Module I: Description of Sensory and Motor Problems in Asperger’s Syndrome and Impact on Function

Gross Motor Problems

The most common terms used to describe the movements of a person with Asperger’s Syndrome are the terms "clumsy” or “awkward”. These words are often used in reference to an unusual gait. As an example, Gillberg states that the children in his study “appeared to be generally clumsy and had a stiff or awkward way of walking (often without an arm swing), or were uncoordinated in posture or gesture” (p 526). 14 One parent describes her child’s gait by stating, “Walter’s physical movements are awkward. His manner of walking varies from a stiff gait, nose pointed up and arm held back, to a wide stride with arms flailing”(p.438)9. Another mother describes her child’s gait as a kind of “John Wayne signature walk”6 and still another says “He takes tiny steps and will hold his torso very stiffly. He won’t swing his arms in a natural fashion. This is especially visible when Jimmy feels that he is being watched (p .177)”. 4

Balance has also been reported to be poor in children with Asperger’s Syndrome. Miyahara and his colleagues 17 indicate that all but two of their 26 children with Asperger’s Syndrome scored poorly on the balance portion of the Movement Assessment Battery for Children. Iwanaga, Kawasaki and Tsuchida 15 found that nine of their ten children with Asperger’s Syndrome scored below the fifth percentile on the standing balance and walk line tasks of the Japanese version of the Miller Assessment for Preschoolers. One mother talks about the number of times she and her husband needed to take their child to the emergency room for stitches because of his tripping and falling4 .

Ball skills may also be poor. Tantum18 indicates that of the three motor assessments given to his adults with Asperger’s Syndrome, the most errors, compared to the control group, were in ball skills. Manjiviona and Prior 16 also comment on the particular problem their children with Asperger’s Syndrome had with ball skills. They felt that the children had particular problems with controlling the force and the direction of the ball.

Picture of a child swinging

It is interesting to note that some forms of unusual motor behavior in persons with Asperger’s Syndrome may actually be means of attempting to increase sensory input. In his book, Beyond the Wall, Stephen Shore describes how he “learned the wonder of the swing set”8. He would pump the swing as high as he could and them jump off at the precise moment when he would move in a long arc and have a smooth landing. He also describes riding his bike as fast as he can into snow banks in order to feel the exhilaration of flying over the handlebars into the snow. He attributes his enjoyment of these activities (being high or being in flight) to an increase in his body awareness. His wife also describes an incident when they were dancing and Stephen spun her around and around until she was so dizzy she felt sick. She indicates that it took her an hour to recover while Stephen never got dizzy at all. One wonders if the massive amount of sensory input in spinning also helped “body awareness”. After all, not many people can spin like that and not get dizzy or need to fling themselves over the handlebars of their bicycle to increase body awareness.

In an interesting study that compared the motor skills of persons with Asperger’s Syndrome to matched controls, the authors suggest that the problems in the pattern of deficits seen in their Asperger participants (poor standing balance with eyes closed, tandem gait, and repetitive finger-thumb apposition), may be a problem in proprioception20. Proprioception is the sensory information we receive from the body particularly from muscles, joints and tendons. Because of this deficit, the authors felt that persons with Asperger’s Syndrome might be over reliant on visual input to maintain balance and position in space.

Proprioceptive sensory input provides us with an internal awareness of our body and our body in space. It is something we take for granted but it is critically important to both physical and emotional well being. In order to better appreciate the role of proprioceptive input and how it works with vision in guiding actions, consider the following exercises.

Exercise 3:

Have you ever know a child who just fell out of his desk chair? This is not easy to do. Try “falling” out of your chair. Note all of the protective mechanisms that come into play to reestablish your center of gravity and keep you from falling. These mechanisms are provided by proprioceptive information along with information from the vestibular system (the “balance center” located within the inner ear. If these systems do not work properly or are under responding, it would be possible for a child to just “fall” put of his chair.

Try this. Move two chairs together so they are about 15-inches apart. and walk between them. Did you turn to the side to do this? If you were walking through a room and came to this 15-inch gap, you would automatically realize that you could not get through that space without turning and going through sideways. This would not be something you had to stop and think about, you would just do it. You can do this because you have an internal “map” of your body that is created through propioceptive information and this map is constantly being updated telling you where your arms are etc. When you visually viewed the space and automatically “measured” the distance against your internal map of the body, you concluded that you are to wide to go through a 15-inch space without turning to the side. What would happen if your internal body map was faulty or poorly developed? Would you find that you hit the door jam when going through a door, that you bumped into desks when going through a classroom? Would you look clumsy?

When moving in space you expect a certain combination of vision and proprioceptive information to occur together. When they do not, there is a moment of “disconnect” or disorientation. We have all had the experience of sitting on a train or bus and having the bus/train next to us move and momentarily having the feeling we are moving. The feeling is not “normal” but rather disorienting. The confusion comes because the visual image we see, objects flowing past our visual field, is the same image that we would see if we were actually moving. But the brain also expects that when you move there will be corresponding proprioceptive input coming in at the same time as we tense our muscles to counteract the momentum of the movement. When this proprioceptive component is not there, we are momentarily disoriented. Think of what it might be like to have this disorientation as a common experience.

As noted, children with Asperger’s Syndrome have been described as clumsy and this clumsiness can be seen in both their fine motor and gross motor skills. In some instances, poor motor skills may be attributed to muscle weakness, as seen in some of the children described by Asperger, or to poor balance. But we also need to look at other factors that contribute to efficient motor behavior, factors such as proprioception input, visual spatial input and motor planning. We also need to evaluate a child’s behavior to try and determine if the motor tasks they seek out are being used to increase sensory input in order to achieve some level of comfort or “sensory equilibrium”. This brings us to the second major topic of this module and that is sensory problems.


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This course module was developed by Charlane Pehoski, ScD., OTR