Autism Spectrum Disorder (ASD): Physiotherapy & Motor Management

While Autism Spectrum Disorder (ASD) is primarily defined by social and communication deficits, **motor impairments** are present in 80-90% of children with ASD. These motor delays often limit participation in play and social activities. This guide covers the common motor issues (Toe Walking, Dyspraxia, Hypotonia) and evidence-based Physiotherapy interventions to improve function and regulation.

1. Common Motor Impairments in ASD

Physiotherapists often see children with ASD for the following physical comorbidities:

• Hypotonia (Low Tone): "Floppy" core, poor posture, leaning on objects, W-sitting.
• Toe Walking: Idiopathic toe walking is highly prevalent (linked to sensory processing).
• Dyspraxia (Developmental Coordination Disorder): Clumsiness, difficulty planning new motor tasks (e.g., learning to ride a bike).
• Postural Control: Difficulty with static balance and dynamic stability.

The Social-Motor Link:
Motor skills are the "currency" of childhood play. If a child cannot run, catch, or climb efficiently, they are often excluded from playground games, worsening their social isolation. PT helps bridge this gap.

2. Sensory Processing & PT

Most children with ASD have sensory regulation issues. Understanding this is crucial for a successful PT session.

Profile	Behaviors	PT Strategy
Sensory Seeking (Hyposensitive)	Crashes into things, constant running, spins, loves tight hugs.	Heavy Work: Pushing weighted carts, trampoline jumping, obstacle courses to provide proprioceptive input.
Sensory Avoiding (Hypersensitive)	Covers ears, dislikes touch, avoids messy play, fearful of movement.	Calming: Slow linear swinging, deep pressure, quiet environment, predictable routine.
Poor Registration	Seemingly "lazy," slow to respond, low arousal.	Alerting: Fast movement, bright colored balls, upbeat music to wake up the system.

3. Management of Idiopathic Toe Walking

Toe walking in ASD is often sensory-driven (seeking pressure) or due to tight heel cords.

• Stretching: Passive stretch to gastrocnemius/soleus (often difficult if child resists touch).
• Orthotics: AFOs (Ankle Foot Orthoses) or carbon fiber plates to block plantarflexion.
• Sensory Interventions: Walking on different textures (grass, sand, foam) to desensitize the feet.
• Serial Casting: Gold standard for severe contractures (casts changed weekly to stretch the tendon).

4. Clinical Strategies for ASD Sessions

Traditional "do 3 sets of 10" instructions rarely work. We must adapt communication.

A. Structure and Visual Supports

• Visual Schedules: Use pictures to show the sequence: "First Ball, Then Swing."
• Timers: "1 minute left on the treadmill" helps with transitions.
• Clear Boundaries: Define the workspace (e.g., "Stay on the blue mat").

B. Motor Learning Strategies

• Explicit Instruction: Break tasks into tiny steps (Chaining).
• Repetition: High repetition is needed to wire the motor plan (Dyspraxia).
• Video Modeling: Show a video of a peer doing the task; visual learners respond well to this.

5. Revision Notes for Students

Prevalence: ASD affects 1 in 36 children. Motor delays are a core feature, not just "clumsiness."
Dyspraxia: Deficit in motor *planning* (Ideation -> Planning -> Execution).
Safety: Many children have reduced safety awareness (elopement risk). Secure the clinic doors.
Intervention: Must be "Play-based" but structured. Use "First-Then" logic.
Toe Walking: Rule out CP/Neuropathy first. Treat with ROM + Sensory + Orthotics.

6. FAQs for Parents

Q1. Will my child grow out of toe walking?

Mild intermittent toe walking may resolve, but persistent toe walking over age 2-3 often leads to tight tendons (contractures) requiring intervention. Early PT is better than late surgery.

Q2. Why does my child fall over so much?

This is likely due to a combination of Hypotonia (weak core stability), Dyspraxia (poor coordination), and poor Proprioception (not knowing where their body is in space). PT targets all three.

Q3. How can I help at home?

Create "Heavy Work" opportunities: carrying groceries, pushing a laundry basket, playground climbing. This calms the sensory system and builds strength simultaneously.

7. 10 Practice MCQs

Q1. Which motor impairment is most commonly associated with ASD?

Answer: C) Low tone and motor planning deficits are hallmark signs.

Q2. A child who constantly crashes into walls and seeks tight hugs is likely:

Answer: A) They are under-responsive and seek intense input to register body position.

Q3. Idiopathic Toe Walking in ASD is often treated with:

Answer: B) These interventions aim to restore dorsiflexion range.

Q4. Dyspraxia refers to difficulty with:

Answer: B) The brain struggles to organize and sequence movement.

Q5. "First-Then" boards (e.g., First Work, Then Play) are an example of:

Answer: B) Visual structures reduce anxiety and improve compliance.

Q6. "Heavy Work" activities (pushing/pulling) are used to:

Answer: B) Proprioception is regulating for both seekers and avoiders.

Q7. Why is ball play (catching/throwing) often difficult for ASD children?

Answer: B) Intercepting a moving object requires complex prediction and timing.

Q8. W-sitting is discouraged because:

Answer: A) It provides a wide stable base so the child doesn't have to use their trunk muscles.

Q9. A child covers their ears when the gym buzzer goes off. They are likely:

Answer: B) Over-responsive to auditory stimuli.

Q10. The primary goal of PT in ASD is to:

Answer: C) Motor competence builds confidence and allows kids to join in play.

References

• Bhat, A. N., et al. (2011). Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders. Phys Ther.
• Tecklin, J. S. (2015). Pediatric Physical Therapy. Lippincott Williams & Wilkins.
• Case-Smith, J., & O'Brien, J. C. (2014). Occupational Therapy for Children and Adolescents. Elsevier.