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Research in Developmental Disabilities 32 (2011) 18141821

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Research in Developmental Disabilities

Postural control and automaticity in dyslexic children: The relationship


between visual information and body sway
Jose A. Barela a,b,*, Josenaldo L. Dias c, Daniela Godoi d, Andre R. Viana a, Paulo B. de Freitas a
a
Graduate Program, Human Movement Science, Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Sao Paulo, SP, Brazil
b
Institute of Biosciences, Sao Paulo State University, Rio Claro, SP, Brazil
c
Paraba State University, Campina Grande, PB, Brazil
d
Faculty of Science, Sao Paulo State University, Bauru, SP, Brazil

A R T I C L E I N F O A B S T R A C T

Article history: Difculty with literacy acquisition is only one of the symptoms of developmental dyslexia.
Received 11 March 2011 Dyslexic children also show poor motor coordination and postural control. Those problems
Accepted 11 March 2011 could be associated with automaticity, i.e., difculty in performing a task without
Available online 16 April 2011 dispending a fair amount of conscious efforts. If this is the case, dyslexic children would
show difculties in using unperceived sensory cues to control body sway. Therefore, the
Keywords: aim of the study was to examine postural control performance and the coupling between
Postural control visual information and body sway in dyslexic children. Ten dyslexic children and 10 non-
Dyslexia
dyslexic children stood upright inside a moving room that remained stationary or
Children
oscillated back and forward at frequencies of 0.2 or 0.5 Hz. Body sway magnitude and the
Vision
relationship between the rooms movement and body sway were examined. The results
indicated that dyslexic children oscillated more than non-dyslexic children in both
stationary and oscillating conditions. Visual manipulation induced body sway in all
children but the coupling between visual information and body sway was weaker and more
variable in dyslexic children. Based upon these results, we can suggest that dyslexic
children use visual information to postural control with the same underlying processes as
non-dyslexic children; however, dyslexic children show poorer performance and more
variability while relating visual information and motor action even in a task that does not
require an active cognitive and conscious motor involvement, which may be a further
evidence of automaticity problem.
2011 Elsevier Ltd. All rights reserved.

1. Introduction

Developmental dyslexia is characterized by a failure to attain the expected literacy skills for a given age, despite adequate
intellectual ability and sufcient education provision (Brookes, Tinkler, Nicolson, & Fawcett, 2010; Nicolson, Fawcett, &
Dean, 2001; Rochelle & Talcott, 2006). The prevalence of dyslexia varies from 7 to 17% of the population, what makes dyslexia
one of the most prevalent developmental disorder (Rochelle & Talcott, 2006), enormously impacting the educational system.
Difculty with literacy acquisition is only one of the symptoms of this complex disorder. Many studies have shown that
dyslexic children and adults perform worse than non-dyslexic children in tasks involving postural control (Brookes et al.,
2010; Patel, Magnusson, Lush, Gomez, & Fransson, 2010; Pozzo et al., 2006; Stoodley, Fawcett, Nicolson, & Stein, 2005;

* Corresponding author at: Instituto de Ciencias da Atividade Fsica e Esportes ICAFE, Universidade Cruzeiro do Sul, Rua Galvao Bueno, 868, Sao Paulo, SP
01506-000, Brazil. Tel.: +55 11 3385 3103.
E-mail address: jose.barela@cruzeirodosul.edu.br (J.A. Barela).

0891-4222/$ see front matter 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ridd.2011.03.011
J.A. Barela et al. / Research in Developmental Disabilities 32 (2011) 18141821 1815

Vieira, Quercia, Michel, Pozzo, & Bonnetblanc, 2009) and gait as well (Moe-Nilssen, Helbostad, Talcott, & Toennessen, 2003).
Dyslexic childrens performance in those task is characterized by larger variability and inconsistency compared to non-
dyslexic peers.
Several experts have suggested that dyslexic individuals may have a mildly affected cerebellum, what could impair
literacy as well as motor skill performance (Fawcett & Nicolson, 2004; Nicolson, Daum, Schugens, Fawcett, & Schilz, 2002).
The main idea is that the mild cerebellar insult would impair the ability of dyslexic individual to learn how to perform tasks
with automaticity, with much less conscious efforts while reading, writing, and performing other tasks such as postural
control (i.e., cerebellar hypothesis) (Fawcett & Nicolson, 2004).
Postural control involves an intricate relationship between sensory information and motor activity (Barela, Jeka, & Clark,
2003), that is, individuals need to automatically identify current body dynamics, such as body position and sway velocity,
and produce appropriate muscular activation in order to maintain or achieve a desired postural orientation. This entire
process seems to be accomplished without considerable cognitive effort (Barela, Barela, Rinaldi, & Toledo, 2009; Stoffregen,
Hove, Schmit, & Bardy, 2006). It could be hypothesized that the performance of dyslexic individuals in tasks involving
postural control would be affected by their diminished ability to automatically relate sensory information and motor
activity.
One strategy to carefully examine the relationship between sensory information and motor action is to manipulate a
specic channel or source of sensory information and observe the motor consequences of it (Schoner, Dijkstra, & Jeka,
1998). To accomplish this aim, we and others have employed a moving room in order to manipulate visual information and
induce corresponding body sway in infants (Barela, Godoi, Freitas Junior, & Polastri, 2000; Bertenthal, Rose, & Bai, 1997),
children (Rinaldi, Polastri, & Barela, 2009; Schmuckler, 1997), and adults (Barela et al., 2009). More importantly, this
corresponding and coherent body sway is induced without deliberate knowledge of it (Stoffregen et al., 2006) and if such
knowledge is provided the coupling established between visual information and body sway is affected (Barela et al., 2009;
Freitas Junior & Barela, 2004). Therefore, examining the relationship between visual information, provided by a moving
room, and body sway in dyslexic children would reveal the dynamics of sensory information and the production of motor
activity at a basic level without involving any higher mental processing and, consequently, examine the automaticity
between these two systems involved in any purposeful behavior. Those concepts brought us to the aim of this study, which
was to examine the performance of the postural control and the coupling between visual information and body sway in
dyslexic children. We hypothesized that dyslexic children would sway more than non-dyslexic children and that the
coupling between visual information and body sway would be weaker in dyslexic children. If the hypotheses were
conrmed, additional evidences would support the likely veracity of the cerebellar hypothesis to explain the genesis of the
developmental dyslexia.

2. Methods

2.1. Participants

Ten dyslexic (11  0.48 year-old) and 10 control children (11  0.59 year-old) participated in this study. Dyslexic children
were characterized as mildly dyslexic and were enrolled in a special program of writing and reading in a Special Education
Institute in Brazil. The non-dyslexic children were enrolled in sport programs offered by the Sao Paulo State University. All
childrens participation in the study was conditioned to the permission given by the parents through signature of an informed
consent form, approved by the Institutional Review Board.

2.2. Procedures

Each participant was brought to the lab and, after a brief period of adaptation to the lab environment, was prepared for a
single-day experimental session. Participants were asked to maintain upright stance inside of a moving room and look at a
cartoon (8 cm  6 cm) placed on the wall in front of and 1 m far from them. The moving room, consisting of three walls and a
ceiling (2.1 m long  2.1 m wide  2.1 m tall), was mounted on wheels so that it could be moved back and forth by a
servomotor (Compumotor, Model APEX 6151). The walls and ceiling were white with black stripes, creating a pattern of
42 cm wide vertical white and 22 cm wide vertical black stripes. A 20-W lamp was placed on the ceiling to maintain the same
luminosity throughout the data collection. The moving room was continuously oscillated back and forward at frequencies of
0.2 and 0.5 Hz, with amplitudes of 0.56 and 0.21 cm, respectively. Peak velocity at each frequency was kept constant at
0.6 cm/s.
A single OPTOTRAK (Northern Digital Inc.) IRED emitter was placed on the participants back (at approximately the 8th
thoracic vertebra level) and a second was placed on the front wall of the moving room. These markers provided information
about the participants trunk sway and moving room displacement in the anteriorposterior, mediallateral, and vertical
directions, with a sampling rate of 100 Hz.
For each participant, 10 trials lasting 60 s each were collected. At the rst and the last trials the room was not oscillated.
From the 2nd to the 9th trials, the room was moved either at 0.2 Hz or 0.5 Hz. The order in which the frequency of 0.2 Hz and
0.5 Hz was applied was randomly selected. After each trial a resting period was provided to the participants and varied from
30 to 120 s.
1816 J.A. Barela et al. / Research in Developmental Disabilities 32 (2011) 18141821

Since it has been observed that prior knowledge about a rooms movement inuences coupling between visual
information and body sway (Barela et al., 2009; Freitas Junior & Barela, 2004), participants were not asked until the end of the
experiment whether or not they noticed anything unusual about the room. None of the participants, dyslexic and non-
dyslexic children, stated that they were aware that the room was moving.

2.3. Data processing

Trunk sway and moving room anteriorposterior and mediallateral time-series were ltered by a 4th order Butterworth
lter with a cutoff frequency set at 6 Hz. Two groups of dependent variables were calculated: one related to the body sway
and another related to the coupling between moving room and body sway. The rst analysis examined the participants
behavior through the variable mean sway amplitude, obtained by calculating the standard deviation of the trunk sway
signal. The mean sway amplitude was used to examine the average performance of the postural control system, indicating
body sway magnitude as children maintained the upright stance position as stable as possible. Mean sway amplitude was
calculated in the anteriorposterior and mediallateral directions in the trials in which the moving room was not oscillated,
and in the anteriorposterior direction in the trials in which the moving room was oscillated.
The second group of variables provided information about the relationship between the moving room and trunk sway.
Since the room was oscillated in the anteriorposterior direction, these analyses focused only on this direction. The coupling
between visual information and body sway was examined through ve variables: coherence, gain, phase, and position and
velocity variability.
Spectral analysis was performed for each trial by computing the individual Fourier transforms of the trunk sway and
moving room time-series. Based upon these transforms, coherence between body sway and the visual stimulus was
computed at the stimulus driving frequencies (0.2 and 0.5 Hz). Coherence measured how strongly body sway was coupled to
the visual stimulus with values close to 1 (0) indicating that the signals demonstrate strong (no) dependency between them.
A transfer function (frequency-response function) at the stimulus frequency was also computed by dividing the
transform of the trunk sway by the transform of the stimulus resulting in a complex-valued transfer function. Two
dependent variables were calculated from this transfer function: gain and phase. Gain is the absolute value of the
transfer function at the stimulus frequency (i.e., 0.2 Hz and 0.5 Hz) and it is a ratio between the amplitude of the
response (i.e., body sway) to the amplitude of the stimulus at the driving frequency. Gain of 1 means that the response
and stimulus amplitudes at the driving frequency are equal. Therefore, gain indicates the inuence magnitude of visual
information on body sway. Phase is the argument of the transfer function. It is a measure of the temporal relationship
between trunk sway and moving room movement. Positive/negative phase values indicate that body sway was behind/
ahead of the moving room. Gain and phase values taken together indicate the coupling structure between body sway
and visual information.
Position variability and velocity variability of the trunk sway was computed as the standard deviation of the trunk sway
after the deterministic response to the sensory drive is subtracted (cf., Jeka, Oie, & Kiemel, 2000). For the position and velocity
trajectories, the Fourier transform was computed, the value of the transform at the stimulus frequency was removed, and
then, the inverse transform was computed, resulting in residual position and velocity trajectories. Position and velocity
variability was computed as the standard deviation of the residual position or velocity trajectory, respectively, and indicate
body sway magnitude and velocity in frequencies other than the one of the visual information manipulation.

2.4. Statistical analysis

Three analyses of variance (ANOVAs) and two multivariate analyses of variance (MANOVAs) were employed to test the
effects of groups (dyslexic and control) and direction (anteriorposterior and mediallateral) or driving frequencies (0.2 and
0.5 Hz) on the dependent variables. The rst statistical test was a 2  2 (group  direction) ANOVA, with repeated measures
on the last factor, performed to evaluate the effects of group and direction on mean sway amplitude in the trials in which the
moving room was not oscillated. The second statistical test was a 2  2 (group  frequency) ANOVA, with repeated measures
on the last factor, conducted to evaluate the effects of group and frequency on the mean sway amplitude in AP direction in
the trials in which the moving room was oscillated.
The following procedures examined the relationship between visual information and body sway, with all the procedures
involving a 2  2 (group  frequency) factors, with the last one treated as repeated measures. An ANOVA was used to test the
effects of group and frequency on coherence; a MANOVA was performed to test the effects of group and frequency on gain
and phase; and nally, another MANOVA, was conducted to evaluate the effects of group and frequency on position and
velocity variability. Appropriate follow-up univariate analyses and post hoc tests were performed, when applicable, with the
overall signicance level set at .05. All analyses were performed using SPSS (SPSS for Windows 10.0).

3. Results

Visual information from the moving room induced body sway in both groups. Fig. 1 depicts time-series of trunk sway and
moving room displacement for a dyslexic child at 0.2 and 0.5 Hz. The overlaid time series shows that the trunk adopts the
frequency of the moving room along the trial.
[()TD$FIG] J.A. Barela et al. / Research in Developmental Disabilities 32 (2011) 18141821 1817

Fig. 1. Trunk sway and moving room displacement time-series for a dyslexic child in the anteriorposterior direction at 0.2 (a) and at 0.5 Hz (b).

3.1. Mean sway amplitude

Results of mean sway amplitude showed that dyslexic children swayed more than control participants, both when the
moving room was not oscillated, as well as when the moving room was oscillated. Fig. 2 depicts mean sway amplitude values
for both groups in the trials in which the moving room was not (Fig. 1a) and was (Fig. 1b) oscillated. In those trial that the
room was not oscillated, ANOVA revealed group effect, F(1,18) = 16.89, p < .005, but neither direction effect, F(1,18) = 0.83,
p > .05, nor group and direction interaction, F(1,18) = 1.64, p > .05, on mean sway amplitude. In those trials that the room
was oscillated, ANOVA revealed both group, F(1,18) = 7.271, p < .05, and frequency effect, F(1,18) = 14.723, p < .01, but no
group and frequency interaction, F(1,18) = 0.003, p > .05. As shown in Fig. 2b, dyslexic children swayed more than the non-
dyslexic children and both children groups swayed more when the room was oscillated at the frequency of 0.2 Hz than when
it was oscillated at 0.5 Hz.

3.2. Coherence

The coupling between body sway and visual information was weaker in dyslexic compared to non-dyslexic children and
at 0.5 Hz than at 0.2 Hz. Fig. 3 depicts average coherence values for both groups and frequencies. ANOVA revealed both
group, F(1,18) = 13.8, p < .001, and frequency effect, F(1,18) = 21.83, p < .001, but no group and frequency interaction,
F(1,18) = 1.8, p > 0.05.

[()TD$FIG]

Fig. 2. Mean sway amplitude (a) in the anteriorposterior and mediallateral directions for both groups when the moving room was not oscillated and (b) in
the anteriorposterior direction for both groups and frequencies when the moving room was oscillated.
[()TD$FIG]
1818 J.A. Barela et al. / Research in Developmental Disabilities 32 (2011) 18141821

Fig. 3. Mean coherence values for both groups in the anteriorposterior direction at the two moving room frequencies.

3.3. Gain and phase

Fig. 4 depicts the average gain and phase for both groups and frequencies. MANOVA used to test the effects of group and
frequency on gain and phase revealed effect of frequency, Wilks Lambda = 0.10, F(2,17) = 76.44, p < .001, but no effect of
group, Wilks Lambda = 0.73, F(2,17) = 3.028, p > .05, and no group by frequency interaction, Wilks Lambda = 0.82,
F(2,17) = 1.77, p > .05. Univariate analyses revealed no signicant effect of frequency on gain, F(1,18) = 3.459, p > .05 but
revealed a frequency effect on phase F(1,18) = 138.576, p < .001. Body sway was almost in phase with the moving room (i.e.,
close to zero degrees) at 0.2 Hz, and lagged behind (i.e., approximately 908) at 0.5 Hz.

[()TD$FIG]

Fig. 4. Mean gain values (top panel) and mean phase values (bottom panel) for both groups in the anteriorposterior direction at the two moving room
frequencies. Note: * indicates differences frequencies (p < .05).
[()TD$FIG] J.A. Barela et al. / Research in Developmental Disabilities 32 (2011) 18141821 1819

Fig. 5. Mean position variability values (top panel) and mean velocity variability values (bottom panel) for both groups in the anteriorposterior direction at
the two moving room frequencies.

3.4. Position and velocity variability

MANOVA conducted to evaluate the effects of group and frequency on position and velocity variability revealed
signicant effect of group, Wilks Lambda = 0.67, F(2,17) = 4.078, p < .05, but neither effect of frequency, Wilks
Lambda = 0.74, F(2,17) = 2.97, p > .05, nor group by frequency interaction, Wilks Lambda = 0.99, F(2,17) = 0.40, p > .05.
Univariate analyses revealed effect of group on both position, F(1,18) = 7.692, p < 0.05, and velocity variability,
F(1,18) = 7.415, p < 0.05. As can be seen in Fig. 5, position and velocity variability was higher in the dyslexic than in
the non-dyslexic group.

4. Discussion

The purpose of this study was to examine the performance of the postural control system and the coupling between visual
information and body sway in dyslexic children. Dyslexic children sway more than non-dyslexic children whether or not the
room was moved. Visual manipulation due to the moving room oscillation induced corresponding body sway in dyslexic
children, showing that these children are able to use information provided by the visual system similarly to non-dyslexic
children. Despite being able to use sensory information to estimate body position and sway magnitude and velocity, the
coupling between sensory information and body sway was weaker and more variable in dyslexic children compared to non-
dyslexic children. These results suggest that dyslexic childrens different performance in motor tasks might be due to
difculties in coupling sensory information and motor activity.
Dyslexic children displayed larger body sway standing upright compared to non-dyslexic children. Differences in
performance of the postural control system between dyslexic children (Brookes et al., 2010; Moe-Nilssen et al., 2003; Pozzo
et al., 2006) as well as dyslexic adults (Patel et al., 2010) and non-dyslexic peers have been observed in static upright stance.
Our results also showed that even when dyslexic children are swaying driven by a externally imposed sensory (i.e., visual)
stimulus, this larger body sway is still observed, suggesting that this difference might be related to an underlying process of
postural control in the dyslexic children and adults.
Dyslexic children showed corresponding body sway based upon the manipulation of visual information, produced by a
moving room, in both frequencies (0.2 and 0.5 Hz). As far as we know, this is the rst study using this experimental protocol
1820 J.A. Barela et al. / Research in Developmental Disabilities 32 (2011) 18141821

in dyslexic children, although a few studies have employed similar paradigm with atypical children (Polastri & Barela, 2005;
Wann, Mon-Williams, & Rushton, 1998). Corresponding body sway displayed at both frequencies of visual manipulation
suggests that dyslexic children can couple to sensory manipulation in order to produce motor action. Moreover, because gain
and phase values were similar between dyslexic and non-dyslexic children (cf., Barela et al., 2003), we can conclude that the
neural underpinning of sensory information and motor action coupling is unaffected in dyslexic children.
Despite our results showing that the underlying processes of the coupling between sensory information and body sway is
similar in dyslexic children, our results also clearly indicated that this coupling is weaker and more variable compared to
non-dyslexic children. Body sway was induced based upon the sensory manipulation; however, dyslexic children were not
able to perform body sway as accurate related to the sensory driving visual information as non-dyslexic children. Coherence
values were lower and position and velocity variability values were higher in dyslexic children compared to non-dyslexic
children.
This higher variability in using sensory information to produce purposeful actions would shed light to explain the more
variable behavior in maintaining the upright stance without visual manipulation, as observed in the present study and others
(Brookes et al., 2010; Moe-Nilssen et al., 2003; Patel et al., 2010; Pozzo et al., 2006), and even in other more complex motor
tasks such as gait (Moe-Nilssen et al., 2003). In order to maintain the upright stance, sensory information must be used to
produce specic muscle activity in order to balance all forces acting on the body (Horak & Macpherson, 1996), dyslexic
children can accomplish this goal but not as accurate as non-dyslexic peers and, as a consequence, larger and more variable
body sway is observed.
Similarly to non-dyslexic, dyslexic children produced corresponding body sway with no explicit and consciously
knowledge that was performing it. Actually, some studies have refer to the induction of body sway by a moving room as
automatic or involuntary responses (Bronstein & Buckwell, 1997; Stoffregen et al., 2006) and we have showed that
knowledge and intention still can change postural responses (Barela et al., 2009; Freitas Junior & Barela, 2004) but it
demands cognitive efforts. Therefore, the present paradigm might become a useful and important tool to uncover underlying
processes related to difculties in tasks such as reading, writing, standing, and walking among others in dyslexic individuals.
Finally, dyslexic causes might be related to become skillful in performing learned tasks, which involves perform tasks
precisely and automatically (Brookes et al., 2010; Fawcett & Nicolson, 2004; Patel et al., 2010). Moreover, based upon our
results we could provide additional evidence that if dyslexia causes are related to automatization, as recently suggested
(Brookes et al., 2010; Fawcett & Nicolson, 2004; Patel et al., 2010), dyslexic children would have difculties in acquiring
skillfulness due to difculties in automatically integrating sensory information into motor action.
The cerebellar hypothesis suggests that postural control decits are due the failure to automate postural responses
(Fawcett & Nicolson, 2004). Despite this suggestion, it was still unclear in which level such process would be affected. Our
results indicate that dyslexic children differ from non-dyslexic children in automatically coupling sensory cues to motor
activity, that is, integrating sensory information into motor responses to balance or move the body in a desired postural
orientation. The weaker and more variable perceptionaction coupling still allows dyslexic children and adults to read, write,
stand, and walk but they perform these tasks not as accurate as non-dyslexic peers. In order to improve performance in these
tasks, they need to allocate cognitive efforts but such strategy is counter-productive and different outcomes are displayed.
In summary, dyslexic children were inuenced as non-dyslexic children by manipulation of visual information
producing corresponding body sway. Despite being able to couple visual information and body sway, dyslexic children
showed more variable postural control performance compared to their non-dyslexic peers. In maintaining an upright
stance, dyslexic children swayed with larger magnitude in both with and without visual manipulation. Moreover, in the
condition in which visual information was manipulated, dyslexic children showed weaker coupling between visual
information and body sway. Based upon these results, we suggested that automatization difculties that have been
suggested to underlie the causes of dyslexia could be directly related to sensory-motor integration. These ndings provide
additional information about the neurophysiological causes and evidence of the correctness of the cerebellar hypothesis to
explain developmental dyslexia.

Acknowledgments

We are grateful to the children and their parents who gave their time and effort to participate in this study. Financial
support: Grant FAPESP/Brazil (rst author) #2009/1605; Assistantship FAPESP/Brazil (A.R. Viana) #2010/03676-7.

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