Leanne Chukoskie

Dyspraxia, motor function and visual-motor integration in autism

This project assessed dyspraxia in high-functioning school aged children with autism with a focus on Ideational Praxis. We examined the association of specific underlying motor function including eye movement with ideational dyspraxia (sequences of skilled movements) as well as the possible role of visual-motor integration in dyspraxia. We found that compared to IQ-, sex- and age-matched typically developing children, the children with autism performed significantly worse on: Ideational and Buccofacial praxis; a broad range of motor tests, including measures of simple motor skill, timing and accuracy of saccadic eye movements and motor coordination; and tests of visual-motor integration. Impairments in individual children with autism were heterogeneous in nature, although when we examined the praxis data as a function of a qualitative measure representing motor timing, we found that children with poor motor timing performed worse on all praxis categories and had slower and less accurate eye movements while those with regular timing performed as well as typical children on those same tasks. Our data provide evidence that both motor function and visual-motor integration contribute to dyspraxia. We suggest that dyspraxia in autism involves cerebellar mechanisms of movement control and the integration of these mechanisms with cortical networks implicated in praxis.

Motor skill in autism spectrum disorders: a subcortical view.

The earliest observable symptoms of autism spectrum disorders (ASDs) involve motor behavior. There is a growing awareness of the developmental importance of impaired motor function in ASD and its association with social skill. Compromised motor function requires increased attention, leaving fewer resources available for processing environmental stimuli and learning. This knowledge suggests that the motor system-which we know to be trainable-may be a gateway to improving outcomes of individuals living with ASD. In this review, we suggest a framework borrowed from machine learning to examine where, why, and how motor skills are different in individuals with ASD.

Low‐dose suramin in autism spectrum disorder: a small, phase I/II, randomized clinical trial

No drug is yet approved to treat the core symptoms of autism spectrum disorder (ASD). Low‐dose suramin was effective in the maternal immune activation and Fragile X mouse models of ASD. The Suramin Autism Treatment‐1 (SAT‐1) trial was a double‐blind, placebo‐controlled, translational pilot study to examine the safety and activity of low‐dose suramin in children with ASD.

‘Looking’ better: Designing an at-home gaze training system for children with ASD

Attention and eye movement control are essential for gathering sensory information in our environment however, both attention redirection and eye movement control are atypical in individuals with autism spectrum disorder (ASD). Improvements in the accuracy and timing of attention redirection and saccadic eye movements could have corollary beneficial effects on social engagement. Here, we show pilot data indicating proof of concept for such training in a laboratory environment and review the logistics of delivering similar-quality, yet affordable, training at home. Finally, we review a novel method for demonstrating whether eye movement behavior that has been modified in a video game environment carries over to a natural social engagement.

A novel approach to training attention and gaze in ASD: A feasibility and efficacy pilot study: Training Attention and Gaze in ASD

In addition to the social, communicative and behavioral symptoms that define the disorder, individuals with ASD have difficulty re‐orienting attention quickly and accurately. Similarly, fast re‐orienting saccadic eye movements are also inaccurate and more variable in both endpoint and timing. Atypical gaze and attention are among the earliest symptoms observed in ASD. Disruption of these foundation skills critically affects the development of higher level cognitive and social behavior. We propose that interventions aimed at these early deficits that support social and cognitive skills will be broadly effective. We conducted a pilot clinical trial designed to demonstrate the feasibility and preliminary efficacy of using gaze‐contingent video games for low‐cost in‐home training of attention and eye movement. Eight adolescents with ASD participated in an 8‐week training, with pre‐, mid‐ and post‐testing of eye movement and attention control. Six of the eight adolescents completed the 8 weeks of training and all six showed improvement in attention (orienting, disengagement) and eye movement control or both. All game systems remained intact for the duration of training and all participants could use the system independently. We delivered a robust, low‐cost, gaze‐contingent game system for home use that, in our pilot training sample, improved the attention orienting and eye movement performance of adolescent participants in 8 weeks of training. We are currently conducting a clinical trial to replicate these results and to examine what, if any, aspects of training transfer to more real‐world tasks.

An instrumented glove for improving spasticity assessment

An instrumented glove worn by caregivers that can augment subjective assessments of spasticity with an objective, repeatable metric with reduced inter- and intra-rater variability and improved resolution over existing standards is highly desirable. We present the design and preliminary results of such a system using commercial, off the shelf (COTS) components. The glove includes spatially-resolved, force-dependent resistive sensor elements and an inertial measurement unit. We developed a mock patient that is equipped with a mechanism to adjust the arm stiffness, a load-cell and a potentiometer to measure the work done to move the arm. The mock patient provides ground truth to validate the proposed concept. We report the power measured by the sensors in the mock patient to move the arm and the power estimated by the glove in moving the arm and show Pearson correlation coefficient of 0.64. We observe that raw sensor data and instrumentation errors contributed to significant outliers in these experiments. Initial assessments by clinician show promise of the proposed approach to improve spasticity assessment. Future work includes improvements to instrumentation and further clinical evaluations.