Autism
Conditions
Brief summary
Flatfoot is a common postural deformity in children, characterized by the collapse of the medial longitudinal arch, leading to abnormal foot posture, gait disturbances, and postural instability. Arch collapse in flatfoot is also due to navicular drop a condition where the navicular bone, located in the midfoot, shifts downward excessively when bearing weight. This excessive drop reflects poor structural support in the foot and is often linked to weakness in the intrinsic foot muscles. The intrinsic and extrinsic muscles of the foot, particularly the abductor hallucis (AbdH), play a vital role in maintaining arch stability. Strengthening exercises like toe spread out movements are specifically designed to target these muscles by abducting and flexing the toes, helping to support and elevate the medial arch. This study aims to investigate the combined effect of toe spread out exercises and walking surface training on navicular drop and jumping performance in children with ASD, focusing on muscle strength and sensory-motor integration to support functional movement and postural control. This randomized controlled trial will be conducted over ten months at Step Up Autism Center and Rehab Care, Lahore, following ethical approval from the Research Ethical Committee of Riphah International University Islamabad (Lahore Campus). Children aged 7 to 12 years, clinically diagnosed with autism spectrum disorder, navicular drop, and poor locomotor skills will be recruited through non-probability convenient sampling. After obtaining informed consent from guardians, eligible participants will be randomly allocated into two groups. Group A will perform toe spread out exercises only, while Group B will perform toe spread out exercises combined with walking surface training. Both interventions will be carried out three times a week for eight weeks. This will be a single-blinded study, where the assessor will remain unaware of the group allocations. Data collection will involve pre- and post intervention assessment using the Navicular Drop Test, Wet Footprint Test (Clarke's Angle), Horizontal Jump Test, and the Test of Gross Motor Development-Second Edition (TGMD-2) to evaluate changes in foot posture, arch structure, lower limb power, and locomotor skills in participating children.
Interventions
Partcipant will sit on the edge of chair with hips and knees at 90 degree flexion, with foot flat on the floor. This position makes sure that there is equal weight distibution across the calcaneus, metatarsals and phalanges. It is also made sure that the feet are hip width apart.Then the participant is asked to lift the toes off the ground(dorsiflexion) , keeping the heel and ball(metarsals) of foot on the ground. While maintaining dorsiflexion of toes, the participant will be asked to flex the first toe medially (bending downward and toward the midline), similarly the fifth toe will be flexed laterally (bending downward and away from the midline) .The position will be held for 3 to 5 seconds with 10 repetiotns.
OTHERToe spread out exercises with walking surface training
Walking Surface • The participant will be barefoot and will be asked to walk in their usual manner and speed. • There will be three different surfaces i.e pile carpet (18mm thickness) for soft sensation, vinyl tile for flat smooth and loose gravel (average height of 14mm) for uneven sensation respectively. • The participant will be asked to walk on the 4 meter walking surface, taking 10 rounds on each
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
7 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* Children aged 7 to 12 years of age * Children of both genders male and female * children having navicular drop \>9mm
Exclusion criteria
* Neurological conditions affecting movement (e.g., CP) * Inability to follow simple verbal commands * Visual or auditory impairment impacting motor performance
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Navicular Drop by Navicular Drop Test | Baseline and 8th Week | The Navicular Drop (ND) Test evaluates medial longitudinal arch stability by measuring the difference in navicular height between neutral/seated and weight-bearing positions. A drop of 5-9 mm is typical, while \> 10mm indicates excessive pronation (arch collapse) or instability, often linked to structural issues |
| Jumping Performance by using Horizontal Jump Test | Baseline and 8th Week | Horizontal jump tests, particularly the Standing Long Jump (SLJ) or Broad Jump, measure lower-body explosive power by recording the furthest distance of three attempts from a takeoff line to the nearest heel landing. Elite men typically exceed 2.50 m, while women excel over 2.0 m , often aiming for a distance greater than their height. |
Countries
Pakistan
Contacts
CONTACTImran Amjad, Phd
CONTACTFareeha Kausar, PPDPT
PRINCIPAL_INVESTIGATORFareeha Kausar, PPDPT
Riphah International University
Outcome results
None listed