Las personas con autismo tienen dificultades en la función motora gruesa (la que implica grandes movimientos de brazos, piernas, torso o pies) y en la coordinación motora, el funcionamiento coordinado de diferentes músculos, articulaciones y huesos.
En niños con autismo se han observado alteraciones en los hitos del desarrollo motor (a qué edad gatea, a qué edad da los primeros pasos), hipotonía (bajo tono muscular), rigidez muscular, acinesia (falta o pérdida del movimiento), bradicinesia (lentitud de los movimientos voluntarios asociada a una disminución de los movimientos automáticos, como el braceo al caminar), alteraciones en el control de la postura y marcha anómala.
Con respecto a las habilidades motoras gruesas, los niños con autismo suelen estar, de media, medio año por detrás de sus compañeros. Aunque esta fase del desarrollo motor no depende del contexto social, hay que recordar que normalmente se domina a base de observar a otros e imitar lo que están haciendo. También pueden tener que ver con una menor capacidad de atención, menores habilidades para el juego, o un exceso de sensibilidad táctil y otras aversiones.
En relación a la hipotonía, un niño con ese bajo tono muscular suele estar como «blandito», siempre apoyándose en algo y a menudo siendo incapaz de mantenerse erguido durante un tiempo prolongado.
Cosas como sentarse o recoger un objeto del suelo dan la impresión de que le cuestan más que a otros niños y pueden producirse problemas de equilibrio, torpeza, caídas frecuentes, dificultades para estar con sus compañeros, se cansa fácilmente o cualquier tarea sencilla parece que le requiere más esfuerzo que a los demás.
La rigidez muscular genera la sensación de que el niño está tenso, al tocarle se nota esa rigidez característica pero es más rara en los niños con autismo que la hipotonía.
Lo más estudiado son las anomalías en el paso o andadura. Por ejemplo, los niños con autismo tienden a reducir la longitud del paso, aumentar la anchura del paso incrementando de esa manera la base de apoyo y aumentar el tiempo en la fase de apoyo, el tiempo en el que el pie está apoyado en el suelo. Todo ello aumenta su estabilidad.
Muchos niños con autismo tienen tendencia a andar de puntillas, algo que puede disminuir su equilibrio, con lo que aumentan las caídas, y también disminuye su resistencia, con lo que aumenta su cansancio y participan menos en actividades sociales.
Estos síntomas motores pueden afectar a la habilidad del niño para llevar a cabo actividades de la vida cotidiana como jugar, hacer deporte, caminar.
A su vez, un modo raro de andadura puede generar dolor, fatiga, callos, debilidad en algunos músculos, estrés de las articulaciones, lo que a su vez puede afectar a las capacidades funcionales del muchacho. Por eso es importante conocer la función neuromuscular y biomecánica de los niños con autismo.
Algunos niños con autismo presentan también dificultades en la planificación motora. Este proceso es lo que permite entender un movimiento, imaginar cómo hacerlo, coordinar a los distintos músculos que deben intervenir y ejecutar esa actividad. Algunos movimientos, como atravesar un espacio lleno de gente de un lado a otro como un recreo, pueden ser complejos y algunos niños pueden tener dificultades planificando ese movimiento o llevándolo a cabo, lo que puede provocar que choquen con otros niños o con objetos.
Estudios desde Kanner en 1943
Aunque la peculiar forma de andar de los niños con autismo ha sido observada desde el estudio pionero de Kanner en 1943 -que describía a estos niños como torpes- es un tema apenas estudiado, con poco más de una docena de artículos. Lo más interesante es un artículo publicado en 1981 y otro en 2011 que estudiaron la forma de andar de muchachos con autismo frente a controles y una revisión de 2015 que resume los estudios previos.
El grupo de Vilensky estudió 21 niños con autismo, 15 controles y 5 niños con hiperactividad y agresividad.
El grupo de Calhoun de la Universidad de New Brunswick en Canadá estudiaron doce niños con autismo y 22 niños controles de las mismas edades. En los dos artículos es un número de casos bastante escaso.
El grupo de Vilensky estudió la marcha y encontró en los niños con autismo fases de apoyo más largas (cuando el pie está en contacto con el suelo), pasos más cortos, un aumento en la flexión de la cadera cuando los dedos del pie se separan del suelo, una disminución de la extensión de la rodilla y un patrón alterado de los contactos de los pies.
Curiosamente, estos autores sugerían que la forma de andar de los niños con autismo recordaba a los adultos con párkinson, lo que podría indicar una afectación en los primeros de los ganglios basales. También se ha comentado la posible implicación del cerebelo, algo de lo que hay más evidencias neuropatológicas.
El estudio de Calhoun y colaboradores encuentra diferencias significativas en la cadencia del paso y la cinética de cadera y tobillo, lo que se refleja en una reducción de los movimientos flexores de la planta y un aumento del ángulo de dorsoflexión. La razón puede ser una hipotonía muscular, que fue confirmada en un tercio de los niños con autismo. No vieron en cambio diferencias para la longitud de los pasos ni en la velocidad de la marcha. No estudiaron otros aspectos que podrían ser de interés como haber hecho electromiografías para medir la actividad de músculos concretos.
Ayudas con fisioterapia
Los fisioterapeutas están formados para ayudar a los niños en todas estas temáticas relacionadas con el movimiento. Si el problema es un retraso en las habilidades motoras gruesas, pueden enseñar ejercicios que se pueden practicar en casa para enseñarles modelos de movimientos y mejorar el equilibrio y la coordinación a través de un juego funcional.
Si el problema es la marcha, pueden enseñar al niño como estirar músculos acortados o fortalecer los más débiles al mismo tiempo que trabajan en la biomecánica del paso. Mientras que el tono es algo inherente al sistema neuromuscular, los músculos se pueden fortalecer para compensar esas diferencias y del mismo modo la planificación motora se puede mejorar trabajando en ejercicios concretos, estableciendo objetivos y trabajando con el niño y los padres.
El análisis de la marcha de los niños con autismo puede ser útil para establecer tratamientos y tener un seguimiento de sus habilidades motoras gruesas.
Finalmente, es posible que estos problemas sutiles detectados en los niños con autismo, que en la mayoría de los muchachos pasan desapercibidos, puedan llegar a afectar notablemente a su forma de caminar y, consecuentemente, a su movilidad, participación en las actividades educativas, laborales y de ocio y, en resumen, a su calidad de vida.
Articulo publicado de autismodiario.org, visita su web.
Para leer más:
- Calhoun M, Longworth M, Chester VL (2011) Gait patterns in children with autism. Clin Biomech (Bristol, Avon) 26(2): 200-206.
- Kindregan D, Gallagher L, Gormley J (2015) Gait deviations in children with autism spectrum disorders: a review. Autism Res Treat. 2015:741480.
- Vilensky JA, Damasio AR, Maurer RG (1981) Gait disturbances in patients with autistic behavior: a preliminary study. Arch Neurol 38(10): 646–649.
- www.boomeranghealth.com/blog/neurodevelopmental-physiotherapy/how-can-physiotherapy-help-my-child-with-autism/
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