Physiotherapy Exercise Prescription

Assessment Priorities (Before Starting)

• Sensory profile (hyper/hyposensitive to touch, vestibular, proprioceptive input)
• Fine vs gross motor coordination gaps
• Attention span (typically 5-10 min in ADHD + ASD)
• Triggers for meltdowns (noise, crowding, touch)
• Whether the child works better 1:1 or in small groups

Phase 1: Sensory-Motor Foundation (Weeks 1-4)

1. Proprioceptive Input Exercises

2. Vestibular Input (Balance and Spatial Orientation)

• Rocking on therapy ball (prone and sitting): 5 min, to improve postural control and self-regulation
• Trampoline bouncing: 5-10 min, one of the most researched vestibular tools for ASD - also increases attention duration
• Balance board standing: 2 min, progressing to single-leg stance
• Spinning on a rotating disk (controlled): 30-60 sec, only if the child tolerates vestibular stimulation (some do not - monitor closely)

3. Tactile Desensitization (if hypersensitive)

• Theraputty manipulation: squeezing, rolling, hiding objects inside
• Textured surface walking (barefoot on foam, grass, sand): 5 min
• Brushing protocol (Wilbarger): can be implemented if OT/PT trained in the technique

Phase 2: Motor Coordination and Attention Training (Weeks 5-8)

4. Rhythmic Movement / Timing Exercises

• Metronome-guided clapping/stepping (Interactive Metronome approach): 15 min/session
• Jumping jacks in rhythm: 3 x 10 reps with verbal count
• Bilateral coordination drills: patting alternating knees while walking, cross-body arm swings
• Hopscotch patterns: directional hopping, sequence memory (good for attention + motor planning)

5. Ball Skills

• Two-handed catching (start at 1 m, progress to 2-3 m)
• Dribbling a basketball in place, then moving
• Kicking a stationary ball for targets
• Balloon toss (slower pace, reduces frustration): 5 min
• Bean bag throwing at targets: works fine motor + eye-hand coordination + attention

6. Obstacle Course

• Crawl under a table, step over cones, jump off a low step, walk along a line
• Start 3-4 stations, increase to 6-8 as attention improves
• Use visual schedule cards at each station (reduces anxiety in ASD)

Phase 3: Social Participation Exercises (Weeks 9-12)

7. Partner/Group Activities (1:1 first, then small group of 2-3)

• Mirror movement exercise: face a partner and copy their slow movements - promotes social referencing and eye contact
• Partner balance challenge: holding hands on balance board together
• Target rolling / passing games: rolling a ball back and forth across a set distance
• Cooperative obstacle course: two children must complete together with defined roles

8. Aquatic Therapy (if available)

• Pool walking/wading: 20-30 min
• Bubble blowing in water (breath control + calming)
• Hydrotherapy float and balance activities
• Kicking drills with kickboard (rhythmic input + proprioception)

9. Martial Arts / Combat Sports Elements

• Basic kicking sequences (front kick, side kick): 3 x 5 reps each side
• Punching pad drills: rhythmic, bilateral
• Block and strike patterns: improves sequencing, body scheme, and coordination
• Must be done in a calm, structured, low-stimulation environment

Phase 4: Aerobic Conditioning (Ongoing)

• Cycling / stationary bike: 20 min at moderate intensity (preferred - predictable, solo, calming)
• Swimming laps or structured swim drills: 20-30 min
• Jogging on a track with a visual endpoint: start 400 m, build weekly
• Jump rope: rhythmic, counting-based, improves attention
• Target HR: 60-75% of maximum (for a 10-year-old: approx. 126-157 bpm)

Session Structure (MANDATORY for ADHD + ASD)

Key Principles

1. Predictability: Same routine every session at first. Changes in routine cause distress in ASD.
2. Visual supports: Use pictures/cards to show each exercise - do not rely on verbal instructions alone.
3. Never force sensory input: If a child resists brushing, spinning, or touch, stop and reassess.
4. Graded difficulty: Always start easier than you think necessary to build confidence and compliance.
5. Family carryover: Teach 2-3 exercises for parents to do at home (proprioceptive heavy work is easiest to teach).
6. Co-treatment with OT: Physiotherapy and occupational therapy work best together for this profile.

Expected Outcomes (by 12 weeks)

• Improved bilateral coordination and motor sequencing
• Longer sustained attention during structured tasks
• Reduced sensory-triggered behavioral outbursts
• Increased willingness to engage in peer activities
• Better postural control and spatial awareness

Supporting evidence: Jia et al. 2024, Eur J Pediatr - Network meta-analysis of 68 RCTs showed combat sports, ball sports, neurodevelopmental motor training, and aquatic exercise are the top 4 modalities for developmental disorders in children. Sensory-motor integration study, 2024 confirmed significant improvement in social interaction scores following sensory-motor integration training in ASD.