International Journal of Current Research and Review Research Article

DOI: http://dx.doi.org/10.31782/IJCRR.2021.13724

Occupational Therapy and Yoga for Children with

Autism Spectrum Disorder for Rehabilitation
IJCRR Professional
Section: Healthcare
ISI Impact Factor
(2019-20): 1.628
IC Value (2019): 90.81
K. Kalaichandran1, P. Swarnakumari2, R. Sankar3
SJIF (2020) = 7.893
1
PhD Research Scholar, Department of Rehabilitation Science, Holy Cross College, Autonomous, Tiruchirapalli-620002, India; 2Associate
Professor, Research Supervisor PG & Research, Department of Rehabilitation Science, Holy Cross College, Autonomous Tiruchirapalli-620002,
Copyright@IJCRR
India; 3Associate Professor & I/C HEAD, (Co-Guide), Department of Psychology, Annamalai University, T.N., India.

ABSTRACT
Introduction: Autism spectrum disorder (ASD) is being identified in an ever-increasing number of countries,1 Research to
date children with these disorders will have poor gross motor skills and the rate of fall risk are increase among these children,
an effective intervention for understudied Autism Spectrum Disorder is needed. Therefore, we investigated to find out the ef-
fectiveness of Occupational Therapy along with Yoga intervention including gross motor skill and fall risk for children with Autism
Spectrum Disorder.
Objective: To find out the effectiveness of gross motor skill for children with Autism Spectrum Disorder and to educate and train
the children with Autism Spectrum Disorder who are prone to fall.
Methods: Nine children with Autism Spectrum Disorder who are prone to fall were selected for this study. Gross Motor Func-
tional Measure scale (GMFMs) and Modified Berg Balance Scale (BBS - M) Pediatric Balance Scale were used for the objective
measurement of children fall risk. The pre and post-therapy values were statistically analyzed on the effect of Occupational
Therapy and Yoga intervention for children with Autism Spectrum Disorder.
Results: The statistical analysis of Gross Motor Functional Measure scale (GMFMs) mean value is 86.7777 vs post-treatment
mean value is 121.444 (t = -8.95182; p<0.00001). The Statistical analysis of Berg Balance Scale between pre-treatment mean
values is 24.777, S.D is 3.18948 and post-treatment mean value is 40.222, S.D 4.7088, t-test value of BBS is 7.68085 and p-
value is < .00001. Based on the statistical report it is suggested that the gross motor skills were improved and the rate of fall was
comparatively reduced for children with Autism Spectrum Disorder.
Conclusion: Occupational Therapy and Yoga can be used effectively as one of the interventions as an integrated therapy to
improve gross motor skills and to prevent falls in children with Autism Spectrum Disorder. Therapists may consider these inter-
ventions when treating children with Autism Spectrum Disorder.
Key Words: Occupational Therapy, Yoga, Fall prevention, Berg Balance Scale (BBS-M) Pediatric Balance Scale, Gross Motor Func-
tional Measure scale (GMFMs), Autism Spectrum Disorder

INTRODUCTION cine hypotheses, which have been disproven. Autism affects

information processing in the brain by altering how nerve
Autism is a neurodevelopment syndrome that is defined by cells and their synapses connect and organize; how this oc-
deficits in social reciprocity and communication, and by curs is not well understood. In the DSM V, autism is includ-
unusual restricted, repetitive behaviours (American Psychi- ed within the autism spectrum (ASDs), along with Asperger
atric Association 2000). Autism is a disorder that usually be- syndrome which is less severe, and a pervasive developmen-
gins in infancy, at the latest, in the first three years of life. tal disorder, not otherwise specified (PDD-NOS).4-6
Autism is caused by a combination of genetic and environ-
mental factors. Risk factors include certain infections during Autism symptoms range in presentation and severity. Autism
pregnancy such as rubella as well as valproic acid, alcohol, children commonly have an intellectual disability, but in
or cocaine use during pregnancy.1-3 Controversies surround some cases, autistic children will have average intelligence.
other proposed environmental causes; for example, the vac- Children with autism may also have motor abnormalities,

Corresponding Author:
K. Kalaichandran, PhD Research Scholar, PG & Research, Department of Rehabilitation Science, Holy Cross College, Autonomous, Tiruchi-
rapalli-620002, India, H/P +91 9942236302; Email: auckkn@yahoo.co.in
ISSN: 2231-2196 (Print) ISSN: 0975-5241 (Online)
Received: 13.11.2020 Revised: 26.12.2020 Accepted: 02.02.2021 Published: 12.04.2021

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 Kalaichandran et al.: Occupational therapy and yoga for children with autism spectrum disorder for rehabilitation professional

fear, anxiety, seizures, sleep cycle disturbances, gastrointes- Procedure

tinal problems, immune dysfunction and sensory disturbanc- The participants were randomly assigned for occupational
es. Not all the features are present in every child. Instead, a therapy and yoga program, pre and post-test were done in
subset of features underlies autism in each individual.7,8 front of parents/caregivers. Standardized assessment tool
which includes Gross Motor Functional Measure scale
Gross Motor Functional Measure scale (GMFMs) and Modi-
(GMFMs) and Modified Berg Balance Scale (Pediatric Bal-
fied Berg Balance Scale (BBS) / Pediatric Balance Scale as
ance Scale) to assess Gross Motor function and Fall in chil-
a Standardized screening tool to assess gross motor func-
dren with Autism Spectrum Disorder and intervention was
tion and fall in children with Autism Spectrum Disorder, the
provided for 22 weeks training program with appropriate
score of less than 0-20 are indicative of a high fall risk that
occupational therapy management such as peg-board activi-
may have limited activities of daily living (ADL) skills and
ties, dexterity, puzzles, balancing, ball play and yoga pro-
demonstrates increased risk of fall.9 The ability to maintain
gram such as for children with Autism Spectrum Disorder.
balance during activities of daily living is essential function-
The entire children received the intervention of 45 min each
al independence and safety of these children with Autism
over 22 weeks, for both occupational therapy and yoga in-
Spectrum Disorder.10
tervention.
Yoga is a popular and now common form of exercise for
children with Autism Spectrum Disorder. It helps teach Criteria for selection
calming techniques, building muscle, and increasing flex- Children with Autism Spectrum Disorder for both male and
ibility, balance, and more. Occupational Therapy helps stu- female those who are prone to fall and poor gross motor
dents organizing sensory systems and increase body aware- skills were selected for this study.
ness. Occupational therapy and yoga have a natural affinity
for one another. Both disciplines promote improved physical
and functional outcomes and used together create a dynamic RESULTS
state of improved wellness. Yoga has emerged as a potential
and valuable tool to boost a child’s ability to focus, as well The statistical analysis of Gross Motor Functional Measure
as control anxiety and sensory-related ecological by Radha scale (GMFMs) mean value is 86.7777, SD 7.89905 and post-
krishna , Rosen blatt. Yoga as an effective behavioural treat- treatment mean value is 121.444, S.D 7.5881, t-test value of
ment for children diagnosed with an Autism Spectrum Dis- GMFM is -8.95182 and p-value is < .00001. The Statistical
order by triggers, Porter and Jennifer.11,12 analysis of Berg Balance Scale between pre-treatment mean
values is 24.777, S.D is 3.18948 and post-treatment mean
Literature suggests that gross motor and balance training of
value is 40.222, S.D 4.7088, t-test value of BBS is 7.68085
both yoga and occupational therapy helps to improve gross
and p-value is < .00001. Table 1 shows the Mean and SD
motor skills and to prevent falls in children with Autism
value of Pre and Post-therapy Management of the Gross Mo-
Spectrum Disorder, only a few studies have mentioned the
tor Functional Measure scale (GMFMs) for Children with
fall prevention training programme and children education
Autism Spectrum Disorder.
for Autism Spectrum Disorder.9-13 Therefore, in this study,
evaluation is done on the effectiveness of gross motor skills
and fall prevention training programme for children with Au- Table 1: Pre and Post-therapy Management of the
tism Spectrum Disorder. Gross Motor Functional Measure scale
Mean SD T Value P Value
Pre -Therapy Value 86.7777 7.89905
MATERIALS AND METHODS
Post-Therapy Value 121.444 7.5881 -8.95182 < .00001
Participants
Participants of this study were a convenience sample of chil-
Table 2 shows the Mean and SD value of the Pre and Post-
dren diagnosed with Autism Spectrum Disorder. All children
therapy Management of Berg Balance Scale (BBS) for Chil-
were between ages 4-8 [Mean] age 5.97) and attended 22-
dren with Autism Spectrum Disorder.
week Occupational Therapy and yoga program. A total of 9
patients included, 5 Male Children and 4 Female Children
diagnosed with Autism Spectrum Disorder participated in Table 2: Pre and Post-therapy Management of Berg
this study. All children attended the intervention phase of Balance Scale
the study, for both Occupational Therapy and Yoga program. Mean SD T Value P Value
This study was ethically approved by the Institutional Ethi- Pre -Therapy Value 24.777 3.18948
cal Committee (IEC) with Ref No: 000113/ 0207/2018 Dated
Post-Therapy Value 40.222 4.7088 7.68085 < .00001
4/07/2018.

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 Kalaichandran et al.: Occupational therapy and yoga for children with autism spectrum disorder for rehabilitation professional

This statistical analysis shows that there is a significant dif- REFERENCES

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APPENDIX b. Pre and Post-therapy value of the Gross

Motor Functional Measure scale (GMFMs) for
a. Name of the participants’ gender with age children with Autism Spectrum Disorder
group Sl. Name of the Pre Therapy Post Therapy
No Participant / Value Value
Sl No Name of the patient Age Gender
Initial
1 R.K 4.0 FC
1 R.K 74 107
2 S.P 5.5 FC
2 S.P 82 113
3 D.S 6.0 MC
3 D.S 80 118
4 K.T 5.8 MC
4 K.T 91 130
5 V.K 7.6 MC
5 V.K 98 128
6 K.D 5.4 FC
6 K.D 88 125
7 S.R 5.0 FC
7 S.R 93 119
8 M.N 6.5 MC
8 M.N 79 122
9 S.M 8.0 MC
9 S.M 96 131
MEAN VALUE 53.8 - 5.97

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 Kalaichandran et al.: Occupational therapy and yoga for children with autism spectrum disorder for rehabilitation professional

c. Difference Scores Calculations Difference Scores Calculations

Pre -Treatment Post - Treatment Pre -Treatment Post - Treatment
N1: 9 N2 : 9 N1: 9 N2 : 9
df1 = N - 1 = 9 - 1 = 8 df2 = N - 1 = 9 - 1 = 8 df1 = N - 1 = 9 - 1 = 8 df2 = N - 1 = 9 - 1 = 8
M1: 86.78 M2: 121.44 M1: 24.78 M2: 40.22
SS1: 561.56 SS2: 518.22 SS1: 91.56 SS2: 199.56
s21 = SS1/(N - 1) = 561.56/(9-1) = 70.19 s22 = SS2/(N - 1) = s21 = SS1/(N - 1) = 91.56/(9-1) = 11.44 s22 = SS2/(N - 1) =
518.22/(9-1) = 64.78 199.56/(9-1) = 24.94

T-value Calculation T-value Calculation

s2p = ((df1/(df1 + df2)) * s21) + ((df2/(df2 + df2)) * s22) = ((8/16)
s2p = ((df1/(df1 + df2)) * s21) + ((df2/(df2 + df2)) * s22) = ((8/16) * 11.44) + ((8/16) * 24.94) = 18.19
* 70.19) + ((8/16) * 64.78)

d. Pre and Post-therapy value of Berg Balance Patient informed consent:

Scale (BBS) for patients with stroke survivor Parent consent form, parental permission for children par-
ticipation in research were approved by the institutional ethi-
Sl No Name of the Pre Therapy Post Therapy
cal committee (IEC), Post Graduate & Research, Department
Participant / Value Value
Initial of Rehabilitation Science, Holy Cross College, (000113),
which was obtained from all the participants of this study.
1 R.K 21 42

2 S.P 30 45 Ethical committee approval and consent to

participate:
3 D.S 22 48
We would like to inform you that, our research has been ap-
4 K.T 23 41 proved by institutional ethical committee (IEC), Post Gradu-
ate & Research, Department of Rehabilitation Science, Holy
5 V.K 26 43
Cross College, (000113), which was obtained from all the
6 K.D 29 38 participants of this study and which is enclosed
7 S.R 21 32 Financial supports and sponsorship / Funding: We did
not receive any specific grant from founding agencies in the
8 M.N 24 35
commercial or public sectors.
9 S.M 27 38
Conflict of interest: There are no conflicts of interest to de-
clare.
Diff (X - M) Diff (X - M)2 Sq. Author Contribution: We (KK, PS & RS) have spent lot of
-3.78 14.27 time and lit bit of our own money.
1. Kalaichandran Kothandapani: https://orcid.org/0000-
5.22 27.27 0002-4682-7842
2. Dr. P. Swarnakumari: https://orcid.org/0000-0002-
-2.78 7.72
6683-5743
3. Dr. R. Sankar: https://orcid.org/0000-0002-1045-9507
-1.78 3.16

1.22 1.49

4.22 17.83

-3.78 14.27

-0.78 0.60

2.22 4.94

M: 24.78 SS: 91.56

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