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Benefits of Pilates for Children with Mild Autism

Anne York

January 14, 2018

Studio 64 Pilates

Brisbane, Australia

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Abstract

Autism is a neurodevelopmental condition affecting a child’s physical and mental

development. It is a lifelong condition, with symptom appearing in early childhood.

Children with Autism are sticklers for routines, which can affect the way they interact with

others, and how they experience the world around them including difficulties with fine and

gross motor skills. Parent who added Pilates exercises such as core strength, back

strength and vestibular proprioception balance to a child’s physical regime reported

improved flexibility, balance, and energy in their children. Other symptoms that may

be helped through Pilates include loss of balance, changes in posture, movement

transitions and environmental transitions; the two biggest challenges these children face.

The focus of this paper is on the importance of Pilates as a rehabilitation tool for children

with Autism. The goal of my programs for these children is not to get every exercise

“correct” but to help neurons fire to integrate both proprioceptive and vestibular

movements to regulate their activity level, emotional regulation and physical strength.

Through set routines children learn to develop the necessary and fundamental skills

that all children benefit from.

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Table of Contents

Abstract Page 2

Table of Contents Page 3

Anatomical Description

Figure 3.1 The Autistic Spinal Posture Page 4

Figure 3.2 The Abdominal Muscles Page 5

Figure 3.3 The Erector Spinae Muscles Page 6

Introduction Page 7

Case Study Page 8

Joseph’s BASI conditioning program Page 9

Conclusion Page 12

Bibliography Page 12

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Anatomical Description

Figure 3.1 The Autistic Spinal Posture

The anatomical posture of children with Autism includes hyperextended knees, a

pelvis that is anteriorly rotated and mild to severe lordosis. Muscles in the erector spinae,

hip flexors and quadriceps are typically shortened and tight which increases the pull on

the pelvis forward. The weakened core and stretched abdominal muscles create an

imbalance in the child’s posture which does not provide adequate assistance in countering

the gravitational pull forward of the pelvis. This can result in proprioceptive challenges,

balance issues and motor control difficulties for ASD children.

http://www.skillsforaction.com/low-muscle-tone http://www.skillsforaction.com/low-muscle-tone

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Figure 3.2 The Abdominal Muscles

There are four important abdominal muscle pairs imperative for

postural/movement control in children with ASD. These include the Rectus Abdominis

(RA), the Internal Obliques IO), the External Obliques (EO), and the Transversus

Abdominis (TA). The (RA) muscles are important for flexion, bending and stability. The

RA muscles, in conjunction with the IO & EO muscles, are responsible for flexion

(including lateral flexion) of the spine. The TA muscle’s

primary function is postural and protective stabilizing the

spine and pelvis before movement of the lower or upper

limbs. http://leanmuscleproject.com/abdominal-muscles

Children with movement difficulties (joint hypermobility and low muscle tone)

benefit from strengthen these core muscles. Movement and standing with a strong upright

posture, keeping the head and trunk steady facilitates their ability to move with balance

responses, anticipatory postural responses and postural stability.

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Figure 3.3 The Erector Spinae Muscles

The Erector Spinae muscles consist of three columns of muscles. The Iliocostalis,

Longissimus, and Spinalis, each running

parallel on either outer side of the vertebra and

extending from the base of the skull to the

Pelvis. The Iliocostalis muscle; responsible for

extension and lateral flexion of the spine is the

farthest from the vertebra extending from the

upper thoracic spine (T6) to the base of the

cervical spine (C6-4).

http://www.musclesused.com/erector-spinae-2/

The Longissimus Dorsi Muscle is the longest of the back, made up of 3 parts, the

Capitis, the Cervicis and the Thoracis. The Capitis Muscles hold the head up and rotating

toward the same side of the muscle that is contracting. The Cervicis Muscles bend the

neck and assist in keeping the cervical spine erect. The Thoracis Muscles assists in the

motion of backward and sidewards bending, keeping the spine erect and pulling the ribs

downward to help with breathing.

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Introduction:

Pilates assists with both movement transitions and environment transitions, which

are the two biggest challenges Autistic children face. Pilates enables these children to

“organize” their body movements to execute more coordinated gait-related issues and

motor skills. The therapeutic approach to helping children with sensory and attention

issues involve the application of strengthening a child’s motor coordination and muscle

development. Proprioceptive therapies entail stretching and contracting the muscles. The

centre of my rehabilitation program is stretching and controlling the muscles. My

program focuses on stretching and strengthening the muscles that support the core TA &

IO/EO); the spine – the extensors, flexors and bilateral coordination and segmental

stability. In the pages to follow, I will review my case study and the rehabilitation Pilates

program that I designed for my client. Please note, I have been trained in Applied

Behavioural Analysis (ABA) and as an Occupational Therapist which is one of the

leading methodologies for treating children with ASD; I have the strategies for managing

un-healthy behaviours and how to apply a ‘just-right-challenge’ applicable for my client.

The program; behaviours and outcomes are not to be generalized to other children with

ASD.

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Case Study

Joseph is a 7-year-old boy who is very active and enjoys a variety of

indoor/outdoor activities. He is part of a soccer team through school, attends swimming

lessons once a week and swims regularly at home. Joseph was diagnosed with a moderate

ASD diagnosis when he was 4 years old. For the first 18-months post diagnosis Joseph

attended an intensive ABA program to build his communication, social and fine motor

skills. Joseph continued to build these skills through his school programs and commenced

seeing a physiotherapist for ongoing gross motor development. The physiotherapist

worked on lengthening his spinal muscles, supporting active knee flexion/extension

through range and core stability work during active movement. Joseph’s physiotherapist

suggested the incorporation of activities to enhance neuromotor development to improve

processing efficiency; which is when his parents came to me for ongoing therapy

sessions. Due to Joseph’s lack of focus, high stim behaviors and reduced communication

I was advised to keep exercises simple and clear but have a well-balanced “just-right-

challenge”. This meant our sessions needed to include functional breaks and incorporate

his preferred activities such as jumping, spinning and rolling. In addition to strengthening

the muscles around his spine and core, other goals for our session were to increase the

strength of his hips and work on balance. Other than his ASD diagnosis, Joseph presented

as a very healthy 7-year-old and was very happy to be trying something new.

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Joseph’s BASI conditioning program

Over the course of 6 months, Joseph joined me for Pilates sessions two times a

week, and I rotated what equipment he used from session to session. Below are two

examples of programs that I implemented with him. Sometimes not all of the blocks were

met due to times constrains or behaviour challenges. Occasionally parts of one program

were switched with the corresponding block exercises in the other program due to flow or

how Joseph was feeling that day. His program focused on building core strength, hip

flexor strength, balance and stretching while working with his physical and mental

limitations; most importantly, continuing to work with his behaviour needs.

The warm-up included some of the BASI fundamental warm-up but was

modified based on his attention span and stim-behaviours on the day of session. Starting

with the fundamental warm up reminded Joseph of the importance of focusing and

stabilizing his body for movement. This foundation work facilitated his understanding of

initiating movement, then using breath through movement. It was a good way for him to

start our sessions to maximize benefit throughout each exercise. Footwork was

completed on the Cadillac. This allowed Joseph to focus his attention on the feet, hips

and knees. As he gained strength in his lower body (without hyperextension of the knees)

we could increase his resistance. His mother and I agreed to do all footwork on the

Cadillac as Joseph would get distracted and hyperactive when on the reformer. The

combination of the push/pull of the springs and the bed travelling was a sensori-

stiumulating activity. During sessions when Joseph needed a break or was demonstrating

inappropriate stim behaviour (such as flapping, jumping, or clenching of his body) we

would work through a jump-board routine on the reformer.

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Abdominals: Majority of our abdominals were completed on the Reformer; through

level one/two options. The movement of the carriage supported his vestibular needs, and

speed regulation.

Hip Work: The Cadillac is beneficial when performing hip work as it promotes a feeling

of stability. As each leg uses a separate spring, it is possible to individually address the

muscular imbalances.

Spinal Articulation: Roll-downs on the Cadillac facilitated stretching and anatomical

posture with minimal distraction.

Full Body Integration: Reverse knee stretch works the body bilaterally. Scooter builds

on this by working the body unilaterally, further strengthening the weaker side by

including more repetitions

Arm Work: Standing Cadillac / Ped-a-Pull

Leg Work: The jump board helped to provide a linear combination of vestibular and

proprioceptive input.

Lateral Flexion: Side Stretch works each side independently. The focus will be on

strengthening the weaker side more and stretching the stronger side more.

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Block Program #1 Program #2

Warm Up (on mat) Roll Downs, Pelvic Tilt,

Pelvic Curl, chest lift with

rotation, Single Leg Lift

Roll Downs, Pelvic Tilt, Pelvic

Curl, chest lift with rotation.

Supine Spine Twist was added

once he has sufficient oblique

strength after 4 weeks)

Footwork (on

Cadillac)

Parallel heals, Parallel

toes,V-position toes, Wide v

heals, Wide v toes, Calf

raises, Prances, Single leg

heals, Single leg toes

Foot work on Cadillac to open

up hamstrings, calves and hips

as well as work on pelvic-

lumbar stabilization and

hamstring ex tensor strength.

Abdominals On Mat: Single leg lifts/leg

changes, hundred prep

Reformer: Chest Lift 1 / 2,

Obliques, Scissors, 100’s.

Hip Work Double Leg Frog, Double

Leg Hip Circles , Double

Leg Walking , Double Leg

Bicycles,

Tower: Single Leg Frog, Single

Leg Circles, Single Leg Hip

Extension, Single Leg Bicycle

Spinal Articulation Cadillac: Monkey

Stretches Standing Lunge Only Standing Lunge Only

Full Body Integration Scooter Reverse Knee Stretch

Arm Work Standing PAP; Chest

Expansion, Biceps,

Rhomboids, Hug A Tree,

Salute

Standing Cadillac Chest

Expansion, Biceps, Rhomboids,

Hug A Tree, Salute

Full Body Integration Elephant – Reformer Elephant – Reformer

Leg Work Wunda Chair- Hamstring

Curl, Single Leg Step ups,

Hip Opener

Reformer – Jump Board,

Single Leg Skating, Leg Press

Standing

Lateral

Flexion/Rotation

Side Stretch (Wanda Chair) Side Stretch (Wanda Chair)

Back Extension Wunda Chair

Swan on Floor, Swan Basic

(proceeding with Back

Extension Single Arm) Rest

Position

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Conclusion

At the end of the 6-months, Joseph’s progress was evaluated through the same

assessments completed at the beginning of the program. These measurements ncluded

range of motion assessments at the shoulder, knees, hips and lateral flexion as well as

muscle strength testings and endurance (ie. Planks). Joseph demonstrated improvement in

all areas of assessments with the greatest success in endurance. Furthermore. Feedback

from his mother concluded Joseph was able to maintain focus better throughout his daily

activities, with prompting he could work through some fundamental mat exercises at

home when he was “stimming”.

Through observations and the program developed within his personalized Pilates

program, a child with mild autism can work through a structured program to increase

core stability/strength and have a positive outcome. While it is not an easy issue to deal

with and can be extremely frustrating, taking the time and energy needed to work on the

behaviour management as well as the physical morbidity, outcomes can be extremely

beneficial. As previously discussed, it is critical to strengthen the muscles of TA &

IO/EO); the spine – the extensors, flexors and bilateral coordination and segmental

stability. By strengthening these muscles you are allowing for greater participation in

daily activity and management of un-healthy behaviours.

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Bibliography

Biel, Andrew, Trail Guide to the Body

Clippinger, Karen. Spine Anatomy & Core Basics Online Workshop #2801. January 13,

2017. https://www.pilatesanytime.com.

Garland, T. (2014). Self-regulation interventions and strategies keeping the body, mind

and emotions on task in children with Autism, ADHD or sensory disorders. Eau Claire,

WI: Pesi Publishing & Media.

Isacowitz, Rael and Karen Clippinger. Pilates Anatomy. Champaign, Illinois: Human

Kinetics. 2011. Print.

Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts

and Science International, 2013.