| Developmental Milestones |
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Physiological Flexion, Full head lag with pull to sit, clears nose from the bed on stomach, Pelvis high with legs flexed, head sags forward in supported sitting, hands fisted yet easily opened Possible Red Flags – absence of isolated finger movement; head always positioned to one side; inability to clear face in prone position; exaggerated back extensor arching 1 month Moves both arms and legs while on stomach; alternately kicks legs while on back; able to briefly align head with trunk in supported sitting; opens and closes hands; reaching efforts depend on body position and are linked with visual gaze on an object Possible Red Flags – difficulty flexing legs under body; limited arcs of extremity movement; absence of reciprocal leg movements; no evidence of grasp and release 2 to 3 months: Arms more extended; lateral weight shifting; rolls to back from the belly; alternately kicking legs while on back; midline head alignment; minimal head lag during pull-to-sit; propped sitting may be emerging; reaches and grasps with eye-hand coordination; finger play in mouth; may achieve a 25-30 degree arc through pivot-prone rotation; rolls from side to back Possible Red Flags (2 to 3 months) – Inability to right head at end of pull-to-sit maneuver; arching of back 4 to 5 months: props on elbows with elbows in line with the shoulders ; will weight shift to free arm and reach with one hand while on belly; will pivot while on stomach; begins to push back up onto hands and knees; will alternate feet to mouth and bridging while on back; will also attempt to roll to side with leg or arm leading while on back; ring sit emerging; attempts lateral weight-shift to support the body with one arm and grasp a toy with the other while in sitting; arms are extended fully up in supine to reach in midline; palmar grasp on cube; holds toy with two hands; pivot-prone rotation; may attempt rocking in quadruped and pushing backwards Possible Red Flags (4 to 5 months)- Lateral weight-shifting difficult in prone; unable to extend arms fully and toward midline in supine; kyphotic sitting position; unable to sit erect even with support 6 to 7 months: Plays with feet while on back, Tucks chin and pulls to sit, reaches with bilateral arms, pushes up on extended arms while on stomach, sits independently with hands propped forward, stands with support at hands, rocks on hands and knees, transitions from all fours to sitting, rapid rolling, able to static sit and play with a toy, crawls on belly Possible Red Flags (6 to 7 months) – inability to achieve midline head position in supine or sitting; no evidence of movement in prone; inability to tilt pelvis to bring thighs to hands
Possible Red Flags (8 to 9 months)- commando crawl or bunny hop; w-sit as the only sitting position 10 to 11 months: Creeps/crawls very quickly; pulls to stand by rolling up over feet; pulls to stand through half kneeling; bounces in standing ;transitions to sitting and quadruped; rotates or pivots while sitting to reach; transitions to prone or supine easily; pincer grasp present; sidesteps or cruises with external support; walks with one hand held; lowers to sit on the floor Possible Red Flags (10 to 11 months)- inability to transition among sitting positions; pulls to stand using arms only; inability to stand on flat feet 12 months: stands up through quadruped; moves rapidly into sitting or quadruped to standing; wide variety of sitting positions includes side sitting; rolls a ball; scoops with a spoon finger feeds; independent walking with high guard arms and wide support base; lowers self with control from standing; may begin to move in and out of a full squat position Possible Red Flags (12 months) – trunk and extremity stiffness; laxity or instability; poor coordination may prevent hands-knees locomotion and emergence of standing
13 to 15 months: Sustained standing without external support; stoops to pick up object and regains standing; stands from the floor without support; holds two cubes in same hand; builds 2-3 cube tower; hurls objects to the floor from table or high chair; flings ball with elbow extension; independent walking; climbs into adult chairs; walks backward a few steps; stoops and recovers easily; carries object while walking; creeps up steps or walks up with external support
Possible Red Flags (13 to 15 months) – Moves around environment using bottom scooting, bunny-hop, or rolling
15 to 18 months: Carries or pulls an object while walking; creeps down steps; steps on ball positioned for kicking; tries climbing steps using the railing; turns book pages several at a time; scribbles; builds tower with 3-4 cubes; takes pegs from board attempts to replace; base of support almost equal to width of pelvis; running not well coordinated or with arm reciprocation; walks to the side a few steps
Possible Red Flags (15 to 18 months) – Lacks independent upright walking
18 to 24 months: Stands on one foot momentarily; steps over low barrier; builds 5-6 cube tower; places pellet in bottle; separates pop beads; imitates motor activities; walks up steps with step-to-pattern and external one-hand support; running speed and fluidity increasing; tries to jump off bottom step
Possible Red Flags (18 to 24 months) – base of support wider or narrower than pelvis; falls often while walking or running
2 years: Kicks small ball forward; throws ball overhead; jumps off low step; builds 6-7 cube tower; turns book pages singly; turns doorknobs; ascends and descends stairs alone with step-to-pattern; attempts foot-over-foot with adult support
Possible Red Flags (2 years) – Not walking or falls often while walking; in-toeing or excessive external rotation; avoids arts and crafts projects; base of support much wider than pelvis or narrowed
2 1/2 years: Jumps off step with 1 foot leading; jumps off floor with 2 feet; can imitate walking on tiptoes; mounts tricycle; imitates straight, horizontal, and circular strokes with marker; tripod grip emerging; running well-coordinated with arm reciprocation; walks on line backward
Possible Red Flags (2- 3 1/2 years) – Not walking or falls often while walking; in-toeing or excessive external rotation; avoids arts and crafts projects; base of support much wider than pelvis or narrowed
3 years: Jumps off step and lands with 2 feet; easily propels riding vehicle with feet on floor, may pedal; jumps over 1-2 inch object; positions arms in anticipation to catch ball; imitates cross-stroke with marker; attempts scissor cut; imitates block bridge building; hand preference emerging; walks up steps reciprocally; running with speed and fluidity; jumps off bottom step
Possible Red Flags (2- 3 1/2 years) – Not walking or falls often while walking; in-toeing or excessive external rotation; avoids arts and crafts projects; base of support much wider than pelvis or narrowed
3 1/2 years: Mounts, pedals and dismounts several types of 3-wheel riding vehicles; stands on 1 foot for >3 seconds; hops on 1 foot; kicks ball; may jump forward several times in succession; strings and unstrings beads based on size; builds bridges using blocks; removes bottle cap to check contents; runs up to a ball to kick it; may jump with 2 feet in succession
Possible Red Flags (3 1/2 years) – Response times insufficient to succeed at catching a ball or soft object; unable to maintain single leg stability to kick, hop, or stand on one leg
4 years: Rotation of body follows forward projection of ball; several hops in succession on 1 foot; stands and walks on tiptoes; rides 2 wheeled bike with training wheels; dynamic tripod pencil grip; makes cross stroke; attempts to trace ling; hand preference is established; running fluid with arm reciprocation
Possible Red Flags (4 years) – Does not attempt skills requiring moderate to maximal balance challenges such as climbing and jumping off heights; catching and kicking balls is difficult; ambiguous hand preference
4 1/2 years: Catches ball by preparing arm as ball approaches, elbows may be at the sides; throws ball to another person 8-10 feet away; jumps 2 – 3 inches off the floor; folds sheet of paper in half; cuts large square from paper sheet; beginning to form letters; walks on curb or beam without falling
Possible Red Flags (4 1/2 years) – Difficulty with skills requiring asymmetric body positioning or disassociated extremity movements, such as throwing with one arm, jumping on one leg
5 years: Jumps forward and sideways with 2-foot landing emerging; jumps over objects 6-8 inches from the floor; throws ball to hit target at 10 feet; roller skates; rides a bike; dynamic tripod grip; draws simple shapes, letters or numbers; places small pegs in pegboard and removes them easily; winds string on spool; broad jumps; drop kicks; jumps rope
Possible Red Flags (5 years) – Difficulty mounting or pedaling any ride on toy; often cannot imitate a motor act after seeing another child complete it; base of support wider than pelvis; cannot catch ball; fist grip rather than tripod grip of marker or pencil GROSS MOTOR DEVELOPMENT IN INFANTS WITH MULTIPLE IMPAIRMENTSby Rita Snell, MA, RPT Snell, R. (1997). Gross motor development in infants with multiple disabilities. In D. Chen (Ed.). Effective practices in early intervention. Infants whose multiple disabilities include visual impairment and hearing loss (pp.167-176). Northridge, CA: California State University, Northridge, Department of Special Education (ERIC Document Reproduction Service No. ED 406-795). Typical development A typical infant tends to follow a known developmental progression that starts at birth. As the infant grows and his central nervous system matures, the gross motor skills develop in a head to foot progression (Gesell, 1940). First, at about two months of age, the infant will learn to hold his head up in attempt to look at the world around him. As he begins to notice light and sounds, the curious infant will look from side to side, developing strength and coordination in the neck and upper back muscles. At three to four months an infant will often roll over for the first time while desperately trying to reach for a favorite toy that is just beyond reach. Around six months of age, when placed in a sitting position, the infant keeps himself balanced by propping himself up with both arms. Within a month or two, he is able to get into and out of the sitting position without any help, and use both hands to explore a toy. On the floor he can scoot across the room on his tummy, and later get up on his hands and knees to crawl. Generally by a year of age, the infant has figured out how to pull up to stand, cruise along the furniture, and maybe even attempt a few steps alone, until he is finally walking, climbing, and getting into everything (McGraw, 1943; Gesell, 1945). Effects of disabilities When an infant is developmentally delayed or neurologically impaired, these motor skills are often delayed, and do not develop easily. Gross motor skills occur in a typical sequence. However, these skills can only occur as the infant develops the balance, coordination and postural control needed to move his body about in space (Shumway-Cook & Woollacott, 1985). An infant’s desire to reach out and explore his surroundings is the primary motivator that eventually leads to gross motor development. When an infant’s disabilities interfere with what he is able to see and hear, or impair his overall motor functioning, then an infant will not follow the developmental sequence as we know it (Teplin, 1983). As a parent or early interventionist of a special needs infant, you may already be working with a physical or occupational therapist. Starting with a detailed assessment of your baby, they have probably established a specific program for you to follow. If so, please consider any precautions or specific instructions they have suggested. The activities presented in this chapter are general ways in which you can interact with your infant, while encouraging progress in gross motor development. Although each developmental level builds on a previously developed skill, the infant experiments with many movements at the same time, which are preparing him for higher levels of activity (Gesell, 1949). Playing with your infant and making it possible for him to explore his surroundings is very helpful for the baby’s development. The extent to which each infant will progress depends on the type of impairment and the amount of neurological damage that is present. In this chapter I will cover the various gross motor skills from head control through walking. First we will examine how these skills occur in normal development, then we can look at ways to adapt the environment as well as our interactions with an infant who has multiple disabilities to encourage these developmental skills. Each of these activities will allow the infant to experience normal movement to increase the likelihood that typical movement patterns will develop. In each of the following areas, I have provided a variety of ways to play with your infant, and facilitate developmental milestones. Since infants are motivated initially through their senses, you can choose the most appropriate activity that meets the auditory, visual or physical needs of each infant. Head control Head control is the first movement that a baby achieves, and is necessary to attain other movement skills such as sitting, crawling, and walking (Illingworth, 1983). Head control requires strength and coordination of the muscles which flex (bend) and extend (straighten) the neck. Infants are born with a flexion pattern throughout their neck and bodies, and will develop extension by repeatedly attempting to lift their head and turn it from side to side. A baby will develop head control in 3 major positions; prone (on tummy), supine (on back), and in sitting, as the infant learns to raise, turn and maintain his head in the upright position. A baby is generally motivated to turn his head in attempt to see an object, or to locate a near by sound. A newborn can distinguish colors, focus on a human face, and follow the movement of the face across his visual field (Miranda, Hack, & Fantz, 1977). When a child has a visual and hearing impairment, there are other ways to encourage head control and exploration.
Place baby on floor, lying on his back or stomach: An important way to develop head control in an infant is in the pull-to-sit position. Place the baby on his back, either on the floor in front of you, or on your lap. Place both of your hands behind his shoulders, providing only as much support as he requires, so that his head does not drop back. If the baby’s neck is very weak, you can place your hands behind his head rather than his shoulders initially, and move your hands down to his shoulders as his head control improves. Slowly raise him up towards you, as you bring him from the supine to the sitting position. As his neck and trunk muscles get stronger, you can do this activity by holding the baby’s hands, and gently pulling him up into sitting. This can only be done when the infant shows the ability to bring his own head forward, and uses his shoulders to help you pull him up into sitting.
Shake a rattle, or place a musical toy to each side, encouraging head turning Use flashlight or brightly colored object to encourage baby’s eyes to focus in midline, then slowly move light from side to side, allowing the infant opportunity to turn head as he follows the light. Gently stroke side of baby’s cheek with your fingers, and with a variety of soft textures (plush toys, washcloth) to encourage head turning to each side. Approach and talk to your baby from both sides to encourage turning in both directions. If an infant has the tendency to look toward one side, make an effort to feed and play with your baby primarily from the opposite side. Position yourself directly in front of baby, and use your voice, a musical toy, or brightly colored object to encourage him to raise head up. If your infant shows no ability to raise head up or turn from side to side, place your hand gently on his forehead, and move him through these positions while providing visual or auditory stimulation. Head control in sitting: Have infant sitting on your lap, facing you. With your hands behind his shoulders, gently move him from side to side, as well as forward and back. Move slowly, allowing him time to respond by keeping his head upright. Playing in front of a mirror is a perfect way to work on head control. Sit on floor in front of mirror, with baby positioned on your lap, facing the mirror. Gently rock him side to side, and forward and back, allowing him opportunity to maintain head upright.
Rolling The ability to roll smoothly from back to stomach, or stomach to back requires some degree of head control, and a rotation movement that occurs along the trunk of the body, between the hips and the shoulders. Rolling is the first movement that allows a baby to change his position, and usually develops between 4 and 5 months of age (Caplan, 1978). An infant with abnormal muscle tone may have difficulty with this movement. Spasticity can cause stiffness through the trunk, interfering with a coordinated rolling movement. A baby who is weak or floppy may not be able to begin the movement, as rolling requires enough strength to move against gravity. As with head control, a baby is generally motivated to roll when an object of interest is off to one side, and he is determined to get to it. An infant with visual and auditory impairments can be encouraged to roll by providing him with brightly colored objects, musical toys, or your voice introduced from the side. If a baby is physically unable to roll, you can help him roll so he can experience this pattern of movement. A child who is visually impaired generally prefers being on his back, and will often learn to roll from his stomach to his back to avoid being on his stomach (Fraiberg, 1971). It is important for these infants to spend some time on their stomach, however, as many skills are developed when a child plays in this position. The prone position allows the baby to develop weight shift to each side, weight bearing through both arms and shoulders as he begins to prop on his forearms (Hanson & Harris, 1986), and trunk rotation as the baby reaches for a toy in front of him. Rolling from stomach to back Place infant on the floor, lying on his stomach: While baby is on his stomach, be sure his head is turned toward one side. Slightly tuck his opposite shoulder under him. Place a rattle or brightly colored toy in front of baby, where he can easily see it. Slowly raise it above where he is lying, encouraging him to follow it while turning his head, and shifting his weight over towards the tucked shoulder. The baby will then be in a position to roll over onto his back as he continues to follow the toy. If he stops following the toy or sound, bring it back to where he can easily see or hear it, and continue again from there. If baby gets stuck anywhere along the way, gently grasp the baby’s top leg and help him to complete the rolling movement. Switch off doing this to both sides. If the baby displays abnormal muscle tone, spasticity may interfere with rolling from stomach to back. You can physically assist the infant with rolling to help teach him this movement. Place the baby on his stomach, and as he looks toward one side, you can tuck his opposite arm slightly under him. Gently grasp the leg on the side toward where he is facing, holding near the hip and the knee. Bend that leg up slightly, and help him to roll over onto his back. This can be repeated to both sides. If a visually impaired infant does not like the prone position, you can use pillows and wedge shapes to help him prop in that position, so that he can develop head and trunk control in his extensor muscles.
Rolling from Back to Stomach Place infant on the floor, lying on his back: Present a rattle or brightly colored toy in front of baby. As he focuses on the toy, move it off to one side, and slightly above the level of his head. As baby follows the object, he will be encouraged to roll toward his side, facing the toy. If baby is unable to complete the movement, gently grasp his leg on the side opposite the toy, and assist him to roll onto his side, then over to his stomach. Place brightly colored or musical toy to one side, and slightly above the level of baby’s head. Gently grasp baby’s leg on side opposite toy, and rotate that leg across baby’s body, moving him onto his side. Assist infant to reach up toward toy, and continue to roll him onto his side, then over to his stomach, as he completes the rolling movement. If baby cannot see or hear a toy, you can place him on his back, and gently move him through this position so that he can repeatedly experience this rolling movement. Sitting The ability to maintain a sitting position requires a baby to have developed equilibrium reactions and protective responses in the forward, backward, and side to side directions (Bobath, 1964). If a baby has difficulty with maintaining balance, his equilibrium reactions can often be improved by playing with him in the sitting position, and challenging his balance in all directions. If a baby has muscle tightness in his legs, or weakness in his neck or trunk muscles, sitting will be more difficult for the baby. Initially a baby sits by propping forward with both hands in front of him. As his balance and upright posture improve, he maintains the sitting position by placing a hand to one side or the other as needed to keep himself sitting upright. Eventually the baby can hold himself in a good sitting position without the use of his hands for balance. Developing the sitting position: Place baby on the floor in a sitting position, and seat yourself behind him to provide support as needed. Place toy or familiar object on floor in front of infant to encourage him to prop forward on both hands. If baby cannot put both hands on the floor, you can help by placing both of his hands on floor, and gently placing your hands over his to give him the sensation of taking some weight through his hands and arms. While your hands are still over his, rock him forward over his hands several times to help facilitate this propping position.
Once the infant can prop forward, you can begin to encourage side to side balance. Place a toy or familiar object off to one side, and slightly in front of the baby. Assist him to support his weight on the hand near the toy, as he reaches with the opposite hand. As you switch sides with this activity, the baby will have the opportunity to develop weight bearing and protective responses to each side. If the infant falls to the side while in the sitting position, you can teach him to use his hands for balance. Start by placing one of his hands out to the side. Gently shift him off balance to that side, so that he needs to use that arm to maintain sitting balance. Switch off doing this to both sides. As the baby’s arm supports his weight in this off-balance position, he will be learning how his arms can support him. The baby will begin responding by putting his arms out automatically as he leans to one side, until eventually he can maintain the sitting position without the use of his arms.
The visually impaired infant generally develops sitting around the same time as a sighted infant. It is common for them to be slower learning to get in and out of the sitting position. Try to provide a reason for the baby to get out of sitting, such as a musical toy just out of his reach. There are many opportunities throughout the day to practice sitting with your infant. Each time you change a diaper or dress your infant, encourage them to assist in coming to sit by rolling toward one side, and pushing up into sitting with that arm. Pull to stand, cruising and walking Once an infant develops strength, coordination, and balance to move about freely on the floor, he will begin to pull up to stand and discover ways to explore things that were previously out of his reach (Bly, 1980). As a baby pulls to his feet and stands, he gains further strength and control in his trunk and leg muscles. Soon he develops enough strength and balance to “cruise” along furniture, as he sidesteps to reach a new destination. This sidestepping teaches the weight shift your baby will need to take steps forward in walking. When an infant has increased muscle tone, the stiffness through the legs and possibly the trunk may interfere with pulling to stand, and maintaining the upright position. Often the spasticity will make both legs move stiffly together and cause the baby to weight bear up on his toes. When this happens, the baby will benefit from activities that encourage the legs to work separately, and help maintain the feet flat on the floor. Adaptive equipment is sometimes needed to assist your baby with walking, such as special braces or a walker. These would be recommended by your therapist or orthopedist, and they will be able to instruct you in the proper use of any adaptive equipment that is necessary. A visually impaired infant will often be delayed in walking, as he may feel insecure in the upright position. Very little of his body is supported once he is up on his feet, and he may prefer being on the floor until closer to 18 months of age (Fewell, 1983). Once he does show some interest in walking, he will need to be encouraged to move toward musical or noisy objects, or a familiar voice that is slightly out of his reach. It is also normal for the visually impaired infant to keep his feet further apart for a longer time, as he is understandably more unsure of himself without the visual input, and this will allow him to feel more balanced and secure during the first few months of walking. Pull to Stand: Once your baby gets around well on the floor, he will probably begin to play in the “tall kneel” position, where he is up on both knees, and usually holding onto a surface such as a couch or low table. If your infant is unable to assume this position, you can place him in this kneeling position, where he can support himself against a couch or low table or chair. Position yourself behind him, with your hands at his hips. Gently shift him over to one side, which places most of his weight on that leg, and very little weight on the opposite leg. This will allow him to pick up the leg he is not weight bearing on, and bring it up, so that he is in a half kneel position. From here, he can pull himself all the way up to stand, or you can assist him up into a standing position by keeping your hands at his hips, and shifting his weight slightly forward over his feet, and upward. Position yourself seated on the floor, near a low table or couch. Place baby on your lap, facing away from you. Place a toy of interest, or a snack on the low table, and with your hands at his hips, shift his weight forward over his feet, and help him to assume the standing position. As he develops more strength and trunk control, allow him to do more of the work in pulling up to a standing position . Once your baby is in the standing position, you can help improve his standing balance by gently shifting his weight from side to side, and encouraging him to support his weight on each leg, as you rock him to each side. Place your hands at his hips as you shift his weight from side to side, so that his arms are free to help him balance.
Cruising: To help strengthen your baby’s trunk and hip muscles so that he is able to cruise along furniture, have him stand on your lap while you are sitting on the couch or a chair. Hold both of your baby’s hands, and gently move your legs up and down, one at a time, so that he will be shifting his weight from one side to the other. If he needs more support, place your hands at his hips to do this activity. Walking: Have baby push a small chair, box, or push toy with a handle that is made for this purpose. Stand behind your infant, and give support with your hands at his hips, as you move the object just a few inches in front of your baby. Allow him the time to shift his weight forward, and take a step, as he moves toward the object he is pushing. Repeat this, continuing to move object just a few steps at a time, so baby has a chance to balance himself as he moves forward over alternating legs. Position yourself on the floor behind baby while he is in a standing position. Place your hands at his hips, so that his arms are free to help him balance. Move yourself along behind your baby as you help him shift his weight from one leg to the other, allowing him to move forward in a walking pattern. As his balance and upright posture improve, offer him less support. Try to make walking a purposeful activity for your baby, and encourage him to be up on his feet as you need to move from one room to another. When it is bath time, for example, assist him into an upright position, and use the technique described above to help him weight shift, and take steps forward into the bathroom. Summary All the play activities discussed here are presented in a way to help you understand normal development and movement patterns that your infant can benefit from. Once you understand the various ways to help your baby, you can begin to incorporate these ideas into everyday play that will be fun for both you and your baby. Most of the activities can be done on your lap as you sit on the floor or the couch, or even across your chest as you play on the floor with your infant. Just carrying your baby from room to room during the day can be an opportunity to help your baby develop head control if you provide only the support he needs, and allow him to assist with holding his head and trunk upright. If he tends to look primarily to one side, carry him in a way that he must look to the opposite side to see you. Having your infant stand on your lap, supported at the shoulders or hips, or even standing him next to you while you sit on the couch is a great opportunity to encourage upright posture, weight shift, and equilibrium in standing. Introducing toys and food from different sides encourages head control and trunk rotation that is needed in all of your baby’s motor skills. Dressing is an excellent opportunity to work on balance and weight shift if you have your baby stand to put on his pants, and sitting at the edge of the couch or your lap to put on his shoes and socks. Gross motor development is an important area to develop in your infant, as it will allow him the opportunity to be mobile, and to interact with his surroundings. It is exciting to see the changes in your baby’s overall growth and learning as he gains control over his movement and his motor abilities. References Bloom, M. (1980). Life span development: Bases for preventive and interventive helping. New York: Macmillan. Bly, L. (1980). The components of normal movement during the first year of life.Chapel Hill, N.C: University of North Carolina. Bobath, K. & Bobath, B. (1964). The facilitation of normal postural reactions and movements in the treatment of cerebral palsy. Physiotherapy, 50, 246-252. Butterworth, G. & Hicks, L. (1977). 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New York: Hafner. Miranda, S.B., Hack, M., & Frantz, R.L. (1977). Neonatal pattern vision: A predictor of future mental performance? Journal of Pediatrics, 91, 642-647. Shumway-Cook, A. & Woollacott, M.H. (1985). The growth of stability: Postural control from a developmental perspective. Journal of Motor Behavior, 17, 131-147. Teplin, S.W. (1983). Development of blind infants and children with retrolental fibroplasia: Implications for physicians. Pediatrics, 71, 6-12 Resource list Batshaw, M.L.(1997). Children with disabilities (4th ed.). Baltimore: Paul H. Brookes. Boehme, R. (1990). Approach to treatment of the baby. Tucson, AZ: Therapy Skill Builders. Brown, C.C. & Gottfried, A.E. (Eds.) (1985). Play interactions: The role of toys and parental involvement in children’s development. Skillman, NJ: Johnson and Johnson. Diamant, R.B. (1989). Positioning for play; home activities for parents of young children. Tucson, AZ. Therapy Skill Builders. Finnie, N. (1975). Handling the young cerebral palsied child at home. New York: E.P. Dutton. Hagstrom, J. & Morrill.J. (1981). Games babies play and more games babies play. New York: Pocket Books. Jaeger.D.L. (1987). Home program instruction sheets for infants and young children. Tucson, AZ. Therapy Skill Builders. Parks, S. (1988). HELP … at home. Activity sheets for parents. Palo Alto, CA: VORT.
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