Body Awareness Training for Motor Skills and Activity Performance in Children With Intellectual Disabilities

Overview

We tested whether adding a simple, structured Body Awareness Training (BAT) program to conventional physiotherapy improves motor skills, everyday activity performance, and participation (goal achievement and satisfaction) in children with mild to moderate intellectual disability.41 children aged 8-15 years with mild or moderate intellectual disability completed the study. They were randomly assigned to receive either standard physiotherapy (control) or the same physiotherapy plus Body Awareness Training (intervention).All children received conventional physiotherapy three times per week for six weeks (18 sessions total). The physiotherapy included warm-up, range-of-motion, stretching, strengthening exercises and electrotherapy. The intervention group received an additional 30 minutes per session of Body Awareness Training during the same period. BAT activities were simple, rhythmic, and child-friendly. Both groups improved in some fine motor domains, but improvements were larger in the group that received Body Awareness Training. The BAT group showed additional significant gains in manual dexterity, balance, and running speed/agility that were not observed in the control group. Children in the BAT group reported greater improvements in everyday activity performance and higher satisfaction. The BAT group also achieved better outcomes on individualized functional goals (GAS) for several prioritized activities. Most improvements were maintained at the 10-week follow-up. Adding short, structured Body Awareness Training to routine physiotherapy may provide extra benefits for motor coordination, balance, and meaningful everyday functioning in children with mild-moderate intellectual disability. BAT exercises are low-cost, adaptable, and can be integrated into regular therapy sessions; they may help bridge improvements in motor skills to better performance and participation in daily life. Clinicians should individualize intensity and progression according to each child's abilities and stop or adapt activities if pain, excessive fatigue, or breathlessness occurs.

This randomized, assessor-blinded controlled trial evaluated a reproducible rehabilitation approach that integrates a standardized Body Awareness Training (BAT) module into conventional pediatric physiotherapy for children with mild-moderate intellectual disability. Grounded in sensorimotor and interoceptive theories of motor learning, the intervention aimed to improve proprioceptive, vestibular and interoceptive processing to support motor control, postural strategies and attentional regulation and thereby enhance activity performance and participation within the ICF framework. The study used a six-week, thrice-weekly dosing schedule (18 sessions); control sessions were 60 minutes of individualized physiotherapy (warm-up, ROM, stretching, strengthening, electrotherapy, cool-down) while the intervention sessions added a 30-minute BAT module delivered one-to-one by a trained physiotherapist. BAT core elements-body scanning, opening/closing and cross-body coordination, rhythmic tactile "catwalk" stimulation, standing alignment tasks, controlled weight-transfer and stability-limits practice, and breathing-wave integration-were delivered in a flexible, modular sequence and progressed in complexity and challenge across weeks according to each child's tolerance and mastery; tempo, repetitions, sensory support and assistance level were adapted individually and documented. Therapists completed standardized fidelity checklists and session logs; a subset of sessions was audited to ensure adherence. Safety procedures included screening exclusions (recent orthopedic surgery, contraindicating comorbidity, severe communication barriers), real-time monitoring for pain, excessive fatigue, dizziness or respiratory distress with immediate modification or cessation as needed, and withdrawal for participants missing \>3 sessions. Outcomes spanned impairment to participation (BOT-2 SF, COPM, GAS) assessed at baseline, post-treatment and 10-week follow-up by a blinded assessor. Statistical planning used an a priori power calculation, repeated-measures mixed ANOVA for continuous outcomes and non-parametric analyses with effect sizes for ordinal GAS data; analyses were per-protocol with minimal missing data and no imputation. The intervention is intentionally low-cost and modular to support clinical adaptation, though trial delivery relied on trained, single-therapist, one-to-one sessions; implementers wishing to target strength specifically should add progressive overload components and longer follow-up is recommended to assess durability. De-identified data, the BAT manual and fidelity checklist are available from the corresponding author on reasonable request.