Comparison of rhythmic auditory and visual cueing on neuromuscular coordination in autistic children: an exploratory study

Objective Children with Autism Spectrum Disorder (ASD) exhibit motor control deficits linked to atypical sensorimotor synchronization, impacting daily function. While rhythmic sensory cueing is a promising intervention, prior studies often rely on behavioral measures, failing to elucidate the underlying neuromuscular efficiency. This study aimed to explore the comparative effects of auditory cueing (AC) or visual cueing (VC) to determine which is more effective for enhancing neuromuscular coordination.Methods Recruitment and physiological testing in children with ASD present significant challenges in sensory sensitivities and task tolerance; therefore, a within-subjects, counterbalanced crossover design was used to maximize statistical power and control for inter-individual heterogeneity. Nine children ultimately completed the full protocol. Participants performed a rhythmic handgrip task at 15% of maximal voluntary contraction under AC and VC. Surface electromyography was recorded from the flexor digitorum superficialis (FDS) and extensor carpi radialis (ECR) muscles. Intermuscular coherence in the 8–12, 15–35, and 35–60 Hz bands, as well as muscle activation and fatigue metrics of root mean square (RMS), median frequency (MDF), and mean frequency (MNF) were calculated.Results The primary finding indicates a significant effect between cueing modalities on intermuscular coherence in the 15–35 Hz (β) band. Maximal coherence was significantly higher during AC compared to VC (Z = −2.192, p = .028). In contrast, no significant differences were found for RMS, MDF, nor MNF for FDS (p = .960, 0.175, 0.257, respectively) or ECR (p = .139, 0.359, 0.242, respectively).Conclusion The dissociation between improved neural coordination and unchanged physiological cost preliminarily suggests that AC may enhance motor command quality. Clinically, AC appears to be a promising strategy for interventions targeting motor stability in ASD, though the observed individual variability necessitates a personalized approach.