Children with developmental disorders, such as autism spectrum disorder (ASD), often exhibit clumsiness alongside their primary symptoms, affecting their concentration and academic learning [1-3]. Interventions that evaluate and address their fine motor problems remain limited. Inclined board training on a desk has been used for feeding training in children with cerebral palsy, as an assistive tool for those with visual impairment, and for writing training in general school children [4, 5]. However, no prior study has explored the use of inclined board training on children with developmental disorders. This study investigated the effects of an inclined board on children with low muscle tone and ASD, demonstrating its ability to support the head and upper body, facilitate a more comfortable sitting posture, and positively influence drawing, a fine motor task. This report introduces a novel approach to enhance the motor and learning abilities of children with ASD.

The study focused on a 5-year-old girl with ASD, whose parents reported restlessness, poor sitting posture, and difficulty in writing since the age of 4 years. She attends a rehabilitation center twice weekly, undergoing 40 min of physical, occupational, and speech therapy during each session. Her motor development milestones included head control at 3 months, rolling over at 4 months, sitting at 7 months, crawling at 10 months, and walking at 14 months. She exhibited low muscle tone across her body, had limited crawling experience, and scored over five out of nine items on the Beighton scores for low muscle tone [6]. The Japanese Sensory Inventory Revised was used to assess her sensory stimulation reception [7], which revealed moderate deviations in muscle, vestibular, and proprioceptive senses.

A 20° 30 × 40 cm inclined board (Figure 1) was placed on the learning desk. Environmental settings were adjusted for optimal chair and desk height, back contact with the backrest, and both feet vertically touching the ground.

Figure 1: Installation of the inclined board.

The evaluation criteria included forward inclination, plantar contact in the sitting posture, and fine motor skills using the Frostig visual perception and drawing tests. The subject’s progress was deemed effective if there were improvements in sitting posture and fine motor skills, whether or not the inclined board was used. Based on a study by Sasada et al.[8], the sitting posture evaluation used a scoring system of 1 for improvement, 0 for unchanged, and -1 for worsening. The Frostig visual perception test and Task 3: Mirror Drawing from Tsuji’s Educational Psychology were used to assess the patient's fine motor skills [9]. Patterns were changed in each session, but all sessions were 600 mm in length and 3 mm in width, with 11 bends in 50 mm intervals. Measurements were taken in intervals of more than 3 days, with the drawing test instructing the subject to “draw a line as quickly as possible, without going beyond the double line.” The occupational therapist and the subject performed the task using the subject’s usual pencil on an A4-sized copy paper with a printed image without using an eraser. Ethical considerations included obtaining consent from both the subject and parents after explaining the study’s purpose.

The presented values are ordered without and with the inclined board. Forward inclination enhanced sitting posture from -1 to 1 (Figure 2). Plantar contact remained absent with no observed change. Eye-hand coordination in the Frostig test increased from 5 to 6 points. Drawing task time improved from 31.4 to 20.3 s, and the number of deviations decreased from 16 to 8.

Figure 2: Seated posture while performing descriptive tasks (Left to right) without the inclined board and with the inclined board.

Using an inclined board for children with ASD and low muscle tone showed improved sitting posture, drawing time, and accuracy. This is consistent with Miyahara et al.'s findings [10] that body instability during drawing tasks may impair neat writing. The inclined board reduced this instability, improving the patient’s fine motor skills. This highlights the cost-effective utility of inclined boards for children with ASD exhibiting drawing challenges.

This study employed a 20° inclined board for children with ASD and low muscle tone, revealing enhancements in forward inclination posture and drawing time, with reduced deviations. This suggests the potential for improving posture and drawing accuracy in children with ASD through the utilization of an inclined board.

Funding information

No funding was received for this work.

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