How do we think about movement? Are the differences between healthy movement patterns and deficits easy to spot? How much do individual movement skills vary? Families of children with autism spectrum disorder are often confronted with technical terms and diagnoses related to physical abilities; “low tone”,“motor planning delays”,and “trunk stability deficits”. Physical therapy can provide an intervention that can bridge the gaps when the appropriate programming is applied.
What is physical therapy?
Physical therapy (PT), as any field, is a broad practice that branches into numerous areas of specialty. Physical therapy, along with occupational therapy, is often part of the three common therapeutic interventions for young children with ASD along with speech and behavior therapies. The primary goal for physical therapy with respect to the young autism population is developing gross motor skills that will improve performance in activities of daily living.
Want to know a secret? Not all practices are created equal. When discussing physical therapy, it is important to consider that it is a large field and there will be differences in approaches, practitioners, and outcomes. As opposed to fitness trainers, physical therapists must be board licensed and complete a residency.
From a general perspective, physical therapy focuses on enhancing motor patterns and skills that relate to gait, play, chores, and situational daily movement. Depending on the practice, the therapists, and the environment, physical therapy may also incorporate specific interventions or training for balance, coordination, and motor planning. For example, some facilities will be equipped with balance beams, sensory tools, and bicycles/tricycles with augmented stability devices.
In school-based environments, a physical therapist will work within a student’s IEP (individualized education program). A physical therapist may work on skills that promote enhanced or improved functioning in the educational environment. Postural control while standing or sitting, navigating stairs, and carrying objects may be part of the program for a student who presents with low tone, gait abnormalities (such as shuffling feet), and motor planning delays.
Supporting children on the spectrum with motor planning
Motor planning is often discussed with the ASD population. Motor planning refers to the sequencing of movement when performing a task. Think about throwing something in the garbage, brushing your teeth, or finding an object that rolled under the bed. All of these actions require a different set of movements performed in a specific order. Individuals with autism may have difficulty performing these tasks independently due to both inhibition of physical performance and processing delays.
How long should it take us to get down on the floor and begin searching for the object under the bed? Consider the process if we break it down step-by-step;
1) Get into quadruped (hands and knees on floor) position
2) Crawl forward or sideways towards edge of bed
3) Lower head and shoulders in sight range of floor
4) Reach with one arm while stabilizing with knees, trunk, and opposite hand
Efficient motor planning may not enable us to find the object under the bed (did we leave it in the closet?), but we can use these physical abilities to initiate and carry out the search. For many children with autism spectrum disorder, there may be some obstacles in the way of starting the movement sequence and completing the task. The inhibited abilities of motor planning may present as less stability when getting into or maintaining the quadruped position and the amount of time it takes for the individual to complete the task.
A physical therapist may specialize in early intervention for children with ASD under three years of age. This is a critical developmental stage in which we typically observe the development of crawling, standing, and walking. When significant delays are present in these milestones, a PT may provide services in the child’s natural environment, providing ongoing support for general gross motor strengthening and motor planning.
Motor planning deficits have both a physical and neurological basis. In addition to the underlying deficits in strength and stability, the cognitive processes involved in performing sequential tasks are inhibited for many children with autism. As a result, individuals with autism need more practice with strengthening, stabilizing, and motor sequencing activities. For physical therapists, along with any other therapeutic intervention, the goal is to develop skills that will generalize or carry over into daily activities.
The strength and motor planning deficits that are common in childhood for individuals with autism do not “automatically” disappear as the individual ages. Even with increased body mass and bone density in late childhood and early adolescence, the underlying physical pathologies can still present well into adulthood.
In my private one-to-one fitness practice, I often begin working with individuals when they are in their late teens, twenties, and older. Some had early therapeutic interventions for physical and occupational therapy. Many did not. Strength and gross motor programming must be an ongoing presence for the ASD (or any) population.
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Quality and variations of treatment
While physical therapy treatment approaches may vary, we want to focus on efficacy by way of outcomes. Individuals with ASD, depending on various skill levels, may acquire physical abilities faster or slower. Some individuals may need many repetitions of an exercise or movement before independent mastery occurs. Behavioral or self-regulatory skills must also be considered. How on-task and focused is the individual? Are they actively engaged in the activity or more of a passive participant? How often are they receiving treatment/programming?
Physical therapy for children with ASD can, as discussed, be provided in a variety of settings. Some physical therapists may provide families with home programs to both provide the child with more frequent movement practice and generalize skills to new people and environments. These “home assignment” skills can range from riding a bike to throwing a ball to working on stair climbing.
Harnessing the child’s motivation
As many parents will know, motivation to participate is often a barrier for children with ASD. Aversion to new or specific stimuli, rigid adherence to preferred activities, and hyper-sensitivity to schedules and routine can cause difficulty in providing an effective movement intervention. Physical therapists must also discover ways to develop and maintain motivation for their clients.
For younger children, it may be access to a particular toy, book, game, or some seemingly random object. A physical therapist may use the reinforcer as part of a contingency to motivate the individual sufficiently for engagement and completion of the activity. Used consistently, these contingencies can gradually shape the child’s focus and performance of an exercise or movement skill and enhance not only their physical ability but the motivation to continue.
Finding the right physical therapy professional
Credentials are only the beginning, albeit a very important beginning. From here, parents can ask about general and specific aspects of programming, goals, practices, and the physical therapist’s experience working with the autism and special needs populations.
Remember to also ask about program philosophy. What are their fundamental practices and what guides these? What is the thought process behind programming and movement selection? How are short-term goals assessed and measured? Is the practitioner able to articulate their process for assessing and addressing skills? How do they address behavioral challenges and low motivation? How are expectations set?
Granted a litany of questions may seem overbearing, but the answers will provide a window into how a professional operates and their ability to convey information. We’re also not dealing with magic. In most cases, real, meaningful results will take at least a few sessions and a rapport needs to be established between the physical therapist(s) and the child.