Therapy that engages multiple senses in a playful context may help improve hand coordination in children with Rett syndrome, a preliminary study suggests, but more research is needed.
The study, “Sensory Integration and Functional Reaching in Children With Rett Syndrome/Rett-Related Disorders,” was published in the journal Clinical Medicine Insights: Pediatrics.
Difficulty with hand movements — in particular, difficulty going from an intention to a physical movement — is characteristic of Rett syndrome, and there is a need for therapeutic interventions to help manage these symptoms.
In the new study, researchers tested one such intervention called Ayres Sensory Integration (ASI). This involves having a child play with balls, swings, scooter boards, and other equipment, ideally providing the child with a “just-right” balance between playing and doing physical therapy.
In their paper, the researchers said: “In theory, these activities improve the nervous system’s ability to process, organize, and integrate sensory information [and] improve functioning.” ASI has shown promising results in studies of children with sensory processing problems and autism, but it has never been evaluated in children with Rett syndrome.
The study included five children (ages 3–10) with Rett syndrome who were followed for two months prior to ASI, then got ASI (three one-hour sessions per week) for three months, then were followed for an additional two months.
To measure hand movements, which can be difficult in children with Rett syndrome, the researchers recorded the children in their classrooms, counting the number of times that they reached for or grabbed a non-food item.
“In our experience, children with [Rett] demonstrate vastly different behaviors when reaching for classroom materials versus food-related items,” the researchers noted, “Therefore, we deliberately excluded food-related activities from our structured observations.”
Immediately following the start of ASI, the children’s average number of grasps per day increased significantly, from 15.8 to 18.1. In the first two months of ASI, grasps per day gradually decreased to a low of 15.5; then increased, reaching 18.2 at the end of the study.
The researchers think that the initial increase was because of ASI, and the subsequent decrease can probably be explained by fatigue. They suggested that future studies might want to alter the “dose” of ASI, saying: “For children with [Rett syndrome], the set dosage of three 1-hour ASI treatments per week may have been too ambitious.”
Reaching behaviors followed a similar trend, albeit with less pronounced changes; ultimately, the average number of reaches per day before ASI and at the end of the study were not significantly different (23.3 and 22.9, respectively). The researchers acknowledged that it can be difficult to distinguish deliberate reaching behavior from more random movements; as such, this measurement may be less reliable than the measurement of grasps.
This was a very small study, and more research is needed, but the results do support the notion that ASI may be beneficial for children with Rett syndrome.
“This study provides preliminary data suggesting that ASI may have small positive effects on the rate of grasping in children with RTT and warrants further study before recommending it in routine practice,” the researchers stated.