Helping Children With Neurological Disabilities Build Strength Through Everyday Movement

A 30-minute or one-hour exercise physiology or physiotherapy session is valuable for assessing movement, practicing technique and providing professional guidance. However, it is often the child’s everyday habits that have the greatest influence on whether they achieve their goals.

Consider a child whose goal is to walk independently. They may practice walking during their weekly therapy session, but if they spend most of the remaining week sitting, they have limited opportunities to repeat and strengthen the movements involved.

Therapy sessions matter, but progress does not stop when the appointment finishes. Families and support workers should leave with practical guidance on how to incorporate movement practice into daily life in a way that is accessible, achievable and motivating for the child.

Why Everyday Movement Matters

Children develop physical skills through regular repetition. This does not mean that every activity needs to feel like formal therapy.

Movement can be included in play, school routines, screen time, transfers, trips to the park and everyday movement around the home.

For children with neurological disabilities, this is particularly important because they may spend more time sitting than typically developing children. This can include time spent in a wheelchair, watching television, playing video games, completing schoolwork or resting between activities.

The aim is not to remove the quiet activities a child enjoys. Instead, we can look for realistic ways to break up longer periods of sitting and create more opportunities for meaningful movement throughout the day.

Breaking Goals Down Into Everyday Activities

Broad goals such as “walk independently” or “improve transfers” can feel overwhelming. It is often more useful to break each goal down into smaller movements that can be practiced during enjoyable activities.

• Goal: Improve Transfers From a Wheelchair to Another Chair

Activity: Create an obstacle course

An obstacle course can be adapted to your child’s interests, abilities and environment. It may include:

• Crawling between obstacles

• Climbing onto and off low surfaces

• Moving between cushions, benches or chairs

• Practicing transfers between obstacles

• Reaching, pushing or pulling during the course

If the height of an obstacle is too difficult, lower it. Your child can still practice the same movement pattern at a level that feels safe and achievable.

As their confidence and strength improve, the height, distance or number of repetitions can gradually be increased.

• Goal: Walk Independently

Activity: Add walking practice to a daily routine

Choose a time and place that already forms part of the child’s day.

For example:

“When we come home from school, we will complete four supported laps of the hallway before having some iPad time.”

The exact distance should be appropriate for the child. One child may complete four hallway laps, while another may practice taking a few steps between two pieces of furniture.

Connecting the activity to an existing routine makes it easier to remember and maintain. A clear reward can also help the child understand when the activity begins and finishes.

• Goal: Improve Leg Strength and Work Toward Independent Walking

Activity: Cycling

Cycling can be an excellent way to develop leg strength, endurance and confidence. Although cycling does not directly practice walking, it repeatedly uses many of the muscle groups involved in lower-limb movement.

It also gives children an opportunity to move quickly, explore and have fun.

Ways to make cycling more motivating might include:

• Cycling to the playground, followed by 10 minutes of play

• Riding through bubbles

• Using a water pistol at the end of each section

• Racing a parent or support worker

• Following a simple course or treasure hunt

• Earning a small, immediate reward after reaching a set distance

The bike and level of assistance should be matched to the child’s abilities. Some children may use a tricycle, adaptive bike, foot straps, supportive seating or assistance from an adult.

Making Therapy Enjoyable!

Children are more likely to participate in an activity when it connects with something they enjoy.

Exercise does not always need to involve repetitions performed in a quiet clinical environment. It can involve water pistols, bubbles, wrestling games, music, obstacle courses, playgrounds, cycling or a favourite toy.

A child who does not enjoy practicing standing for five minutes may happily stand while throwing a ball, playing a game at the kitchen bench or trying to reach bubbles.

The therapeutic goal remains the same, but the activity becomes meaningful to the child.

A mobile exercise physiologist can also observe which toys, spaces, routines and rewards are already available at home. These can then be used to create a program that is more practical for the family to continue between appointments.

Reducing Long Periods of Sitting

Quiet activities such as watching television or playing video games are often an important source of enjoyment and rest. They do not necessarily need to be removed.

Instead, families can introduce short movement breaks or change the child’s position during these activities.

Depending on the child’s individual needs and professional recommendations, options may include:

• Using a Stander

A standing frame may allow a child to spend part of their usual play or screen time in a supported standing position.

The stander should be correctly fitted and used according to advice from the child’s treating team.

• Tall Kneeling

The child might spend five minutes in tall kneeling after every 30 minutes of seated activity.

Tall kneeling can be incorporated while playing at a low table, throwing a ball, completing a puzzle or interacting with a screen positioned at an appropriate height.

• Changing Sitting Position

Where appropriate for the child, sitting cross-legged may provide an alternative to prolonged W-sitting.

A wedge, cushion, supportive seat or nearby surface may be used if the position is initially difficult. Seating recommendations should always reflect the individual child’s comfort, mobility and clinical needs.

• Introducing Movement Breaks

A five-minute movement break could include:

• A short balloon-volleyball game

• Supported standing

• Tall kneeling

• Crawling to collect toys

• A hallway walk

• A transfer practice game

• Lying on the floor and completing funny ball activities

• Dancing or moving to one favourite song

These short periods can add up. Six five-minute movement breaks provide an additional 30 minutes of activity across the day without requiring one long exercise session.

When combined with transfers, walking practice, cycling and active play, a child may significantly reduce their total sedentary time.

Incorporating Movement at School

School can sometimes be more difficult because teachers and school staff may have restrictions around lifting or physically assisting a child.

However, many therapeutic movements can still be included in the school day when the family, therapists and school team work together.

Movement Breaks

During classroom movement breaks, the child may be able to practise supported standing rather than remaining seated.

For example, they may stand with a desk in front of them and their wheelchair positioned safely behind them, provided this has been assessed and approved by the child’s treating team and school.

Toilet Transfers

If the child is already going to the toilet during the day, this may provide a natural opportunity to practice the transfer technique taught during therapy.

Rather than using a completely different method at school, staff can be shown how to support the child to use the same safe and consistent approach.

Chair Transfers

When transferring from a wheelchair to a classroom chair, the child may be able to practice the steps worked on during their exercise physiology or physiotherapy session.

Even one or two additional transfer practices during the school day can create regular repetition over the course of a week.

The child’s therapists should work with the school to ensure the activity is appropriate, safe and realistic within the classroom environment.

Working With the Child’s Support Team

The most effective strategies are usually those that can be understood and followed by everyone supporting the child.

This may include:

• Parents and carers

• Support workers

• Teachers and teacher aides

• Exercise physiologists

• Physiotherapists

• Occupational therapists

• Other allied health professionals

  
  

A home program should not simply be a long list of exercises handed to a family. It should explain when the activity can be completed, how it can be adapted, what assistance is required and how it connects to the child’s goals.

It should also be realistic. Families already have busy routines, and children need time to rest, learn and enjoy themselves.

The aim is to identify small changes that can be maintained, rather than creating an overwhelming program that is quickly abandoned.

What Progress Can Look Like

Progress is not limited to achieving one major outcome such as independent walking.

It may also include:

• Completing more of a transfer independently

• Standing for longer with less support

• Increasing the distance cycled

• Becoming more confident during movement

• Improving leg or upper-body strength

• Participating more actively at school

• Spending less time sedentary

• Recovering more quickly after activity

• Becoming more willing to attempt a difficult movement

• Participating in family and community activities

These smaller changes are meaningful. They can build toward larger goals while also improving the child’s confidence, participation and independence.

How Mobile Exercise Physiology Can Help

Mobile exercise physiology allows therapy to take place in the environment where the child spends their time.

This may include the home, local playground, community, hydrotherapy pool or another familiar setting.

Working in these environments makes it possible to practise the activities that matter in daily life. It also helps identify barriers that may not be obvious in a clinic, such as the height of a chair, the layout of a hallway, the child’s bicycle setup or the support available during an after-school routine.

The role of the exercise physiologist is not only to work with the child during the appointment. It is also to help families and support teams create more opportunities for safe, enjoyable and purposeful movement throughout the week.

A weekly session can provide the direction. Everyday movement provides the repetition.