46 HOME INSTRUCTIONS

Head Approximation

To aid child in holding head more erect

1. Place child in sitting position, with head and trunk straight. You may have to support the head and trunk in a straight position.

2. Place your hand on top of child's head.

3. Firmly push down on head and release.

4. Repeat several times.

Child will be able to maintain head in an erect position.

47 HOME INSTRUCTIONS

Approximation through the Shoulders

1. Place child in a sitting position with a straight trunk. You may have to support the trunk in a straight position.

2. Place your hands on child's shoulders.

3. Firmly press down and release.

4. Repeat several times.

Child will be able to sit with an erect back.

Neck, back, or legs will become stiff.

48 HOME INSTRUCTIONS

Ball Rolling

1. Place child in a propped sitting position (see Figure 1).

2. Place your hands over the child's hands and assist child in rolling the ball forward (see Figure 2) . As the child improves at this activity, you may decrease your assistance.

When child pushes ball, arms will straighten.

Child's arms will turn in.

49 HOME INSTRUCTIONS

Hand Sweep

1. Place child in a sitting position. Sit behind the child.

2. Hold the child's arm as pictured in Figure 1.

3. Lift child's arm and brush fingers on the floor in a forward motion (see Figure 2).

4. Place child's hand with palm flat on the floor (see Figure 3).

5. Apply pressure downward through the arm. Be sure to keep the elbow straight (see Figure 3).

6. Repeat several times if necessary to get the fingers open and straight.

Child will take some weight on hand with fingers and elbow remaining straight.

Hand will remain fisted or elbow will bend.

50 HOME INSTRUCTIONS

Weight Shift and Protective Extension to Side

1. Place child in a sitting position.

2. Place one hand on the child's shoulder and the other hand on the child's opposite elbow (see Figure 1).

3. Gently push the child at the shoulder (see Figure 1).

4. Assist child in straightening arm and placing hand on the floor (see Figure 2).

5. Intermittently press arm down and release. Repeat several times. Do not lift child's hand off floor (see Figure 2).

Child will bear some weight on arm with elbow and fingers straight. Gradually less assistance should be required to perform this activity.

Elbow will bend or hand will remain fisted.

51 HOME INSTRUCTIONS

To prepare child to shift weight and balance in sitting position

1. Place child in a sitting position.

2. Gently but firmly tip hips to the right while holding right shoulder up.

Desired Response

The child will respond with trunk curving and elongation on the right (see diagram below).

OR

Gently but firmly tip hips to the left while holding left shoulder up.

The child will respond with trunk curving and elongation on the left.

Trunk will remain stiff.

52 Tilting with Arm External Rotation

1. Place the child sitting or, the floor.

2. Support the child by holding at the elbows with the arms straight and thumbs up (see Figure 1).

3. Slowly tilt the child sideways.

4. Gently lift the arm upward as you tilt to the same side (see Figure 2).

The trunk will arch to the side away from the tilt.

1. The child will place his hands down and not adjust the trunk.

2. The head will be unstable.

3. The legs will become stiff and close together.

53 HOME INSTRUCTIONS

Tilting Straddling Leg (for Trunk)

To encourage trunk control

1. Place child straddling your leg.

2. Support the child by holding at the hips as needed (see Figure 1).

3. Slowly tilt the child sideways by rolling your leg and tilting child's pelvis (see Figures 2 and 3).

4. Repeat in opposite direction.

2. Child will maintain the head upright.

1. Child will lose balance.

2. The body will arch back and become stiff.

54 HOME INSTRUCTIONS

Reaching on Stool

To encourage weight shift and reaching

1. Place child on a stool.

2. Provide a favorite toy to reach for just beyond child's grasp.

3. Support at hips or lower trunk if needed.

Child will be able to reach without falling.

1. Child may fall to the side.

2. Child may bend down on one side of trunk.

Reaching to the side Reaching with both hands

55 HOME INSTRUCTIONS

1. To encourage straight arms with outward rotation in sitting position

2. To encourage a straight back and tucking of the head

Instructions

1. Place child in sitting position.

2. Place the arms behind the child as shown (elbows straight, thumbs out).

Desired Response

Child will maintain sitting position with good head control, supporting self on hands. This position can be used while child is watching television or any activities.

Undesired Response

1. Child will arch back.

2. Child will stiffen legs.

3. Child will slump.

56 HOME INSTRUCTIONS

Side Sitting

1. Place child in a side-sitting position (see Figure 1) on right or left side.

2. Provide toys to play with (see Figure 2).

3. Support as needed.

1. Child will maintain balance in side-sitting position.

2. Child will use one hand and two hands to play.

1. Child will be unable to balance.

Dorsiflexion with Knee Extension

To help child learn to pull foot up while knee is straight

1. Place child in sitting position with one knee straight.

2. With firm pressure, rub the ankle from the forefoot to the foreleg. (This should be done on the big toe side of the ankle.)

3. Place a toy (such as a ring) on the child's foot. Have the child reach for the toy while keeping the knee straight.

The foot will pull up either while you are rubbing or when child reaches for the toy.

The child will pull away from you or bend the knee.

58 HOME INSTRUCTIONS

Heel Pressure with Lateral Weight Bearing

To facilitate bearing weight on the heel and outside of the foot

1. place child sitting on a stool with foot flat on the floor with most of the weight on the outside border.

2. Gently apply downward pressure to the knee.

3. At the same time, gently apply pressure outward on the foot.

The child will bear weight on the outside of the foot and heel.

The child will bear weight on the toes or inside of the foot.

59 HOME INSTRUCTIONS

Prone to Sit

To encourage child to come up to a sitting position To encourage bearing weight on arm

To facilitate trunk rotation

1. Place child lying on stomach. One of your hands should be on opposite hip, place your other hand under arm next to you (see Figure 1).

2. Gently pull up, back, and then down on hip. Assist, as needed, with hand under shoulder by pulling forward and up (see Figure 2).

3. This activity should be done slowly and steadily to encourage child to help in coming to a sitting position (Figure 3).

Child will assist in sitting by using head, trunk muscles, and arm.

Back and legs will stiffen.

60 HOME INSTRUCTIONS

Side Sit to Kneel

To attain kneeling from side-sitting position To strengthen hip patterns for standing

1. Place child in a side-sitting position as pictured in Figure 1.

2. Encourage child to come to a kneeling position by holding toy above child (see Figures 2 and 3).

Child will be able to come to kneeling from side-sitting position.

Child will sit back on heels before kneeling.

61 HOME INSTRUCTIONS

To enable child to move from sitting to hands-knees position

If Place child in a sitting position. Bend knee on side toward which you are rotating (see Figure 1).

2. Place one hand on child's hip, one on chest. (Example: tilt to right, place right hand on chest, left hand on hip as in Figure 2.)

3. Slowly rotate child's trunk and tilt toward a hands-knees position (see Figure 3).

4. Continue to rotate until child is in a hands-knees position (see Figure 4).

Child will be able to assist in going from sitting to hands-knees position.

Child will get to hands-knees position without rotating trunk.

62 HOME INSTRUCTIONS

1. Place child on back.

2. Bend one leg up (see Figure'1). .

3. Gently bring leg across body (see Figure 2).

4. Once the child is lying on the side, you may slowly move child back and forth until movement is followed with upper trunk (see Figures 3 and 4). Note: Go slowly to allow child to assist the movement.

The child will follow with upper trunk and roll to stomach.

1. The child will become stiff.

2. The child's arm will hang back so child cannot come forward.