Effect of Oculomotor Exercise on Writing Capabilities on Autism

Autism spectrum disorders (ASD)are neurodevelopmental disorders that are clinically characterized by a triad of features: impairments in social interaction, impairments in communication, and presence of restrictive repetitive and stereotypical behaviors, interests, or activities (DSM-IV). In addition to these core deficits, ASD is associated with a high prevalence of fine motor difficulties and executive function impairments that contribute to acquisition and performance of skilled motor tasks. It is therefore not surprising that handwriting difficulties are frequently reported in children with ASD.

Handwriting is a functional skill that profoundly affects children's academic and psychosocial development. Difficulties in acquiring and applying these skills subsequently lead to problems such as slow writing and illegible written .Such difficulties may have implications on the child's successful participation in school and play activities, potentially leading to problems in academic performance and lowered self-esteem .Therefore, students with handwriting difficulties are especially prone to frustration, disappointment, and under achievement. The aim of our study is to improve handwriting quality of children with ASD.

participants in the group will receive visual motor integration program and handwriting intervention program.

Oculomotor exercises as follow:(1) Eye follow with a stationary head 2)Saccadic eye movements 3) Gaze stability 4)Eye/head co-ordination 5)Balancing exercises

(1)Eye motor coordination (2)position in space(3)coping-figure ground(4)spatial relationship(5)visual closure(6)constancy of shapes(7)far and near coping

Oculomotor exercises as follow:(1) Eye follow with a stationary head 2)Saccadic eye movements 3) Gaze stability 4)Eye/head co-ordination 5)Balancing exercises 6)Eye motor coordination (7)position in space(8)coping-figure ground(9)spatial relationship(10)visual closure(11)constancy of shapes(12)far and near coping Hand writing intervention as follow (1)Eye motor coordination (2)position in space(3)coping-figure ground(4)spatial relationship(5)visual closure(6)constancy of shapes(7)far and near coping

Rating scale of gaze stability 0= negative Gaze stable smooth well coordinated,percise and fast movement of the head,fluent change of head movement direction modreate positive Gaze stable,slightely irregular head movement strong positive Gaze repeatedly unstable ,head movement slow and irregular

Rating scale of sequential head and eye movements 0= negative Clear,regular ,smooth, dissociated movements,of head and eyes. moderately positive slightely decelerated eye movements.occasional associated eye-head movements ,head unstable. strongly positive clearly decelerated , irregular and often associated eye -head movements test not feasible.

0= negative Smooth, percise, fast eye movements,fast change of gaze direction,head remain stable moderately positive slightely irregular eye movements.Short stops before changing gaze direction.Head slightly unstable strongly positive Eye movements clearly slower or irregular.Prolonged maintenance of gaze direction before changing direction.Obvious head movement.Test cannot be performed.

Inclusion Criteria: Mild autism (score 55-71) on Gilliam Autism Rating Scale (GARS-3). Intelligence quotient (IQ) score 70-100. Writing difficulties Exclusion Criteria: Middle ear disorders Physical or mental conditions that may affect handwriting (e.g., seizures) Uncorrected visual or hearing impairments.

Accardo AL, Finnegan EG, Kuder SJ, Bomgardner EM. Writing Interventions for Individuals with Autism Spectrum Disorder: A Research Synthesis. J Autism Dev Disord. 2020 Jun;50(6):1988-2006. doi: 10.1007/s10803-019-03955-9.