Lifting more than weights: practical insights into strength training for a child with special needs—a case report

Abstract

Background

Resistance training remains underused in the rehabilitation of children with neurodevelopmental disorders, despite growing evidence of its multidimensional benefits beyond muscular strength. This case describes how an adapted resistance exercise program appeared to support functional, behavioral, and emotional changes in a child with developmental delay secondary to perinatal hypoxic brain injury.

Case presentation

A 13-year-old girl of European descent with global developmental delay following perinatal cervical trauma and hypoxic brain injury, studying in a specialized educational institution, participated in a 12-week individualized resistance training program. Sessions were held 3 times per week for 45–60 min, depending on her concentration and tolerance. Exercises included bodyweight squats while holding on to wall bars (stall bars), knee push-ups, assisted abdominal crunches with leg fixation, and pull-ups on an inclined rehabilitation board (Evminov board), all tailored to her abilities and closely supervised. Her communication was limited to a few words and gestures, and she presented with impulsive behavior, poor motor control, and sensory processing difficulties. After 12 weeks, she showed observable improvements in posture, gait stability, endurance, and engagement during physical tasks. Teachers and caregivers also noted reduced irritability, better emotional regulation, and more consistent participation in group activities.

Conclusions

This case illustrates the feasibility and potential benefit of integrating individualized resistance training into rehabilitation programs for children with developmental disabilities. Such low-cost, simple interventions may complement standard therapies and enhance well-being in institutional or school settings. These observations are based on qualitative reports and should be interpreted with caution.

Background

Children with neurodevelopmental disorders, especially those resulting from perinatal brain injury, often experience persistent motor impairments, behavioral challenges, and reduced independence. Rehabilitation programs in institutional or school settings typically emphasize stretching, balance, and coordination exercises, whereas resistance training remains underused despite accumulating evidence of its broader physical and psychosocial benefits [1, 2].

Recent studies have shown that strength-based interventions for children with cerebral palsy, autism spectrum disorders, and intellectual disabilities can enhance not only muscle strength and mobility but also postural control, behavioral self-regulation, and social participation [3, 4]. These multidimensional benefits are thought to arise from improved neuromuscular activation, sensory integration, and adaptive neuroplasticity [5, 6]. Moreover, school-based exercise programs have been associated with better physical activity and fitness in children and adolescents while physically active pediatric populations with neurodevelopmental or motor disorders may also demonstrate better well-being and quality of life [7–9].

Despite this evidence, practical reports describing the real-world adaptation of resistance training for children with combined motor and behavioral challenges remain scarce. This case report describes a 13-year-old girl with developmental delay following perinatal hypoxic brain injury, in whom a low-cost, individualized resistance exercise program appeared to support observable improvements across physical, emotional, and social domains. The case highlights the feasibility and potential value of implementing such programs within resource-limited educational settings.

Case presentation

A 13-year-old girl of European descent with global developmental delay secondary to perinatal cervical trauma and hypoxic brain injury was enrolled in a specialized educational institution providing individualized support and rehabilitation. Her developmental difficulties became evident soon after birth, following a delivery-related injury that initially went unrecognized but later manifested as a hypoxic event with subsequent neuronal loss and an epileptic seizure in infancy.

At the time of intervention, her height was 164 cm and weight 41 kg (BMI ≈ 15.2), giving her a lean and muscular build. She could ambulate short indoor distances with intermittent support, corresponding approximately to Gross Motor Function Classification System (GMFCS) level II. Her communication was limited to a few words (“Yes,” “No,” “Mama”) and the syllable “Ka!” instead of her name. She exhibited impulsive behavior, poor motor planning, sensory processing difficulties, and occasional aggression toward peers and teachers. Despite these challenges, she demonstrated an ability to understand non-verbal cues, respond to humor, and display moments of strong social connection and quick wit.

On examination, she showed poor postural control, reduced muscle tone in both upper and lower limbs, unstable gait, and limited endurance. She relied on environmental support (furniture, walls) for ambulation, and her attention span varied significantly depending on emotional state and sensory input. At baseline, she could maintain unsupported standing for approximately 15 s, perform 4 supported squats and 2 modified knee push-ups, and walk about 15–20 m only with pauses and external support. These observations were used as practical functional reference points in the absence of standardized assessment tools. Her medical history included early-life epilepsy (no seizures for over 5 years and no current medication). Previous rehabilitation had focused mainly on stretching, balance, and relaxation exercises.

The diagnosis had been established before the present intervention on the basis of perinatal history, delayed developmental progression, prior clinical and rehabilitation assessments, and persistent motor, communication, and behavioral impairments observed in daily functioning. Detailed family history was not available to the author from the school records accessible in the educational setting. Before the present program, the child had participated in routine rehabilitation activities focused mainly on stretching, balance exercises, relaxation work, and occupational support; however, the outcomes of these earlier interventions had not been systematically documented, which limited direct comparison. Given the chronic nature of her condition, the short-term goal of the program was not normalization of function but improvement in postural control, task engagement, tolerance to structured physical activity, and behavioral regulation within the school setting.

A 12-week individualized resistance training program was designed to complement her ongoing physical education and occupational therapy. Sessions were conducted 3 times per week, each lasting 45–60 min depending on her focus and tolerance. Exercises were simple, progressively challenging, and performed under direct supervision:

• bodyweight squats while holding on to wall bars (stall bars);

• knee push-ups;

• assisted abdominal crunches with legs fixed by the therapist, who also supported her arms during difficult repetitions;

• pull-ups on an inclined rehabilitation board (Evminov board), with therapist assistance as needed.

Practical challenges during implementation included limited verbal communication, variable attention, impulsive behavior, and the need for frequent verbal, tactile, and manual cueing. The resource-limited school environment also required the use of simple existing equipment rather than specialized training devices. Progression was, therefore, based primarily on observed technique, tolerance, engagement, and behavioral readiness rather than on a rigid loading schedule.

Each session began with a brief warm-up and balance activities, followed by the core strength exercises, and ended with stretching and relaxation. Assistance was gradually reduced as she gained control and confidence. The training was conducted within the school’s regular rehabilitation schedule by the author, a certified rehabilitation specialist.

Her engagement fluctuated initially due to variable mood and attention, but she gradually became more consistent and motivated, even requesting to repeat some exercises spontaneously. During the first weeks, sessions focused mainly on familiarization, behavioral regulation, and tolerance to structured exercise, and frequent cueing was required. In the middle phase of the program, the participant tolerated a greater number of repetitions with fewer interruptions and less hands-on assistance. By the final weeks, she completed a larger proportion of the session with improved trunk control, more stable stance, and more consistent engagement in the tasks. Over time, she displayed visibly improved posture, reduced reliance on external support during walking, stronger grip and trunk stability, and increased social interaction during group activities.

The chronological course of the intervention is summarized in Table 1.

Table 1.

Timeline of intervention and assessments

Timepoint (week)	Event/observation
0	Baseline observation and anthropometric measurement (height 164 cm, weight 41 kg). Intervention planning and consent obtained
1–12	Resistance training sessions 3× per week (45–60 min each); gradual progression in volume and control; close supervision
12	Post-intervention observation and teacher feedback collected (functional and behavioral changes summarized in Table 2)
16	Follow-up observation: maintenance of improvements noted; continued voluntary exercise under teacher supervision

The intervention was part of the child’s routine school rehabilitation activities; no experimental procedures were conducted. Written informed consent for participation and publication was obtained from the legal guardian.

Outcome and follow-up

At the end of the 12-week resistance training program, the participant demonstrated measurable and observable improvements across physical, behavioral, and social domains, as summarized in Table 2.

Table 2.

Summary of functional progression (subjective observational data)

Functional domain	Baseline	Post-intervention (week 12)	Follow-up (week 16)
Supported squats	4 reps	10 reps	9 reps
Modified push-ups	2 reps	6 reps	5 reps
Standing without support	~15 s	>60 s	>60 s
Walking endurance	15–20 m with support	40 m unaided	40 m unaided
Emotional regulation	Frequent outbursts	Occasional, brief	Rare
Social engagement	Minimal initiation	Frequent interaction	Maintained

Physical outcomes

Her posture became more upright and stable, with reduced trunk sway during walking. She was able to perform 10 consecutive supported squats (baseline: 4) and 6 modified knee push-ups (baseline: 2) without rest. The duration of upright standing without hand support increased from approximately 15 s to over 60 s, and she could walk continuously along the school corridor (≈40 m) without external assistance, compared to frequent pauses and support at baseline. Grip strength, though not formally measured, was visibly improved, as she began holding and moving small objects more confidently during class tasks.

Behavioral and social outcomes

Teachers and caregivers reported a decrease in irritability and impulsive outbursts, improved tolerance for frustration, and enhanced emotional regulation. The girl began initiating playful interactions, laughing spontaneously, and responding appropriately to verbal and non-verbal cues. She showed greater persistence during challenging tasks and more active participation in group activities. These observations were consistent among multiple staff members independently.

Follow-up

At a 4-week follow-up (week 16), the improvements were largely maintained. She continued performing selected exercises voluntarily under teacher supervision 2–3 times weekly. No adverse effects, discomfort, or injuries were observed during or after the intervention.

Although no standardized functional scales (e.g., GMFM, Pediatric Balance Scale) were used, qualitative improvements were consistently observed by teachers and the therapist. These findings should, therefore, be interpreted as preliminary and descriptive.

This case illustrates that a simple, closely supervised resistance training program can be feasibly integrated into institutional rehabilitation and may be associated with improvements in physical function, behavior, and engagement, though causality cannot be established without objective measures or controls.

Discussion

This case provides preliminary observational evidence suggesting that an individualized resistance training program may be a feasible and potentially beneficial adjunct to rehabilitation in children with developmental and behavioral challenges. The observed changes in posture, gait stability, and social engagement were consistent with findings from previous reports describing positive associations between structured exercise and improvements in motor and psychosocial domains among children with neurodevelopmental disorders [1–3].

The mechanisms that might underlie such improvements are multifactorial and remain speculative in the absence of direct measurements. Enhanced neuromuscular activation and improved coordination may contribute to functional mobility, while structured, predictable sessions may promote emotional regulation and attention through behavioral conditioning and sensory integration [4–6]. In particular, Healy et al. [2] found that physical activity interventions improved social responsiveness in children with autism, suggesting that the behavioral context of exercise can itself support adaptive engagement. Similarly, Verschuren et al. [1] highlighted the role of resistance training in improving participation and perceived competence in children with cerebral palsy, effects likely mediated by increased self-efficacy rather than purely muscular change.

Alternative explanations for the observed outcomes must be considered. Improvements might reflect natural developmental progression, increased one-on-one attention (Hawthorne effect), or concurrent therapies and social interactions within the institutional environment. The absence of blinding, control conditions, and standardized outcome measures limits causal interpretation. In addition, the author conducted both the intervention and assessment, introducing a high risk of observer bias.

Accordingly, the value of the present report is primarily descriptive and practice-oriented rather than confirmatory. It should be interpreted as a real-world illustration of feasibility and potential clinical relevance, not as reproducible proof of efficacy.

Despite these limitations, this case illustrates the practical feasibility of implementing low-cost, individualized strength exercises in an institutional school setting using minimal equipment. The program was well-tolerated, required no specialized devices, and appeared to foster motivation and social interaction—aspects often overlooked in conventional therapy.

Future work should include objective functional and behavioral outcome measures (e.g., Gross Motor Function Measure, Pediatric Balance Scale, or Aberrant Behavior Checklist), detailed documentation of concurrent interventions, and longer-term follow-up to evaluate the durability of observed changes. Controlled trials or small case series could further clarify which components of resistance training (e.g., frequency, progression criteria, or supervision level) most strongly influence outcomes in this population.

Conclusions

This single-case observation suggests that a simple, individualized resistance training program can be safely implemented and may be feasible as a supportive component of rehabilitation for children with developmental disabilities. The positive trends observed in motor performance, engagement, and emotional regulation highlight the potential value of structured strength-based activities in educational or institutional settings. Further systematic research using standardized outcome measures and controlled designs is needed to clarify the scope and mechanisms of these effects.

Author contributions

The author conceived the idea, designed and supervised the intervention, collected and interpreted the observations, drafted and revised the manuscript, and approved the final version for publication. The author is the guarantor of this work.

Funding

This work received no external funding. The author conducted and reported this case independently.

Availability of data and materials

All data supporting the findings of this case are contained within this article. No additional datasets were generated or analyzed.

Declarations

Ethics approval and consent to participate

Formal institutional review board (IRB) approval was not required for this single educational case intervention, as it involved routine physical activity within the child’s existing school program and did not constitute experimental research. The program was implemented under supervision of the school’s physical education and rehabilitation staff, with prior written consent from the child’s legal guardian. The intervention adhered to ethical principles outlined in the Declaration of Helsinki and the CARE reporting guidelines.

Consent for publication

Written informed consent was obtained from the patient’s legal guardian for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interest

The author declares that there is no competing interest.