# A Coordinated Project-Management Approach to Multisite Implementation of Motor-Rehabilitation Programs for Children With Autism Spectrum Disorder in United States Healthcare Systems: A Narrative Review

## TL;DR

This review proposes a coordinated project-management approach to scale motor-rehabilitation programs for children with autism across multiple U.S. healthcare sites.

## Contribution

A new Coordinated Project-Management Framework is proposed to address multisite implementation challenges in ASD motor rehabilitation.

## Key findings

- Motor-rehabilitation interventions improve motor skills and participation in children with ASD.
- Barriers to multisite implementation include inconsistent training, infrastructure, and reimbursement.
- Implementation frameworks and project-management methods can help overcome these challenges when integrated.

## Abstract

Motor impairments are common in children with autism spectrum disorder (ASD) and contribute to reduced functional independence, participation, and quality of life. Although motor-rehabilitation interventions can improve motor and adaptive outcomes, services are often fragmented, inconsistently delivered, and difficult to scale beyond single clinical settings. Multisite implementation of ASD motor-rehabilitation programs remains limited, underscoring the need for coordinated approaches that address both clinical and organizational challenges.

This integrative narrative review synthesizes representative literature on motor-rehabilitation interventions for children with ASD alongside implementation-science and project-management frameworks relevant to multisite healthcare delivery in the United States. A broad search of peer-reviewed literature and policy sources published between 2000 and 2025 was conducted. Evidence was synthesized qualitatively with attention to implementation-relevant factors, governance structures, and scalability considerations; no quantitative synthesis or statistical analysis was performed.

The reviewed literature indicates that motor-rehabilitation interventions can improve motor proficiency, adaptive behavior, and participation in children with ASD. However, the evidence base is dominated by small, single-site studies with substantial heterogeneity in intervention design and outcome reporting. Key barriers to multisite implementation include variability in workforce training, infrastructure, reimbursement models, data systems, and family engagement across settings. Implementation-science frameworks (e.g., the Consolidated Framework for Implementation Research (CFIR), Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM), and Normalization Process Theory) and project-management methodologies offer complementary strategies to address these barriers but are rarely integrated within ASD motor-rehabilitation research.

Drawing on these domains, this review proposes a Coordinated Project-Management Framework to guide multisite implementation through iterative phases of initiation, planning, delivery, monitoring and evaluation, and sustainability. Scaling effective motor-rehabilitation services for children with ASD will require coordinated, multisite implementation rather than isolated clinic-based efforts. Future research should prioritize piloting and evaluating this framework in real-world healthcare networks using hybrid effectiveness-implementation designs to improve access, consistency, and equity in ASD motor rehabilitation.