side effects.     

Impact of aging on visual reweighting during locomotion

ObjectivesThe purpose of this study was to investigate the ability of young and old subjects to reweight visual cues while walking at normal and fast speeds.MethodsTen young (23.49 ± 4.72) and ten older adults (age 76.22 ± 3.11) were asked to physically walk straight while viewing a virtual scene in a head-mounted display (HMD) unit under three conditions: no visual perturbation, blank (no visual input), and visual perturbation. Subjects performed the tasks walking at two speeds: preferred self-pace and fast. Variables calculated included trajectory, heading angle, and body segment orientations.ResultsIn the perturbation condition, the older adults walked with higher segmentation and more deviations of the body’s centre of mass. Only the young subjects were affected by the walking speed, with an improved performance when walking fast.ConclusionsOld age affects the ability to re-weight visual information and make postural or locomotor adjustments in real time. The lower errors of the young adults in the fast conditions suggest decreased cortical control of locomotion with increasing speeds.SignificanceVisual information presented in real time can impact on balance and mobility in older adults, and thus should be given serious consideration for the purpose of evaluation and intervention.     

Cortical responses associated with the preparation and reaction to full-body perturbations to upright stability.

OBJECTIVE: To examine the cortical activity associated with 'central set' preparations for induced whole-body instability. METHODS: Self-initiated and temporally unpredictable perturbations to standing balance were caused by the release of a load coupled to a cable affixed to a harness while participants stood on a force plate. Electroencephalographic and electromyographic signals were recorded. RESULTS: Peak activity was located at the Cz electrode. The predictable condition elicited a DC shift 950 ms prior to perturbation onset and was 18.0+/-10.5 micro V in magnitude. Pre-perturbation activity was not associated with the motor act of perturbation initiation and was dissociable from cortical activity related to anticipatory postural muscle activation. Following perturbation onset, N1 potentials were observed with a peak amplitude of 17.6+/-7.2 micro V and peak latency of 140.1+/-25.9 ms. In unpredictable trials, pre-perturbation activity was absent. The peak amplitude (32.0+/-14.8 micro V) and latency (156.5+/-11.8 ms) of the post-perturbation N1 potential were significantly larger (p=0.002) and later (p<0.001) than for predictable trials. CONCLUSIONS: Self-initiated postural instability evokes cortical activity prior to and following perturbation onset. Pre-perturbation cortical activity is associated with changing central set to modulate appropriate perturbation-evoked balance responses. SIGNIFICANCE: These findings establish a link between reactive balance control and cortical activity that precedes and follows perturbations to stability.     

No evidence for impaired multisensory integration of low-level audiovisual stimuli in adolescents and young adults with autism spectrum disorders

Abrupt click sounds can improve the visual processing of flashes in several ways. Here, we examined this in high functioning adolescents with Autism Spectrum Disorders (ASD) using three tasks: (1) a task where clicks improve sensitivity for visual temporal order (temporal ventriloquism); (2) a task where a click improves visual search (pip-and-pop), and (3) a task where a click speeds up the visual orienting to a peripheral target (clock reading). Adolescents with ASD were, compared to adolescents with typical development (TD), impaired in judgments of visual temporal order, but they were unimpaired in visual search and orienting. Importantly, in all tasks visual performance of the ASD group improved by the presence of clicks by at least equal amounts as in the TD group. This suggests that adolescents and young adults with ASD show no generalized deficit in the multisensory integration of low-level audiovisual stimuli and/or the phasic alerting by abrupt sounds.     

Dorsal‐movement and ventral‐form regions are functionally connected during visual‐speech recognition

Faces convey social information such as emotion and speech. Facial emotion processing is supported via interactions between dorsal‐movement and ventral‐form visual cortex regions. Here, we explored, for the first time, whether similar dorsal–ventral interactions (assessed via functional connectivity), might also exist for visual‐speech processing. We then examined whether altered dorsal–ventral connectivity is observed in adults with high‐functioning autism spectrum disorder (ASD), a disorder associated with impaired visual‐speech recognition. We acquired functional magnetic resonance imaging (fMRI) data with concurrent eye tracking in pairwise matched control and ASD participants. In both groups, dorsal‐movement regions in the visual motion area 5 (V5/MT) and the temporal visual speech area (TVSA) were functionally connected to ventral‐form regions (i.e., the occipital face area [OFA] and the fusiform face area [FFA]) during the recognition of visual speech, in contrast to the recognition of face identity. Notably, parts of this functional connectivity were decreased in the ASD group compared to the controls (i.e., right V5/MT—right OFA, left TVSA—left FFA). The results confirmed our hypothesis that functional connectivity between dorsal‐movement and ventral‐form regions exists during visual‐speech processing. Its partial dysfunction in ASD might contribute to difficulties in the recognition of dynamic face information relevant for successful face‐to‐face communication.     

Decreased centrality of cortical volume covariance networks in autism spectrum disorders

Autism spectrum disorders (ASD) are a group of neurodevelopmental conditions characterized by atypical structural and functional brain connectivity. Complex network analysis has been mainly used to describe altered network-level organization for functional systems and white matter tracts in ASD. However, atypical functional and structural connectivity are likely to be also linked to abnormal development of the correlated structure of cortical gray matter. Such covariations of gray matter are particularly well suited to the investigation of the complex cortical pathology of ASD, which is not confined to isolated brain regions but instead acts at the systems level. In this study, we examined network centrality properties of gray matter networks in adults with ASD (n = 84) and neurotypical controls (n = 84) using graph theoretical analysis. We derived a structural covariance network for each group using interregional correlation matrices of cortical volumes extracted from a surface-based parcellation scheme containing 68 cortical regions. Differences between groups in closeness network centrality measures were evaluated using permutation testing. We identified several brain regions in the medial frontal, parietal and temporo-occipital cortices with reductions in closeness centrality in ASD compared to controls. We also found an association between an increased number of autistic traits and reduced centrality of visual nodes in neurotypicals. Our study shows that ASD are accompanied by atypical organization of structural covariance networks by means of a decreased centrality of regions relevant for social and sensorimotor processing. These findings provide further evidence for the altered network-level connectivity model of ASD.     

Changes in the activity of the cerebral cortex relate to postural response modification when warned of a perturbation.

OBJECTIVE: To determine whether the cerebral cortex contributes to modifying upcoming postural responses to external perturbations when provided with prior warning of the perturbation. METHODS: Electroencephalographic (EEG) potentials were recorded from 12 healthy human subjects (21-32 years of age) before perturbing their balance with backward translations of a platform under their feet. The subjects responded with and without a visual cue that warned them 2s before the perturbation (the Cue and No Cue conditions, respectively). RESULTS: Contingent negative variation (CNV) was evident before perturbation onset in only the Cue condition. In the Cue condition, the subjects also produced smaller center of pressure (CoP) displacements than in the No Cue condition. The cue-related difference in the subjects' CNV potentials correlated with the cue-related difference in their CoP displacements. No significant associations existed among the CNV potentials and any cue-related postural adjustments made before the perturbation. CONCLUSIONS: Cortical activity before an externally triggered perturbation associates with modifications of the ensuing postural response. SIGNIFICANCE: This is the first study to demonstrate a cortical correlate for changes in central postural set that modify externally triggered postural responses based on anticipation.     

Postural Stability in Children with Autism Spectrum Disorder

Maintaining upright posture is a complex process involving multiple afferent systems. The aim of this study was to measure the postural stability of children with Autism Spectrum Disorder (ASD) compared with children with typical neurodevelopment and to measure the relative contributions of the visual, somatosensory, and vestibular afferent systems in each group. Eight boys with ASD and eight age-, race-, and gender-matched controls participated in this study using force platform technology with customized software to measure postural sway under conditions designed to eliminate or modify visual and somatosensory input. Children with ASD had significantly larger sway areas under all test conditions in which afferent input was modified. These results are consistent with a deficit in the integration of visual, vestibular, and somatosensory input to maintain postural orientation.     

Visual event-related potentials to biological motion stimuli in autism spectrum disorders

Atypical visual processing of biological motion contributes to social impairments in autism spectrum disorders (ASD). However, the exact temporal sequence of deficits of cortical biological motion processing in ASD has not been studied to date. We used 64-channel electroencephalography to study event-related potentials associated with human motion perception in 17 children and adolescents with ASD and 21 typical controls. A spatio-temporal source analysis was performed to assess the brain structures involved in these processes. We expected altered activity already during early stimulus processing and reduced activity during subsequent biological motion specific processes in ASD. In response to both, random and biological motion, the P100 amplitude was decreased suggesting unspecific deficits in visual processing, and the occipito-temporal N200 showed atypical lateralization in ASD suggesting altered hemispheric specialization. A slow positive deflection after 400 ms, reflecting top-down processes, and human motion-specific dipole activation differed slightly between groups, with reduced and more diffuse activation in the ASD-group. The latter could be an indicator of a disrupted neuronal network for biological motion processing in ADS. Furthermore, early visual processing (P100) seems to be correlated to biological motion-specific activation. This emphasizes the relevance of early sensory processing for higher order processing deficits in ASD.     

Electrophysiological evidence for selective impairment of optic flow perception in autism spectrum disorder

People with autism spectrum disorder (ASD) often show inferior global motion performance with superior performance in detail form perception, suggesting dysfunction of the dorsal visual stream. To elucidate the neural basis of impaired global motion perception in ASD, we measured psychophysical threshold and visual event-related potentials (ERPs) with a 128-channel system in 12 ASD and 12 healthy control adults. Radial optic flow (OF) and horizontal motion (HO) were used as the visual stimuli. The former was related to the ventro-dorsal stream formed by the inferior parietal lobule, while the latter was conveyed from the dorso-dorsal stream formed by the superior parietal lobule. No significant group differences were observed in the motion thresholds for both OF and HO. N170 and P200 were elicited as major components of ERPs in both groups. However, the latencies of both components for OF but not HO were significantly prolonged in ASD compared with the control group. Our ERP results suggest that ASD has a selective impairment for OF processing even though the psychophysical thresholds are preserved. Therefore, we provide the first electrophysiological evidence for altered function of the higher-level dorsal visual stream in ASD, specifically the ventro-dorsal stream closely related to OF perception.     

Differential amygdala response to lower face in patients with autistic spectrum disorders: An fMRI study

Much functional neuroimaging evidence indicates that autistic spectrum disorders (ASD) demonstrate marked brain abnormalities in face processing. Most of these findings were obtained from studies using tasks related to whole faces. However, individuals with ASD tend to rely more on individual parts of the face for identification than on the overall configuration. Therefore, this neuroimaging evidence might reflect differential visual attention systems in face recognition. It was hypothesized that differential brain function is shown between ASD and control participants with face recognition tasks presenting parts of faces separately. Nine adults with high-functioning ASD and 24 age-matched normal comparison participants were studied using a 3T-MR scanner. We investigated brain activation when processing whole faces and parts of faces displaying positive or negative expressions. The control group showed bilateral amygdalae activation to the whole face, but not to parts of the face. The ASD group showed bilateral amygdalae activation to the lower face (mainly mouth region), but not to the whole face and upper face (mainly eye region). These findings suggest that differential amygdala function for face processing exists in ASD. This aberrant amygdala function might cause abnormalities in gaze processing or recognition of emotional expressions, shown clinically in ASD.     

Contrast sensitivity for motion detection and direction discrimination in adolescents with autism spectrum disorders and their siblings

The magnocellular (M) pathway hypothesis proposes that impaired visual motion perception observed in individuals with Autism Spectrum Disorders (ASD) might be mediated by atypical functioning of the subcortical M pathway, as this pathway provides the bulk of visual input to cortical motion detectors. To test this hypothesis, we measured luminance and chromatic contrast sensitivity, thought to tap M and Parvocellular (P) pathway processing, respectively. We also tested the hypothesis that motion processing is impaired in ASD using a novel paradigm that measures motion processing while controlling for detectabilty. Specifically, this paradigm compares contrast sensitivity for detection of a moving grating with contrast sensitivity for direction-of-motion discrimination of that same moving grating. Contrast sensitivities from adolescents with ASD were compared to typically-developing adolescents, and also unaffected siblings of individuals with ASD (SIBS). The results revealed significant group differences on P, but not M, pathway processing, with SIBS showing higher chromatic contrast sensitivity than both participants with ASD and TD participants. This atypicality, unique to SIBS, suggests the possible existence of a protective factor in these individuals against developing ASD. The results also revealed impairments in motion perception in both participants with ASD and SIBS, which may be an endophenotype of ASD. This impairment may be driven by impairments in motion detectors and/or by reduced input from neural areas that project to motion detectors, the latter possibility being consistent with the notion of reduced connectivity between neural areas in ASD.     

Abnormal activation of face processing systems at early and intermediate latency in individuals with autism spectrum disorder: a magnetoencephalographic study

The neurological basis of developmental psychopathology in autism is a matter of intense debate. Magnetoencephalography (MEG) was used to study the neuronal responses associated with the processing of faces in 12 able adults with autism spectrum disorders (ASD), performing image categorization and image identification tasks. The neuromagnetic data were analysed using nonparametric time-series analysis and equivalent current dipole estimation. Comparison data were obtained from 22 normally developing adults. In individuals with ASD, the neural responses to images of faces, observed in right extrastriate cortices at approximately 145 ms after stimulus onset, were significantly weaker, less lateralized and less affected by stimulus repetition than in control subjects. Early latency (30-60 ms) responses to face images, over right anterior temporal regions, differed significantly between the two subject groups in the image identification task. No such difference was observed for images of mugs or meaningless geometrical patterns. These findings suggest that, during the course of development in individuals with ASD, the cortical activity associated with the processing of human faces assumes a different-from-normal localization in extrastriate brain regions. This abnormal localization may be associated with unusual, but nevertheless face-specific, fast processing pathways.     

Motor Difficulties in Autism Spectrum Disorder: Linking Symptom Severity and Postural Stability

Postural stability is a fundamental aspect of motor ability that allows individuals to sustain and maintain the desired physical position of one’s body. The present study examined postural stability in average-IQ adolescents and adults with Autism Spectrum Disorder (ASD). Twenty-six individuals with ASD and 26 age-and-IQ-matched individuals with typical development stood on one leg or two legs with eyes opened or closed on a Wii balance board. Results indicated significant group differences in postural stability during one-legged standing, but there were no significant group differences during two-legged standing. This suggests that static balance during more complex standing postures is impaired in average-IQ individuals with ASD. Further, current ASD symptoms were related to postural stability during two-legged standing in individuals with ASD. Future directions and clinical implications are discussed.     

Cortical control of postural balance in patients with hemiplegic stroke

Despite its remarkable effect on the activities of daily living, the precise mechanism underlying balance control after stroke remains to be elucidated. In this study, we investigated the cortical activation induced by postural perturbation in 20 patients with stroke using a 50-channel event-related functional near-infrared spectroscopy. A combination of brisk forward and backward movements of a platform without any prior cue was used as an external postural perturbation. Multi-participant analysis of oxygenated hemoglobin signals showed postural perturbation-related cortical activation in the prefrontal cortical areas in both hemispheres as well as the premotor and parietal association cortical areas in the unaffected hemisphere. Regression analysis using the individual Berg Balance Scale as the regressor showed a significant positive correlation between balance ability and the postural perturbation-related changes in oxygenated hemoglobin signals in the supplementary motor areas and prefrontal cortical areas in both hemispheres. Consistent with the previous findings in healthy participants, these findings suggest that the broad cortical network, including the prefrontal, premotor, supplementary motor, and parietal cortical areas in both hemispheres, was essential for balance control even in poststroke patients.     

Neural correlates of language comprehension in autism spectrum disorders: when language conflicts with world knowledge

In individuals with ASD, difficulties with language comprehension are most evident when higher-level semantic-pragmatic language processing is required, for instance when context has to be used to interpret the meaning of an utterance. Until now, it is unclear at what level of processing and for what type of context these difficulties in language comprehension occur. Therefore, in the current fMRI study, we investigated the neural correlates of the integration of contextual information during auditory language comprehension in 24 adults with ASD and 24 matched control participants. Different levels of context processing were manipulated by using spoken sentences that were correct or contained either a semantic or world knowledge anomaly. Our findings demonstrated significant differences between the groups in inferior frontal cortex that were only present for sentences with a world knowledge anomaly. Relative to the ASD group, the control group showed significantly increased activation in left inferior frontal gyrus (LIFG) for sentences with a world knowledge anomaly compared to correct sentences. This effect possibly indicates reduced integrative capacities of the ASD group. Furthermore, world knowledge anomalies elicited significantly stronger activation in right inferior frontal gyrus (RIFG) in the control group compared to the ASD group. This additional RIFG activation probably reflects revision of the situation model after new, conflicting information. The lack of recruitment of RIFG is possibly related to difficulties with exception handling in the ASD group.