A Systematic Review Of Development On Motion-Based Games On Upper Extremities Function For Self-Care Ability Among
Children With Autism Spectrum Disorder
Li Ziming1,2, Saiful Hasley1*, Muhammad Hibatullah Romli1, Raja Ahmad Azmeer1, Puteri Suhaiza Sulaiman1, Xia Yingqiao1, Qingqing Chu1, Beli Wang1
1 Universiti Putra Malaysia, Malaysia
2Hubei Polytechnic Institute, Huangshi, Hubei, China
* Corresponding Author: [email protected] Accepted: 15 April 2023 | Published: 30 April 2023
DOI:https://doi.org/10.55057/ijares.2023.5.1.21
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Abstract: In reaction to the pressing issue surrounding the self-care capacities of children with autism spectrum disorder, this paper reviews the existing empirical studies proving the usefulness of motion-based games therapy for children with autism spectrum disorder. This study is a systematic review of published studies. The databases Academic Search Complete, MEDLINE Complete，CINAHL, Scopus, and Eric were searched, revealing studies that were eligible for review. A total of 20 cross-sectional studies, all of which had relatively small samples, were included in the final analysis. Five included studies were from China, and six were from the USA. Most of the 20 studies employed experimental methodologies to investigate intervention moderation in a specific direction for children with autism. Fourteen employed qualitative research to examine the intervention and had fewer than or equal to 20 participants.
The number of subjects in four studies topped 100, mostly in the form of quantitative research.
The other four papers used a mixed-methods approach. This review demonstrates that interventions (interactive games such as somatosensory games, particularly for hand function training) can significantly enhance autistic children's self-care abilities. However, it is vital to do in-depth research on these therapy tools, given the basic state and growth of children with ASD.
Keywords: motion-based games;upper extremities;self-care ability;autism spectrum disorder ___________________________________________________________________________
1. Introduction
ASD is a neurological developmental disorder characterized by moderate to significant impairments in social interactions, communication, cognitive development, and repetitive and restricted behaviors (American Psychiatric Association [APA], 2013). In addition, with the increase in the number of autistic children in recent years, the lack of autistic children's ability to take care of themselves in their daily lives is causing more and more autistic parents to be deeply worried.(Boutain et al., 2020)(Chi & Lin, 2021)(Jamison & Schuttler, n.d.).Further autistic spectrum disorder (ASD) affects a person's social, cognitive, and behavioral functioning in various ways.(Wolfenden et al., 2019)(Livingston et al., 2019)(Miller et al., 2021)(Gadow, n.d.)(Ben-Sasson et al., 2009).A better knowledge of daily life skills (DLS) characteristics in ASD adolescents could lead to the creation of supports and interventions that help them reach their full potential as adults.(A. W. Duncan & Bishop, 2015)(Rattaz et al.,
2017)(A. Duncan et al., 2021).In other words, their self-care ability for their independent living must be improved as a preparation for the absence of their parents in their future life(Yu et al., 2018b)(Caro et al., 2014)(Chi & Lin, 2021).Moreover, Goal oriented upper extremity motions are an essential element of how we effectively navigate the world daily, from the basic act of gripping a door handle to the complicated bi-manual coordination of tying shoelaces(Travers et al., n.d.).Motion-based games, especially somatosensory games training, are widely used in rehabilitating physical training exercises(Ma & Yang, 2021)(Engineering, 2020)(Mesa-Gresa et al., 2018)(de Moraes et al., 2020).Therefor,a comprehensive systematic review approach was employed in the study to exhaust all relevant current studies, explore all interpretations and views in the field, and identify existing research gaps.
Autism spectrum disorder is a specific combination of symptoms in social communication, repetitive behaviors, and very restricted interests and sensory behaviors that begin early in life(Lord et al., 2020).Children with autism spectrum disorder have impaired behavioral, cognitive, and adaptive development.(Estes et al., 2015)(Wood et al., 2009).The problems of autism spectrum disorder in the upper extremity are generally a combination of fine movements, such as handwriting, grasping, hand-eye coordination, and even coordination of upper limbs. A therapist must evaluate these problems and plan a treatment program based on that evaluation.Self-Care ability is what people do for themselves to establish and maintain health and prevent illness(World Health Organization,1998). For autism, it is a broad concept encompassing hygiene (e.g., teeth brushing, face washing, and showering), meals (e.g., cooking, meal preparation, eating), clothing (e.g., dressing, laundering, mending), domestic (e.g., cleaning, arrangement articles for daily uses). What is more, almost half of young children with ASD are unable to care for themselves（World Health Organization,2019).
Moreover,Wii and Kinect are completely controlled by the game system's sensors (e.g., gyroscope, infrared camera, body scanner), which have been used to support physical therapy plans because they can guide patients to perform a set of controlled movements. Moreover, they are suitable for their health status and conducive to rehabilitation.(Pasquale et al., 2013).To increase their fitness level, children with autism must move their bodies and control their limbs(Ma & Yang, 2021).
The statement of research problem: Self-care behaviors in children with autism have become one of the biggest concerns of parents with autism. In addition, training focused on self-care, and daily living has been repeatedly intervened. These abilities depend mainly on the function of the upper limbs. In the current literature, there are more experimental investigations on autism treatment. However, many of them focus mainly on one aspect, such as physical activity, swimming, and horseback riding, and focus on outcomes such as cognition and socialization, while specifically related studies, especially on handwriting, fine motor, and upper limb activities and self-care abilities, have received increasing attention from autism researchers; therefore, this paper uses a systematic review approach to analyze the main academic perspectives and use the Crowe Critical Appraisal Tool (CCAT) to analyze the results.
2. Data and methods
2.1 Retrieval strategy 2.1.1Goal of research
The goal of this research is to help children with autism improve their self-care abilities. As a result, we use autism and self-care ability as the basic search terms in the literature retrieval.
Then we screen out the possibility of enhancing self-care ability from the search results.
Finally, we utilize the systematic review approach to explore further the potential of hypotheses to complete the composition of the entire paper after discovering that many works are related to motion-based games and putting forward specific hypotheses.
2.1.2 source of the data
Eight researchers used the computer to search the relevant data sites through the UPM library database(Academic Search Complete, MEDLINE Complete，CINAHL ,Scoups and Eric).
2.1.3 Search strategy
For the study, the PICO of the title has been listed to analyze the research to ensure the accuracy of direction through generating searching keywords and making the Inclusion and exclusion criteria. P: children with autism spectrum disorder. I: motion-based games focusing on upper extremities. C: Therapy without using motion-based games. O: self-care ability. Consequently, academic journals should be used as sources. The following search terms were used: (autism OR autistic OR ASD OR Asperger OR “autism spectrum disorder”) and (somatosensory OR motion OR exergam* OR “gesture” OR movement) and (game OR gaming) and ("hand writing" OR "fine motor" OR "dexterity" OR "hand motor" OR "hand motion" OR “hand function” OR "self-care" OR "self care" OR "activities of daily living" OR "daily living activities" OR ADL OR “upper extremities” ) . The last search date was 18th January 2023, and we used four databases: Academic Search Complete, MEDLINE Complete, CINAHL Plus with Full Text, and Scopus. Given the enormous expansion of autism rehabilitation research in the previous decade, this study determined that looking for publications from the recent decade would make the findings more applicable, so the date should be within the last ten years (2013- 2022), and the language imposed no limitation
2.2 Inclusion and exclusion criteria Inclusion criteria
All included articles were based on the research topic, and to ensure this, firstly, all articles had to be based on research on autism, and secondly, they had to be directly or indirectly related to our primary keywords, such as "upper extremities" and "game or behavior" as well as "self- care," and the articles included must be from official academic institutions or academic research journals.
Exclusion criteria
The exclusion criteria are based on standard criteria found in review studies, such as no full text available after the research team has exhausted all other options for retrieving the full text, such as downloading from the library, contacting the author, and being unable to purchase the article, as well as searching online databases (Research Gate, Academia). Non-English items, for starters, had a minor impact on the outcomes. Furthermore, the study team's comprehension of languages other than English is restricted. Second, papers in grey literature format (e.g., theses, books, conferences, abstracts, reports) have not been subjected to a rigorous peer- review process; other forms of reviews (e.g., scoping review, umbrella review, literature review) do not follow the systematic review approach;
2.3 Literature screening and data extraction 2.3.1 Literature screening
Five researchers read the literature and extracted data independently before cross-checking the results; any disagreements will be discussed and resolved or sent to a third party for resolution.
While screening literature, read the title and abstract first. Then, after deleting the obvious
extraneous material, reread the full text to see if it is finally included. Preferred Reporting Items for systematic review and Prisma will be used to document the screening process. PRISMA flowchart is shown in Figure 1. According to the predefined inclusion and exclusion criteria, the screening process will be documented in a Microsoft Excel document.
2.3.2 Search Results
A comprehensive search for all articles published between 2013 and 2022 yielded a total of 1914 articles. The initial agreement rate for pre-selection was percent (18/25), and the selected articles were resolved through discussion among three authors. Finally, 22 articles were chosen for data extraction (Figure 1). The Appendix contained a list of excluded articles and their reasons for exclusion. The process of screening results is shown in the following table:
Figure 1: Screening flowchart
3. Data Extraction
Data extraction will occur, be Instructed, and extracted into a table of individual study characteristic reports. The same two authors evaluated the quality of the articles using the guidelines outlined in the article. A total of 22 items were rated for each included study based on the content of various parts of the article reporting the study, including the author, year, objective, participants, data collection, research design, invention, finding, and themes. Each item will be listed in great detail for further examination.
Author Country Objective Participant Research design invention Findings and themes 1 SuCai,et.al
(2017)
china to examine the effects of gesture-based games on the learning of children with ASD.
Three children with ASD meet the criteria 3
CS，EX
（observation）
(TD)
Two gesture- based games
1.The effectiveness of using gesture-based games in assisting the learning of children with ASD.
2.Participant can transfer the rules and skills from the first game to complete the tasks in the second game.
2 Chuang &
Kuo (2017)
china To develop a motion- sensing digital game- based SID therapy to help such children be more engaged in physical training,
Five subjects with SID from 8 to 11 and their parents 5
EX nterview Clinical observation (sensory profile)
Motion- Sensing Game conventional SIT MSDG- SIT
The proposed MSDG-SIT has better effects in improving the bodily-kinesthetic learning of CwSID compared to traditional SIT, especially for the balance, hopping/jumping in a series of circles, and jumping jacks items.
3 Duncan et.al (2021)
USA To test the Daily Living Skills Intervention for adolescents with Autism
34 participants 14–21
Vineland-3 SU experiment
STRW intervention
The STRW intervention demonstrates efficacy and shows promise as a treatment that can lead to successful acquisition and mastery of DLS in adolescents with ASD.
4 Clare et.al (2018)
china To promote physical fitness and mental health of ASD
Children aged 4 to 6
intervention group (56)
and control group(56)
EX SPSS 24.0 ANOVA
game-based exercise training
The training program by front-line healthcare providers can facilitate the program
to be used sustainably in the community
5 Massimiliano Conson (2015)
Italy To test the impact of bodily (senso-rimotor) information on simulation skills of adolescents with (ASD).
36 right-handed adolescents（10- 20）
18 samples with ASD and 18 TD.
EX ANOVA SPSS 15.0 experimental tasks
simulation 1.posture manipulation influence biomechanical effect in ASD .
2. strong impact of body information on motor simulation in ASD .
6 ZHAO et.al.
(2021)
USA To develop collaborative Haptic-gripper virtual skill training system on the teaching strategies reflecting real-world tasks involve more than one skill domain.
10 children with ASD and 10 with TD(8-12)
EX
usability study
Collaborative haptic- gripper fine motor skill training system
1.The performance improved in both individual and collaborative fine motor skill training tasks.
2.ASD were more collaborative manipulations and initiate more conversations with partners in collaborative tasks.
3.Fine motor skill practice have positive impacts on communication and collaboration between partners with ASD in team-based activities.
Author Country Objective Participant Research design invention Findings 7 Hu & Han.
(2019)
china To investigate effect of gesture-based via Leap Motion-aided VR technology to teach matching skills to students with ASD
Three male 1th- grade students aged 6–7 years old
EX
multiple probe design
Effects of gesture- based match- to-sample instruction
1.gesture-based match-to-sample instruction was effective and participants had more task
engagement when taught with the VR technology.
2.Research involving more advanced instruction content with academic and vocational skills.
8 Miltenberger
&Charlop
（2013）
USA To assess the effects of interventions designed to teach children with autism to play two athletic group Games.
three children with autism(age 6,9,9)
EX
usability study
Athletic Group Play
1. The achievement of fundamental motor skills and rules training boosted the appropriate group play of children with autism during handball sessions with high-function children and neurotypical peers.
9 Brittany G.
Travers (2016)
USA To examined longitudinal grip strength and finger tapping development in ASD compared to TD ages 5 to 40 years old.
110 ASD and 78 TDC
EX
semi-parametric penalized smoothing splines
manual motor ability
1. Individuals with ASD may experience increasingly more pronounced manual motor performance difficulties as they transition from adolescence into adulthood.
2. manual motor performance in ASD could be a limiting factor for developing independent living skills in adulthood.
10 Yesim Fazlioglu (2013)
Turkey To compare play skills of 6-year-old ASD and TD
150 children with autism and their parent
SU SPSS
Comparison between ASD and TD
The play skills of autistic and mentally retarded children are more deficient than the play skills of normally developed children.
11 Dănuț
& Maria (2021)
Romania TO verify positive effects of the proposed motion games on psychomotor skills of students with ASD
5 cases (4 boys and a
girl, aged 10-11)
EX—user test mathematical analysis (No-contol group)
motion games
1.The use of structures and games contributes to a significant improvement of the psychomotor and intellectual performances of students with ASD.
12 Gormley .et.al.
（2020）
Ireland to evaluate the impact on children’s life skill acquisition rates.
Four children (three boys, one girl)
EX
visual analysis (no control group)
Training behavioural therapists in presession pairing skills
1.PSP protocol can augment life skill acquisition rates for
young children with ASD,
2.PSP protocol within a teaching procedure that employs backward chaining and least-to-most prompting strategies.
Author Country Objective Participant Research design invention Findings and themes 13 Couper
et.al.(2014) New
Zealand To Compare acquisition of and preference for manual signs, picture exchange, and speech- generating devices in nine children with ASD.
Nine children with ASD
who exhibited very limited or no expressive language
EX A discrete-
trial AAC systems.
1.children with ASD would learn to use iPad - based SGD to request access to toys.
2.Children choosing one of AAC options more frequently than other options during AAC preference assessments.
3.Children would learn to use preferred option more quickly than the less preferred option.
14 Nuntanee
&Daranee (2019)
Thailand To improve the balance Control of Children with ASD
Twenty participants diagnosed with ASD,
aged 8 to 19 years
EX——User
testing Motorized Elephant- Assisted Therapy
the motorized elephant-assisted therapy program could be an alternative treatment method to facilitate better balance control in individuals with ASD.
15 Jull &
Mirenda, (2015)
Canada To improve community Instructors’ ability on Swimming Skills to Children With Autism
six community- based swimming instructors and eight children with ASD.
EX——inter- observer agreement User testing
a Staff Training Program
1.The training can have a positive impact on instructors .
2.The intervention package can accommodate the variable registration requirements and lesson structures that may be present in community recreation centers.
16 Gencheva.et.al
(2021) Bulgaria evaluate the impact of therapeutic riding on motor skills with ASD。
5 ASD --1 girl and 4 boys,(age4.9- 7.2）
EX
User testing Therapeutic on motor skills
1.therapeutic riding can improve motor planning, motor performance, and arranging motor tasks.
17 Alsaedi (2020)
Australia To assess the Motor Performance Skills in the Gulf Region
235 children 180(ASD) and 55(TD)
EX-
observational BOT-2
1. children with ASD were classified as displaying a motor performance deficit that fell within the below-average range.
18 Kang
& Chang
（2017）
China employ the Kinect sensor to gamify shower training.
4 male and 2 female elementary school children with ASD
EX game
technology 1.assess effectiveness of proposed system with regard to elementary-age children with ASD acquiring the skills required to successfully take a shower independently.
19 Duncan
（2014）
USA To understand the gap between
cognitive abilities and daily living
417 adolescents with ASD（4 - 18 ）years
SPSSFSIQ and the DLS standard
1.aspects of cognitive behavioral therapy such as encouraging skill acquisition and self-sufficiency may lead to improvements
20 Parlak et.al.
(2021)
Turkey To explain the effects of sports training on social and academic skills in autistic individuals.
10 individuals with autism (6-16)
EX 12-week
physical activity program
1.Slow progress in the transition from activity to activity in more than one person with the effect of sporting activities.
2.Individuals with ASD improved the ability of rhythmic counting
EX=experiment CS=case study SU=Survey Table-2 :Characteristic reporting of individual studies.
4. Quality Evaluation
Five researchers independently assessed the quality of the included literature. The guideline methodology quality evaluation employs the guideline research and evaluation tool (CCAT), evaluates 22 items and overall quality in six areas of the scope and purpose of the guideline, participants, precision, clarity, applicability, and independence of the guideline, and determines whether to recommend the guideline.
4.1 Analytical Method
For the Crowe Critical Appraisal Tool(CCTA), the evaluation system is developed from the following items: preliminaries, introduction, research design, sampling, data collection, ethics, results, and discussion. Each item counts for one point to five points, so the total quality score ranges from 0 to 40. The inter-rater reliability of the total quality score for the included studies of the two authors was high.
Table: 3 The procession of CCTA
According to the above table, there are 10 papers with CCAT scores greater than 80%, representing the thesis statement's comprehensiveness and the basic quality of the papers on the other. These papers are also discussed in the results and discussions that follow.
4.2 Summary Of Main Recommendations
Because the concepts of upper extremity movements and related concepts such as self-care abilities are still so broad, no single paper can tell a complete story about all the relationships between all upper extremity movements and every self-care ability of children with autism, and most of them argue from one side or make partial arguments. Most of these papers drew their conclusions from specific motor intervention programs for children with autism, with 11 papers being more comprehensive in their discussion, experiments, interventions, and
Author
Preliminaries (0-5) Introduction (0-5) Design (0-5) Sampling (0-5) Data Collection (0-5) Ethical Matters (0-5) Results (0-5) Discussion (0-5) Total score n(%)
1 SuCai,et.al(2017) 4 5 4 4 3 2 4 3 29(73%)
2 Chuang & Kuo(2017) 5 4 4 3 4 0 4 4 28(70%)
3 Duncan et.al(2021) 5 4 4 5 4 2 4 3 31(78%)
4 Clare et.al(2018) 5 5 3 5 3 4 4 4 33(83%)
5 Conson(2015) 3 3 3 4 3 1 5 5 27(68%)
6 Zhao et.al.(2021) 5 4 5 4 4 3 5 5 35(88%)
7 Hu & Han.(2019) 4 5 5 4 4 3 4 4 33(83%)
8 Miltenberger&Charlop（2013） 4 5 4 4 4 1 4 4 30(75%)
9 Travers(2016) 5 5 4 4 4 1 4 5 33(83%)
10 YesimFazlioglu(2013) 5 4 4 2 4 4 4 4 31(78%)
11 Dănuț& Maria(2021) 5 4 4 4 4 2 4 5 32(80%)
12 Gormley.et.al.（2020） 3 4 4 3 3 3 4 5 29(79%)
13 Couper et.al.(2014) 4 4 4 4 5 2 4 5 32(80%)
14 Nuntanee&Daranee (2019) 4 3 4 3 4 2 4 4 28(70%)
15 Jull & Mirenda,(2015) 4 4 4 3 4 1 4 5 29(73%)
16 Gencheva.et.al (2021) 4 3 3 3 4 2 3 4 29(73%)
17 Alsaedi (2020) 4 4 4 3 3 3 3 4 28(70%)
18 Kang&Chang（2017） 5 5 4 4 4 1 4 4 33(83%)
19 Duncan&Bishop（2014） 4 4 4 3 4 2 4 3 28(70%)
20 Parlak .et.al.(2021) 3 3 4 3 4 2 4 4 27(68%)
inferences. Four of the eleven papers focused on virtual game interventions, five on project- based task tests, and two on sports interventions. The evaluation of self-care skills was the subject of two papers.
5. Result
From the previously screened articles, we can see that most papers explored the different roles of the motor-based game on the self-care ability of ASD. The useful mainstream findings mainly focus on the paper(13-20). We can see that many of the explorations and tests revolve around upper limb abilities (e.g., mostly fine hand movements, and a handful also gross movements of the upper limbs), and the evaluation criteria (e.g., CAST, AQ-Child, CPEP-3, ABAS-II, CRSASSC) has been used in some of the screening papers, and has highlighted consistency across the papers(19-20). Four papers(15,16,17,18) use tasks as the traditional way to intervene and draw inferences. For example,(Yu et al., 2018a) demonstrate that combining the ABAS-II assessment with a game-based exercise training program that includes a hand grip strength test and overhand throwing can improve motor skills and physical fitness while reducing stereotypical and maladaptive behaviors.
Two papers focused on sports as an upper limb intervention for children with autism, such as the "virtual game," and we can conclude that four papers focused on sports as an upper limb intervention for children with autism. In addition, two papers explored an individual ability, including one that presented a point of view and one that presented a point of view. Combining these four different types of articles and the conclusions derived from them, this paper is based on the purpose of the study.
6. Discussion
The above categorical summary and discussion, combined with the research objectives of this systematic literature review, necessitates a comprehensive discussion of the findings.
Therefore, this systematic review aims to confirm the recent research on the improvement method of self-care ability through the motion-based game on upper limbs. In general, we have the following finds:
Before the statement of findings, some points need to be clear presentation: It has been strongly confirmed that Children with ASD's poor performance in gross motor composites (reflexes, stationary, locomotion, and object manipulation) and fine motor composites (grasping and visual-motor integration) was indicated by(Jasmin et al., 2014).Furthermore, the associated relationship between self-care and motor skills in children with autism was revealed by (Travers et al., 2018).
More specifically, motor skills are prioritized in developing individuals at times in their lives when motor ability affects everyday living skills and independence. However, motor issues may affect functional limitations throughout life for many children with developmental disabilities. Moreover,(Travers et al., 2018)show that manual motor development is uncommon at this age. A variety of adapted daily life skills are based on manual motor abilities (i.e., dressing, handwriting, preparing food, etc.), More crucially, grip strength and finger tapping would be linked to existing adapted daily living skills and could predict future adaptive daily living abilities.
Then the findings of this systematic review should be presented as following three-point:
The First finding comes from the traditional way of task of motion of upper extremities:Based on the previous literature identifying multiple motor impairments in individuals with ASD,(A.
Duncan et al., 2022) demonstrate that an exercise training program for preschool children with ASD leads to increased motor skills and physical fitness, as well as fewer stereotyped and maladaptive behaviors.Furthermore, by using and rationally adapting a varied complex of structures and motion games, (MOCANU & GAVRILA UDREA, 2021) significantly improved the psychomotor elements that can be obtained at the level of ASD at the age of 10- 11. (Alsaedi, 2020)Investigate whether using and logically changing a diverse complex of structures and motion games can result in beneficial gains in the psychomotor characteristics of children with ASD.
Furthermore, combining the four papers' main contents, the conclusion can be drawn that (Jasmin et al., 2014) and (Travers et al., 2018)indicated that children with ASD revealed poor performance in upper extremities function (grasping and visual-motor integration), which affect the quality of daily life skills(handwriting, eating, dressing), and grip strength and finger tapping need to be trained to improve the motor function of upper extremities.
The second finding comes from the way virtual motion-based games of training :By checking children’s performances in items of the fine motor skills assessments,(Cai et al., 2018) , Some skills, such as staring at items, looking at one's own hands, and moving eyesight with objects, are boosted by gesture-based games, which aid improve their performance in terms of fine motor skills, recognition, and learning assistance. The same situation was also demonstrated by (Zhao et al., 2021).Furthermore, using a collaborative Haptic-Gripper fine motor skill training system can provide grip control and hand movement training in both individual and collaborative modes. What is more, Individual fine motor task performance is improved by collaborative fine motor tasks that require participants to plan, coordinate and communicate about their motor manipulations. Additionally, socially embedded movement-based situations are beneficial for developing imitation praxis, interpersonal synchrony, and motor performance.
Similarly, the paper(Chuang&Kuo,2016) provides another system of MSDG-SIT (Motion- Sensing Digital Game-based Sensory Integration Therapy ) and proves it has better effects in improving the bodily-kinesthetic learning of CwSID (children with sensory integration dysfunction )compared to traditional SIT(sensory integration therapy ), especially for the balance, hopping/jumping in a series of circles, and jumping jacks items, it also has the positive effect on the improvement of not only on motion skills (e.g.postural-ocular movement, bilateral integration, sequencing, movement coordination)but also on regulation(e.g .rules, gregarious performance, frustration tolerance, emotional control, confidence, adaptive behavior)
Although the intervention utilized auditory reinforcing statement and visual prompt, other prompt strategies such as words and sound could also be added to expand the feasibility and application of gesture-based instruction via Leap Motion-aided VR technology, which provides a promising option to special education teachers and general education teachers in working with children with ASD(Hu & Han, 2019).
To summarize all the above viewpoints, Combining(Cai et al., 2018),(Zhao et al., 2021), (Chuang&Kuo,2016), and(Hu & Han, 2019), the conclusion can be made that by checking children’s performances of fine motor skills assessments or using a collaborative Haptic- Gripper fine motor skill training and MSDG-SIT, Some skills(e.g.hand-eye alignment and coordination,postural-ocular movement, grip control, collaborative behavior, movement coordination) are boosted by virtual motion-based games.
The third finding focus on the assessment of effect on intervention of motion based game on self-care ability among children with ASD.
There are many scales on assessment of autism,such as CAST,AQ-Child,CPEP-3,ABAS- II,CRSASSC, they have different focuses and some of them are intertwined, but based on a systematic review of the literature, more focused and validated scales will allow for more focused future research.
Firstly,(Alsaedi, 2020) indicate that the use of the SFBOT-2 can be justified based on the results of our unpublished pilot study, which highlighted the difficulty and time commitment associated with administering the full version of the test.Simultaneously,for the assessment of self-care ability or DLS behavior, STRW is a manualized intervention that includes behavioral approaches and supports (e.g. task analysis, reinforcement, chaining), video modeling, technology, visual supports, direct instruction, and modeling. (Will et al., 2019); (Wong et al., 2015). It consists of 15 weekly 90-minute sessions focusing on self-care and hygiene, laundry, cooking, kitchen safety, food shopping, and money management for both teenagers with ASD and their parents.It is a guide to our future research and the validity of the study.
7. Conclusion
This systematic review is exhaustive of all searchable literature, and it is evident that both traditional motor play interventions and virtual play interventions have been shown to promote upper limb movements, cooperative behaviors, and social participation, all of which play a key role in the improvement of autonomy in children with autism. Therefore, these intervention behaviors can be further evaluated by STRW to help children with autism grow better.
Motor skills are prioritized in the lives of typically developing individuals regarding daily living skills and independence. Children with autism perform poorly in gross motor combinations (reflexes, stillness, movement, and object manipulation) and fine motor combinations (grasping and visual motor integration); however, there is a correlation between autistic children's self-care and motor skills, various adaptive daily living skills (i.e., dressing, writing, food preparation, and so on) Motion-based games are based on manual motor skills, grip strength, and finger tapping. They teach autistic children how to use their senses in tandem and include sensory stimulation activities. It has evolved into an essential and all-encompassing treatment for autism spectrum disorders. For example, the gesture-based game can improve some skills, such as staring at items, looking at one's own hands, and moving eyesight with objects for children with ASD, because it aids in improving their performance in terms of fine motor skills, recognition, and learning assistance, by checking children with ASD's performances in items of the fine motor skills assessments.Moreover, by utilizing a collaborative Haptic-Gripper fine motor skill training system, grip control and hand movement training can be provided in individual and collaborative modes. In addition, CwSID bodily- kinesthetic learning improves motion skills (e.g., postural-ocular movement, bilateral integration, sequencing, movement coordination), particularly balance. Self-care abilities like hygiene, laundry, cooking, kitchen safety, food shopping, and money management can be intervened, including behavioral approaches and supports (e.g., task analysis, reinforcement, chaining), video modeling, technology, visual supports, direct instruction, and modeling. More research is required that focuses primarily on the video gaming experience of children with ASD in specific behavior of self-care ability and hand function, such as fine motor training through virtual games on daily living skills and independence.
8. Limitation
The limitations of this paper lie mainly in the fact that the definition of play includes sports games, virtual games, fine motor games, and so on. All these upper limb activities have been shown to have some effect on the autistic child's self-care skills, but they have not been systematized and deepened. In addition, these games are still limited to basic motor training, and a more specific game design theory for autistic children needs to be explored.
9. Significance
The high documented prevalence of self-care ability impairments in children with ASD has drawn attention to what could be a major problem in the development of ASD. A number of studies have compared children with ASD to control participants to assist develop a theoretical model that could reveal potential mechanisms for the motion-based game to enhance the improvement of daily life skills of children with ASD. This research, to the best of our knowledge, is the first systematic review of these studies.
Conflict of interest
There are no conflicts of interest reported by the authors in relation to this manuscript.
Funding
The study was funded by the Hubei Institute of Technology (21xjr01Y) and Research on the Design of Somatic Games Based on Autistic Children's Self-care Ability, Provincial Education Department Project, Hubei Province, China, and with supervision from Universiti Putra Malaysia academics.
Acknowledgements
We appreciate everyone who took part in this study. My supervisors, Dr Saiful Hasley, Dr Muhammad Hibatullah Romli, Dr Raja Ahmad Azmeer, and Dr Puteri Suhaiza Sulaiman, deserve special recognition for their enthusiasm and effort in making research possible.
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