Short report on research trends during the COVID-19 pandemic and use of telehealth interventions and remote brain research in children with autism spectrum disorder

Abstract

Following the outbreak of the COVID-19 pandemic, the delivery of face-to-face (F2F) therapeutic interventions and neuroimaging assessments for children with autism spectrum disorder has been disrupted. To resume interventions and assessments, many services are now using telehealth-based online platforms. Using the Zoom conferencing platform, our research group has been providing creative play-based interventions to school-age children with autism spectrum disorder. The feedback on this telehealth intervention experience has been generally positive (mean satisfaction score: 4.4 on a 5-point Likert-type scoring range) and our preliminary data from six children with autism spectrum disorder suggest training-related improvements in gross motor, balance, and imitation skills. Despite the positive results, it remains to be explored if the effects of telehealth interventions are similar to those of F2F interventions. Neuroimaging techniques could provide objective measures of intervention effects. However, this will require researchers to resume neuroimaging research while adopting safe public health protocols to control the risk of COVID-19 transmission. In this short report, we summarize existing safety protocols for F2F neuroimaging research, our own experiences of safely conducting alternative, on-site and off-site neuroimaging data collection, as well as the potential opportunities of using online data sharing and low-cost, remote neuroimaging/electrophysiological techniques to continue brain research during the pandemic. Lay abstract The COVID-19 pandemic has caused disruption in F2F healthcare delivery and neuroimaging research, especially when involving vulnerable populations such as children with autism spectrum disorder. Given the easy access to multiple video conferencing platforms, many healthcare services have moved to an online delivery format (i.e. telehealth). It is important to monitor the behavioral and neural effects of telehealth interventions and resume neuroimaging research while adopting public health safety protocols to control the risk of COVID-19 transmission. We summarize existing safety protocols and our own experience from in-person functional near-infrared spectroscopy neuroimaging data collection (on-site, at home, and in outdoor settings), as well as potential opportunities of using online data sharing and low-cost, remote neuroimaging/electrophysiological techniques to continue brain research during the pandemic.

Analysis of the SPARK study COVID‐19 parent survey: Early impact of the pandemic on access to services, child/parent mental health, and benefits of online services

“…et al, 2020 ; Tenforde et al, 2020 ; Tomlinson et al, 2018 ; Tohidast et al, 2020 ). This author has modified an ongoing movement intervention clinical trial involving face‐to‐face interventions to a hybrid format wherein families are able to choose between in‐person vs. online/telehealth visits to complete testing and interventions as outlined in recent publications (Su et al, 2021 ; Bhat et al, 2021 ; Srinivasan et al, 2021 ). Allowing families to choose their preferred mode of clinical trial delivery has made it feasible to conduct the study in spite of hesitancy among families to participate in nonessential clinical interactions such as participating in a research study during the pandemic.…”

“…Together, these challenges may have further affected children's and parent's emotional and mental health outcomes (Bellomo et al, 2020 ; Chen et al, 2020 ; Kalb et al, 2021 ; Nonweiler et al, 2020 ; Spinelli et al, 2020 ). As clinicians, educators, and researchers started rethinking therapeutic service, learning, and research delivery models including protocols in this author's lab (Bhat et al, 2021 ; Srinivasan, Su, et al, 2021 ; Su et al, 2021 ) many have chosen a hybrid delivery model – a combination of face to face interactions with precautions or a remote/virtual mode of care/education/research delivery. However, remote/virtual models of care do not work for all subgroups of children and more systematic studies will be needed to examine the perceived benefits of adding the option of virtual services.…”

Neural Effects of Physical Activity and Movement Interventions in Individuals With Developmental Disabilities–A Systematic Review

“…In certain tasks involving synchronous reaching and body sway, fNIRS activation was associated with ASD severity and communication performance ( 69 , 71 ). Moreover, in an ongoing RCT study, we are investigating the neural effects of creative movement and physical activity/exercise-based movement interventions compared to sedentary, standard of care interventions using fNIRS to track the intervention-related differences during executive functioning and interpersonal synchrony tasks in children with ASD ( 147 ). In short, there are alternative, child-friendly approaches robust against motion artifacts that should be considered to study intervention-based changes in neurobiomarkers in individuals with wide-ranging severity in developmental disabilities.…”

“…Lastly, after the onset of the COVID-19 pandemic, there has been a rise in use of telehealth as an alternative intervention delivery method. It will be important to understand the differences in behavioral and neural effects of physical activity/movement interventions delivered through virtual vs. traditional, face-to-face approaches (144)(145)(146)(147). Further research is needed to understand how different types and delivery methods of physical activity/movement interventions might lead to differential neural effects on social communication and cognitive performance.…”

Effects of Creative Movement Therapies on Social Communication, Behavioral-Affective, Sensorimotor, Cognitive, and Functional Participation Skills of Individuals With Autism Spectrum Disorder: A Systematic Review

“…From a theoretical perspective, CMT approaches are grounded in the ecological Dynamical Systems Theory (DST) ( 91 , 92 ) and the Shared Affective Motion Experience (SAME) theory ( 93 ). The DST emphasizes that basic perception-action cycles of bodily movement form the basis for higher-order social communication and cognitive skills ( 82 ). Similarly, the SAME theory suggests that music- and movement-based experiences are multimodal in nature and activate similar “mirror” networks in the brain of participants, thereby forming the basis for social, emotional, and motoric connectedness between them ( 83 ).…”