Toe Walking Assessment in Autism Spectrum Disorder Subjects: A Systematic Review.
Clinicians still need a shared, numbers-first test for toe walking in autism.
01Research in Context
What this study did
Valagussa et al. (2018) hunted for every paper that measured toe walking in kids with autism. They wanted to see if any test gave clear, number-based scores.
The team read dozens of studies. They compared how each one checked for toe walking. Some used simple checklists. Others just wrote notes.
What they found
No study offered a tidy, numbered scale. Every tool was wordy and different from the next.
Because the tests were so mixed, doctors could not tell if a child was getting better or worse over time.
How this fits with other research
Valagussa et al. (2024) later built the exact tool the review asked for. Their new video-coding protocol turns toe-walking clips into three clear groups and gives real numbers.
Wilder et al. (2022) and Hodges et al. (2018) showed toe walking can be treated, but they used simple yes-or-no counts. The review explains why those counts may not be precise enough.
Hasan et al. (2017) and Gong et al. (2020) found other gait problems in autism, yet they also lacked a single shared metric. The review’s gap applies to wider gait work, not just toe walking.
Why it matters
If you treat toe walking, you now know old measures are shaky. Borrow the new 3-group video code from Valagussa et al. (2024) to get reliable baseline numbers before you start any shoe insert or wristband plan. Clear scores let you prove your intervention works.
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02At a glance
03Original abstract
There is increasing evidence that autism spectrum disorder (ASD) subjects have also motor impairments. Toe walking (TW) is a phenomenon that can be found in ASD subjects during gait, even if this condition was found not to be necessarily related only to walking, since these children often also stand and run on their tiptoes. Since persistent TW in ASD subjects may contribute to secondary shortening of the Achilles's tendon, it becomes important to have an assessment tool and/or outcome measure for both the clinical and rehabilitative settings. The aim of this systematic review is to critically evaluate and describe the methods employed to assess toe walking in ASD subjects. The systematic review protocol was previously registered on PROSPERO. We conducted an extensive literature search in PubMed, CINAHL, PsycINFO, The Cochrane Library, and Scopus databases. There were no restrictions on the types of study design eligible for inclusion. Ten studies were included in the systematic review. Risk of bias of the included studies was conducted using the following instruments depending on the study types: STROBE Statement, Cochrane risk of bias tool, and CARE checklist. Almost all the included studies (8/10) proposed a tip-toe behavior (TTB) assessment only during walking. Nine out of ten of the included studies assessed TTB using a qualitative methodology. The results evidenced the heterogeneity of qualitative methods and a lack of a structured quantitative test to assess toe walking in ASD subjects. Autism Res 2018, 11: 1404-1415. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY ABSTRACT: Toe walking (TW) is a phenomenon that can be found during ASD subject's gait. The persistence of this behavior may contribute to secondary Achilles's tendon shortening. In this perspective it becomes important to have an assessment tool and/or outcome measure for both the clinical and rehabilitative settings. The current systematic review aimed to describe the methods employed to assess TW. The results evidenced the lack and the need of a structured quantitative test to assess TW in ASD subjects.
Autism research : official journal of the International Society for Autism Research, 2018 · doi:10.1002/aur.2009