Hypotonia and Autism: Full Body Workout to Increase Muscle Tone
What is Hypotonia?
Hypotonia, or "low muscle tone," is a condition where muscles have less tension, making them feel softer. This can affect strength, coordination, and endurance, requiring children to work harder to perform basic movements. In children with autism, hypotonia occurs in about 50% of cases, impacting motor control and posture.


Quick Intro: Who We Are
Hi, I'm Sergio, a Pediatric Occupational Therapist. Together with my wife, Rosa, who is a Speech Therapist, we opened our private practice in San Antonio, Texas. We've helped many families, and 80% of the kids we work with have a diagnosis of autism.
Mission: To connect parents with the right therapists and provide clear, actionable answers for their child's development.
How to Improve Muscle Tone in Kids with Autism
Consistency in activating the muscles strengthens the brain-to-muscle connection, much like creating a well-worn path through a grassy field. Below is a five-week workout plan to help build strength while making activities fun and engaging.
Five-Week Workout Plan for Hypotonia in Autism

Causes of Hypotonia in Autism
The root cause of low muscle tone in autism isn’t fully understood. In simple terms, it’s often due to the brain struggling to communicate efficiently with the muscles. Think of it like having low phone signal: the brain sends messages to activate the muscles, but some signals get delayed or lost.
1. Step-Ups: place items like puzzles, favorite toys, or art supplies at various heights (like on a table, shelf, or taped to a wall) to keep the activity engaging. Start with objects close to the child’s level to build confidence, then move them slightly higher for added challenge. For variety, place items in a pattern, such as a circle or line, so the child steps up, collects an item, steps down, and moves to the next. This keeps the activity dynamic and improves both leg strength and coordination.

Signs of Hypotonia in Children with Autism
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Always leaning against furniture or people for support while playing.
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Only sitting in a W-position
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Difficulty crawling or walking
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Fatigue quickly during physical activities
Week 1: Focus on Legs
Why it’s important: Strong legs provide the foundation for balance, posture, and mobility, making it easier for children to walk, run, and engage in physical activities.
2. Kicking Games: Line up items like blocks, action figures, or balls to create different targets for kicking in various directions. You can change positions (forward, side, or backward kicks) and distances to increase difficulty and keep it fun.

Week 2: Core and Back Strengthening
Why it’s important: A strong core supports good posture, enhances coordination, and improves endurance for tasks like writing, sitting, and running.
3. Jumping Practice: Add colorful mats or cushions for safe landings. Start with hand support, holding your child by the chest or hands. Progress to independent jumps and introduce small hurdles to jump over once they gain confidence.

1. Modified Bowling: Place small toys or blocks as “pins” in a line or triangle at the end of a play mat. Have your child lie on their stomach and lift their chest to roll a lightweight ball toward the pins.

2. Inclined Sit-Ups: Use a pillow or wedge to create an incline, placing a favorite stuffed animal or toy at the top to motivate them. As they get stronger, decrease the incline, requiring more core engagement.

Week 3: Arms and Shoulders Strengthening
Why it’s important: Strong arms and shoulders improve fine motor control, making tasks like cutting, eating with utensils, and handwriting easier.
3. Trunk Twists: Sit your child on the floor with items (like puzzle pieces, crayons, or small toys) on either side. Have them twist to pick up items and place them in front or across their body. This encourages rotational movement and builds core stability, especially if you create a task they enjoy (like assembling a puzzle).

1. Throwing Objects: Start with lightweight items (pillows, plush toys) for short-distance throws. Gradually increase both distance and item weight as your child’s strength improves. You can make this more engaging by setting up “targets” (like buckets or baskets) at different distances.

2. Water Play: Ask your child to hold up a pitcher with one or two hands. As you pour water into the pitcher, it helps strengthen the shoulders and grip. To add fun, use colored water or small floating toys that they pour out with each attempt.

Week 4: Hand Strength Activities
Why it’s important: Hand strength is essential for self-care activities, like dressing and opening snacks, as well as for developing fine motor skills required for writing.
3. Blinds Game: If your child enjoys looking out the window...ask your child reach up to open and close blinds or curtains repeatedly around your house. For more variety, alternate hands, encouraging your child to use each arm to balance muscle development.

1. Play-Doh Games: Hide small toys or themed items in Play-Doh, encouraging your child to dig and pull them out. For added difficulty, use Theraputty (a firmer material), gradually increasing resistance as they build hand strength.

2. Spray Bottle Fun: Fill spray bottles with water and encourage your child to spray plants, windows, or tables. Adjust spray distances for more challenge, and add fun by letting them “draw” with the water on different surfaces.

Week 5: Face and Mouth Control
Why it’s important: Strengthening face and mouth muscles helps with eating, drinking, and speaking, improving both communication and sensory comfort.
3. Scissor Practice: Use scoop scissors and set up a sensory bin filled with various textures, animals, and other small toys.

1. Silly Faces Game: Use a mirror or phone camera to practice making exaggerated faces together, like smiles, frowns, or funny expressions. This is a great time to teach emotions, helping improve facial muscle strength and social understanding.

2. Blowing Games: Place lightweight objects, like cotton balls or small paper towers, and have your child blow them over using a straw. It’s a playful way to strengthen breath control and mouth muscles while adding a fun element.

3. Tongue Control Practice: Spread a favorite sauce or use a lollipop, encouraging your child to reach different areas around their mouth with their tongue. This activity is great for improving tongue movement, essential for both eating and speech.

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