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

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.

Inclusion criteria

• Age between 8 and 15 years
• Mild or moderate intellectual disability with sufficient cognitive and verbal communication ability to understand and follow instructions.

Exclusion criteria

• Receiving any treatment other than conventional physiotherapy within the previous 6 months
• Having any orthopedic disorder or history of orthopedic surgery
• Communication problems in parents or caregivers
• Absence from more than three treatment sessions.