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Physical Therapy for Autistic Children

When it comes to treatments and therapies for autism, physical difficulties often go overlooked. While most autistic children do not need physical therapy, the Autism Society states that about 30% have a moderate to severe loss of muscle tone, and would greatly benefit from treatment. Many children with autism need help with gross motor skills, posture, lack of coordination, and balance. In addition, children with Rett’s Syndrome, or those with additional disabilities such as Cerebral Palsy or Spina bifida need extensive physical therapy services.

What is Physical Therapy?

Physical therapists work with individuals to build, or rebuild, mobility, strength, and motor skills. While most clients are recovering from an injury or stroke, some therapists also work with patients who struggle with everyday activities. These problems include:


Physical Skills: Riding a Bicycle

  • developmental delay
  • muscle weakness, stiffness, or flexibility
  • poor balance, coordination, and posture
  • difficulty moving and doing things
  • physical pain
  • respiratory control
  • motor output difficulties due to sensory issues
  • range of joint motion

Physical therapists observe and assess a patient’s physical deficits, and design a personalized therapy program to improve mobility, sensory integrity, and personal independence. They also offer strategies to help patients cope with their symptoms.

Therapists work across a wide variety of settings, including health care, occupational, and educational services like hospitals and clinics, rehabilitation centers, schools, and community organizations. They help individuals improve their daily living skills in both home and school environments, and work with athletic programs. From activities and games that help gait, build strength, and improve body mechanics to teaching parents techniques they can use at home, a physical therapist works on impairments in any body system that impacts movement.

How Physical Therapy Helps Children with Autism

Both sensory impairment and physical inadequacies can affect a child’s ability to learn, perform day-to-day living skills, and social interactions. Many children with autism can benefit from intensive programs designed to improve their developmental delay, muscle tone, and gross motor skills. These pediatric physical therapy services will enable autistic children to perform better in practical, real life applications like:

  • walking, running, climbing stairs, or riding a bicycle
  • sports programs and other physical activities
  • learning life skills and self care (Related: Teaching Life Skills to Autistic Children)
  • participate in physically demanding school activities
  • improve respiratory issues

Motor planning difficulties make it hard for autistic children to execute physical movement, enact proper sequencing, and even timing. What appears to be clumsiness, inattentiveness, and aversion to play can actually be a physical impairment. While a child may hear what a parent or teacher wants him to do, and understand, sensory integration may interfere with his ability to carry it out.

Both occupational and physical therapies help improve movement dysfunction caused by sensory issues. However, occupational therapy focuses on better integration through improving fine motor skills, like school activities. Pediatric physical therapy improves sensory dysfunction by working on gross motor skills, coordination, strength, and ease of movement.

Related: Occupational Therapy for Autism

Hand-Over-Hand and Hand-Over-Leg Techniques

Gross motor skills involve the large muscles of the body: arms, legs, and trunk. When moved repetitively, eventually the brain learns to perceive, organize, and properly interpret incoming sensory data. It can then command appropriate movement. Physical therapy trains the brain through hand-over-hand and hand-over-leg techniques.

When trying to teach an autistic child to dress himself, proprioceptive sensory issues might prevent him from putting his leg into his pants. Even if the child understands how to dress himself, his brain might not allow movement. He is not disobeying. He physically cannot do it. To help him, parents can put their hand on top of the child’s leg (hand-over-leg) and push his leg into his pants. Likewise, if the child’s arm doesn’t move properly, parents can put their hand on the child’s arm (hand-over-hand) and guide it into the armhole of his shirt.

While the technique is simple, it takes many hours of repetition before the brain understands. Just dressing the child once in the morning is not enough. To train the brain, parents need to use hand-over-hand and hand-over-leg techniques repeatedly, like an exercise.

Additional Physical Therapy Exercises and Activities

Pediatric physical therapists often travel to schools to work with children on the playground. They help them improve muscular and joint movement, coordination, strength, and social skills within a real life context. Parents can incorporate similar activities at home. The more active children are, the better developed their large muscles will become.

Typical child activities: Any activity or exercise that gets children walking, jumping, running, skipping, swinging, or sliding will help large-muscle development. While typical play activities differ from country to country, parents can use what was popular when they were young. Games like “follow the leader,” tag, running races, climbing up on things, jumping rope, and chasing after bubbles are good ways to keep a child active.

Improving balance: Bending over and picking things up, weeding the garden, or doing an art project on the floor will challenge a child’s balance. In addition, parents can place tape, rope, or a chalk-line on the ground and then encourage the child to walk on the line without falling. Also, walking on different types of surfaces like crushed rocks, bubble paper, or sand will help improve balance.

Music and Dancing: Parents can encourage the child to dance to his favorite songs. He does not need legitimate dance steps or a set routine. Enough, if he is wiggling. Homemade musical instruments add to the fun. An empty oatmeal box can become a drum. A toilet paper roll turns into a noise shaker by filling it with dried beans or rice, and then wrapping it with paper and taping.

Roughhouse: Parents can get down on the floor with the child and roll him, spin him, let him crawl away or jump on their back – anything the child has an interest in doing. For some kids, that may even include pillow fights.

Throwing balls and other objects: Anything the child throws will increase arm movement and strength: rocks, a homemade beanbag tossed into a laundry basket or box, a balloon filled with water, or even newspaper crumbled into a ball. If standing balance is weak, parents can sit on the floor and toss a ball back and forth between parent and child. If the child has good balance, an object can be hanged from the ceiling to encourage the child to jump up and touch it.

Setting up an obstacle course:  Autistic children can crawl over or under a wooden bench, step over a tower of blocks, carry water from one place to another in a gallon jug or bucket, jump on a mini trampoline or an old mattress, walk on a homemade balance beam, or roll and tumble on a set of pillows. A hula-hoop, an old tire, or an inflatable inner tube can be placed on the floor and the child encouraged to jump inside the circle, and back out. While playing outside is always best, an obstacle course also makes a great inside rainy-day activity.

Although sensory issues require helping techniques, it is wise to give autistic children time to figure out how to move their body. Weak muscles, lack of endurance, and stiff joints will make movement difficult, and such children have a tendency not to move. Parents should always encourage activity, but not too much. It is repetition, rather than perfection, that will help an autistic brain to learn.

  • References
    • 1. Curtis, Kathleen A. Physical Therapy Professional Foundations: Keys to Success in School and Career. Thorofare, NJ: Slack, 2002. Print.
    • 2. Hart, Charles. A Parent’s Guide to Autism. New York, NY: Pocket, 1993. Print.
    • 3. Tilton, Adelle Jameson. The Everything Parents Guide to Children with Autism: Know What to Expect, Find the Help You Need, and Get through the Day. Avon, MA: Adams Media, 2004. Print.
    • 4. “Autism Society – Related Conditions.” Autism Society – Homepage. Web. 10 Sept. 2011..

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