Children with combined cognitive and motor disabilities often present with impaired postural control, proximal muscle weakness, and difficulties in motor planning, which significantly limit their participation in daily and therapeutic activities (1). Conventional pediatric rehabilitation typically relies on repetitive, therapist-led routines that, while functional, may reduce child engagement and intrinsic motivation over time (2). Motivation is increasingly recognized as a critical factor in rehabilitation outcomes; interventions that introduce variety, sensory stimulation, and meaningful tasks tend to sustain engagement and support functional gains in children (3).

In settings with limited resources, low-cost or improvised therapeutic tools offer vital clinical utility when specialized equipment is inaccessible (4). Moreover, core stability or suspension-based interventions—by providing unstable support surfaces—can promote proprioceptive and vestibular inputs, potentially enhancing postural control and core muscle activation (5, 6). Such interventions combine physical challenge with novelty, which may boost motivation.

This case report describes the application of a therapist-constructed suspension trainer, made from accessible materials, to enhance core muscle activation and motivation in a 13-year-old girl with complex neurodevelopmental needs. To our knowledge, no prior reports have documented the use of a simple suspension device in pediatric rehabilitation within a resource-constrained context.

The patient was a 13-year-old girl with a history of perinatal hypoxic–ischemic injury and early-onset seizures, presenting with severe cognitive delay and motor impairment affecting ambulation, balance, and coordinated movement.

On clinical examination, she demonstrated marked weakness of the core and scapular musculature. A stooped posture with rounded shoulders and exaggerated thoracic kyphosis was evident, largely attributable to insufficient upper back muscle activation combined with pectoral muscle tightness. The onset of adolescence and a period of rapid growth further exacerbated postural deviations and increased the complexity of rehabilitation needs.

The patient also displayed reduced motivation toward therapy. Having undergone years of conventional physiotherapy, she exhibited limited engagement, primarily due to the monotony and repetitiveness of traditional exercise routines.

Outcomes were documented through therapist observation, session notes, and caregiver report; no standardized or objective outcome measures were applied. Over the course of sessions, the child progressed from completing 1–2 repetitions with early fatigue to 10–15 repetitions with minimal assistance. Clinically, the therapist observed more stable trunk control during the task, less forward trunk inclination during walking/running attempts, and improved coordination during functional activities. The caregiver also reported increased willingness to participate and reduced avoidance of therapy activities.

Observed changes are summarized in Table 1.

All entries reflect qualitative observations and caregiver report; no standardized measures were applied. In addition to functional gains, caregiver feedback highlighted the psychosocial value of the intervention.

According to the patient's mother:

Such testimony provides contextual information on perceived changes; however, it remains subjective and does not replace standardized outcome assessment.

This case report presents practice-based observations following the use of a therapist-designed, low-cost suspension trainer in a child with neurodevelopmental impairment. Core dysfunction is widely recognized in children with cerebral palsy and related conditions, often contributing to impaired balance, reduced trunk control, and secondary musculoskeletal deformities (1–3). Previous randomized controlled trials confirm that core stability training improves gait, upper limb function, and gross motor outcomes in pediatric populations (1–6). However, many of these programs rely on structured equipment or standardized exercises that may lack adaptability and engagement.

In the present case, the suspension-based intervention integrated therapeutic principles with fitness-derived mechanisms such as progressive overload and dynamic instability. The rope-and-stick construction required active stabilization in multiple planes, offering proprioceptive input consistent with prior evidence highlighting the importance of unstable surfaces and multisensory feedback for postural control (5–7). Importantly, the novelty and play-like nature of the device appeared to reignite the child's motivation, aligning with the broader understanding that emotional engagement and task variability are crucial for sustained rehabilitation adherence (2, 7).

The observed changes in posture and mobility-related task performance, including less slouching and improved walking/running attempts, are broadly consistent with prior reports on trunk/core-focused interventions in pediatric populations (1, 6). Improvements in task performance have also been described in core stability programs targeting upper-limb function in children with cerebral palsy (3). Yet, unlike structured protocols, this approach was embedded in a personalized, context-specific solution requiring minimal cost and no specialized equipment. This may hold particular relevance in resource-limited settings, where access to rehabilitation services and conventional devices can be constrained (4).

In summary, this report presents a low-cost, therapist-designed suspension-based approach associated with observable changes in engagement and task performance in one child with neurodevelopmental impairment. These observations are qualitative and hypothesis-generating and should not be generalized; however, they may inform the development of feasible, motivating interventions for pediatric rehabilitation in low-resource settings.

While the outcomes in this single case cannot be generalized, the report supports further evaluation of similar low-resource, engagement-oriented approaches using standardized outcome measures, independent assessment where feasible, and longer follow-up in small prospective cohorts.