NEUROFUNCTIONAL BASIS AND INTERVENTION PERSPECTIVES FOR TOE WALKING IN CHILDREN WITH AUTISM SPECTRUM DISORDER: AN INTEGRATIVE REVIEW

Abstract

Autism Spectrum Disorder (ASD) is frequently associated with motor impairments, including difficulties in balance, coordination, and gait, particularly toe walking. This study aimed to systematize the evidence on the neurofunctional bases of gait alterations in children with ASD and discuss their implications for physiotherapeutic assessment and intervention. An integrative review was conducted in the SciELO, PubMed, and LILACS databases, including studies published between January 2015 and July 2026. The search resulted in the inclusion of 11 studies, analyzed according to the SPIDER framework. The findings indicated that gait alterations in ASD are multifactorial, involving neurological, sensory, musculoskeletal, behavioral, and psychomotor factors. Toe walking was associated with sensory alterations, balance difficulties, postural control impairments, and changes in gait kinematics. The identified interventions included auditory feedback, serial casting, orthoses, dance therapy, and motor learning strategies, with positive outcomes, although the evidence was primarily based on studies with small samples. It is concluded that physiotherapeutic assessment and intervention should consider the heterogeneity of ASD and adopt a biopsychosocial perspective, prioritizing functionality, autonomy, and children's participation across different social contexts.