The Combined Effect of Active Video Games and tDCS on Balance and Cognitive Flexibility in Children With ASD.

Introduction: This study looked at the effects of combined transcranial direct current stimulation (tDCS) and exergaming therapy on the balance and cognitive flexibility in children with autism spectrum disorder (ASD). Methods: A quasi-experimental randomized controlled trial (RCTs) study was undertaken with 30 children aged 7-10 years, who were randomly allocated to either an experimental group (n=15) getting active tDCS (1.5 mA over the left DLPFC) + Kinect-based exergaming or a control group (n=15) receiving sham tDCS with exergaming. The 4-week intervention (3 sessions per week) was preceded and followed by extensive evaluations using the movement assessment battery for children-2 (MABC-2) and the Wisconsin card sorting test (WCST). Results: Analysis of covariance (ANCOVA) showed significant between-group differences favoring the experimental group for static balance (F=9.537, P<0.001, η Conclusion: The work fills a key gap in neurorehabilitation research by presenting empirical data for combined neuromodulation and digital-motor therapies in ASD. The findings encourage the creation of tailored protocols that target both cognitive and motor networks concurrently. Future studies should look at long-term maintenance effects and the brain processes that underpin these synergistic advantages. This integrated strategy holds promises for improving motor learning and functional results in children with neurodevelopmental problems. Highlights: The research aimed to investigate the synergistic effects of combining tDCS with exergaming on cognitive postural balance in children with ASD. A randomized controlled design was employed, involving thirty ASD participants aged 7-10 years, divided into an active tDCS + exergaming group and a sham tDCS + exergaming control group over a four-week intervention.Children receiving active tDCS alongside exergaming demonstrated a significant improvement in cognitive flexibility compared with the sham group, as measured by standardized executive-function tasks.The active stimulation group showed greater postural stability and enhanced dynamic balance after the intervention, indicating that neural modulation may facilitate better motor control and integration.The concurrent application of tDCS and exergaming likely created a neuroplastic synergy, enhancing cortical excitability and adaptive brain reorganization related to both motor and cognitive domains.The dual-modal intervention appears to be a promising non-pharmacological approach for neurorehabilitation in children with ASD, integrating cognitive training and sensorimotor engagement to target underlying executive and motor deficits. Plain Language Summary: This study explored whether combining transcranial direct current stimulation (tDCS), a gentle electrical stimulation applied to the brain, with active video gaming (exergaming) could improve motor balance and cognitive flexibility in children diagnosed with autism spectrum disorder (ASD). Thirty children aged seven to ten participated and were divided into two groups. One group received real brain stimulation (active tDCS) along with exergaming, while the other group received sham stimulation but played the same games. The intervention lasted four weeks, with three sessions per week. Before and after the treatment, the researchers assessed the children's balance and cognitive skills. Results showed that those who received the combined treatment demonstrated significantly greater improvement in cognitive flexibility, meaning they could shift their thinking more easily, make more accurate decisions, and repeat fewer errors. The findings suggest that this combined approach of brain stimulation and interactive physical gaming may be an effective way to enhance both mental and motor abilities in children with ASD, offering new possibilities for integrated brain-body rehabilitation.