Title : Neuro-exergaming for non-verbal autism spectrum: A case study of neuropsychological function after 15 sessions of pedal-n-play iPACES
Abstract:
Youth on the autism spectrum (ASD) display varying degrees of deficits in cognitive, motor, and social functioning, areas often targeted with various therapy modalities, most efficiently provided as early interventions. Exercise has long been examined as a potential therapy modality for a variety of neurological conditions, with some reports revealing effects for ASD (Cai et al, 2025; Jia et al., 2024). Exergaming, or the combination of interactive video games with physical activity, has also been found helpful (Fang et al., 2018), and has implications for being an effective and feasible therapy option that may help sustain attention using non-social reinforcement. Our lab has previously evaluated off-the-shelf exergames, such as Dance Dance Revolution (DDR), for high-functioning, verbal youth with ASD and found benefits to executive function and repetitive behaviors (Anderson-Hanley et al., 2011); however, little is known about the utility of such interventions for non-verbal or illiterate youth with ASD. The interactive Physical and Cognitive Exercise System (iPACES) was developed in our lab as a “neuro-exergame” to address neurological conditions and target specific cognitive domains, with a priori designed mental challenges, and to address short-comings of off-the-shelf exergame which did not provide methods for controlling features or measuring precise outcomes. Pilot work with iPACES has been promising among youth with ASD (Haller et al., 2017; Ferguson et al., 2022; Pachla et al, 2023). The current case study of a non-verbal youth with ASD, adapted iPACES, creating an image-only version of the exergame iPACES, for a 10-week, 15 session intervention, to assess possible improvements in neuropsychological function. Neuropsychological function was measured using a shortened pediatric neuropsychological battery (e.g., Digit Span, Colored Trails, TABCAT set-shifting), and included additional measures of behaviorally observed sustained attention and exergame performance. Data was analyzed using SPSS. Valid data was obtained for only one of the three neuropsychological assessments due to the youth’s challenges, and no significant change was found in that traditional pre-/post-neuropsychological test performance (Digit Span). However, a significant correlation was found between duration of sustained attention and number of coins collected while neuro-exergaming [ r (n=14 sessions) = 0.65, p < 0.05]. It may be that traditional neuropsychological assessment was insufficient to detect significant change in a single individual. Yet, it is encouraging that a non-verbal youth with ASD was able to participate in longer-term exercise and indicates feasibility of adapting a neuro-exergame such as iPACES, for this population. Furthermore, the nature of intervention, with engaging coin-capture, seems to have benefited attention and thus compliance with exercise. These results suggest additional research with a larger sample, might be warranted to further examine ways to adapt exercise for non-verbal youth with ASD, in particular, the role of facilitating sustained attention such as during neuro-exergaming, and the impact on effectiveness of such interventions, which hints at the importance of using rewarding stimuli in interventions tailored to the ASD population.
