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Physiotherapy
Home programmes for children with motor delay
Sarah Crombie
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CONTENTS
Section one 1
Personal Information About Your Child
Section two 10
Home Exercises
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ACKNOWLEDGEMENTS
I wish to thank the physiotherapy staff at the Wilfrid Sheldon Child Development Centre, especially
Rowenna Hughes, Inge Gregorius and Helen Farmer, for their encouragement and assistance in the
development of this material. Thanks go also to Jane Macer, Irene Sclare, Caroline Griffiths and David
Crombie for their contributions and to Jonathon Evans and Gail Thurley for the illustrations.
Sarah Crombie is currently working as a superintendent physiotherapist for the Royal West Sussex Trust at
St Richard's Hospital, Chichester and in the community. This involves the treatment and management of
children with developmental delay and neurological problems, working closely with their families and carers
at home, the nursery or in school.
Earlier in her career Sarah worked as a clinical physiotherapist at the Wilfrid Sheldon Child Development
Centre, London and at King's College Hospital, London. When working as a senior physiotherapist at the
Centre she was awarded a grant for a two-year project whose purpose was to extend and develop
physiotherapy services in the community. During this time a further grant was obtained to develop and pilot
the programme which is the core of this manual. Sarah is at present undertaking a Master of Science degree
in rehabilitation research at Southampton University.
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INTRODUCTION
The Physiotherapy Home Programmes for Children with Motor Delay has been designed for use by
physiotherapists to compile personalized home exercise and management programmes for children with
motor delay or dysfunction. An illustrated programme can be devised to meet the individual needs of the
child and made easy to read and use at home by parents or by teachers and other staff caring for the child.
This programme can be readily revised and updated as necessary.
The manual is divided into three sections:
Section 1 comprises information sheets on which to enter personal details about the child, important
information related to therapy, individual goals for therapy, equipment lists and so on. As these are individual
sheets, they can be selected and tailored to meet the specific needs of the particular child.
Section 2, the major part of this manual, contains diagrams with a simple text illustrating exercises which
may be continued at home or at school, as an adjunct to any treatment and management programme. The
exercises would need to be carried out under instruction from individual therapist.
Section 3 provides further information on the areas of play and communication.
Overall, the manual will serve as an important source of information and a reminder of exercises to continue
at home. It promotes easy communication between parents and others involved in caring for the child and
ensures that they all work together to share the same goals in the child's therapy and everyday activities.
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SECTION 1
PERSONAL INFORMATION ABOUT YOUR CHILD
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SECTION 2
HOME EXERCISES
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A: Relaxation Techniques
__ Lay baby on your lap or on the floor. Make sure the arms are forward and not curled up under the body.
__With your hand gently pressed down on baby's bottom, slowly rock the hips back and forth.
__This will help to relax your baby generally, and is always a good exercise to start with.
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__ Hold baby on their side with their back against your stomach.
__ Put one hand under the shoulder, one on the hips.
__ Hold the shoulders still and slowly twist the lower part of the body away from and towards you.
__ This is a good exercise to do before others as it helps to relax the body generally.
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__ Lay the child on your legs, keeping the body as symmetrical as possible, that is, with the head in the
middle.
__ Slowly lift and lower the hips to help them relax.
__ Try lifting one hip only so the body twists a little, and then lift the other side. The shoulders should remain
still.
__ The legs will become more relaxed as you do this. Turn them out to help this.
__This is a good exercise to relax your child before doing others.
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__ This exercise should be done when the hips have already been relaxed.
__ With one hand, hold the knee to keep the leg straight.
__ With the other hand, hold the foot bent upwards, that is, as if the child is standing on it.
__ Keep the leg turned outwards and slowly move the whole leg up and down in the direction of the opposite
shoulder.
__ The leg should relax and so relax the hips more.
__ Do the same with the other leg.
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__ Keep the child's arms forwards and place your hand on their bottom to steady the child on the ball.
__ Keep the legs apart and turned out, that is with heels towards each other.
__ Slowly rock the child's bottom from side to side.
__ Gently stretch one leg out and then the other.
__Carry on until you feel your child relaxing.
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__ By first straightening and turning out the arm, you make it easier to stretch out the thumb and then the
fingers.
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__ When trying to part the legs, for example for nappy changing, do not hold the ankles but the knees.
__ Turn the legs outwards as you do this.
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__ Put your fingers under the toes and stretch them out.
__ Lay them down flat.
__ Keep doing this whenever the toes curl up, as this is often a sign of the whole body getting tight.
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__ Carry your baby in a curled up position with the shoulders forward and the hips bent up.
__ Support behind the neck and shoulders, not just the head.
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__ Carry your child as shown, with their legs around your hips.
__Support them under their bottom.
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__ Carry the child with your arm between their legs and your hand under the chest or, if they are bigger, with
one arm under the chest and shoulders and the other keeping the legs up.
__ Try to keep their arms and legs turned out.
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__ Carry baby with their back against your front, legs bent up.
__ Support them under the thighs
__ Keep their legs apart.
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__ Turn your child over onto their front before you lift them up. Put one arm between their legs to keep them
apart.
__ Hold your child close to you and slowly stand up.
__ Remember to bend your knees, not your back.
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SECTION TWO
HOME EXERCISES
__ Place one arm between the child's legs to keep them apart.
__ Roll the child up and towards you, curling them up as you do so.
__ Lift them onto your lap and then stand up.
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C: Prone Activities
__ Encourage your child to lie on their front to play and to take weight on their forearms.
__ Put a toy in front to encourage your child to lift up their head.
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__ This is a good position to help encourage your baby to lie on their front and to lift their head up.
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C10: Encouraging your child to take weight on the arms (ball activity)
__ Hold the child's thighs, and keep the legs apart and turned outwards, that is heels facing each other.
__ Slowly rock the child forwards over the ball until the child's hands are on the floor.
__ Encourage the child to take some weight through their hands.
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D: Rolling
__ With the child lying on their back, practise rolling from side to side.
__ Do this by placing your hand on one hip and slowly moving it so that your child is lying on their side.
__ Do this to both sides and do it slowly so that your child has time to move with you.
__ When your child is able, you can then carry on to help them to roll right over onto their front.
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__ Help your child to roll over from their back to their side.
__ Hold the legs as shown.
__ Try to dothis slowly so that your child can join in and do as much of this movement as they can for
themselves.
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__ With your child lying on their back, hold one leg at the knee.
__ Bend the knee slightly and slowly bring it across their body. This will roll your child over onto their side.
__ Try to do this slowly so that your child can join in and do as much of this movement as they can for
themselves.
__ Reverse this to roll to the other side.
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__ With your child lying on their back, hold their hands above their head with the elbows straight.
__ Slowly bring one arm down and across the body, while keeping the other arm up.
__ Encourage your child to look the way they are rolling.
__ Use the top arm to guide them, encouraging the top leg to bend to help roll over.
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E: Supine Activities
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__ Encourage your child to bring their hands together, and play with their hands in this position.
__ You can also help your child to take their hands to their mouth and reach forward to touch your face.
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__ Lay baby on your lap and encourage them to bring their hands together, as shown.
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__ Encourage your child to touch their feet with their hands by lifting their legs up.
__ you can also help by lifting up their bottom to bring their feet closer and/or by putting theirhead and
shoulders on a pillow.
__ Encourage them to play like this and learnabout their body.
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SECTION TWO
HOME EXERCISES
E: Supine Activities
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__ Place a rolled up towel or blanket behind baby's back to keep them on their side.
__ When baby is sleeping, a blanket tucked diagonally across from the shoulder will help to keep them lying
on their side.
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__ Make sure the child's back is flat against the back of the board.
__ A pillow under their head should help to keep the head straight.
__ A pillow between the legs will help to keep the legs apart. (Remember to support the feet too.)
__ Use the straps to keep the child in this position.
__ Encourage your child to bring their own arms forward and play in this position.
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G2: Getting from lying to sitting: encouraging control of the head (1)
__ Place your hands behind your child's shoulders and gently support the head with your fingertips.
__ Make sure that they are looking at you with their head in the middle.
__ Bring them slowly up to the sitting position.
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G3: Getting from lying to sitting: encouraging control of the head (2)
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G4: Getting from lying to sitting: encouraging control of the head (3)
__ From lying down bring your child up to the sitting position, holding their hands.
__ Make sure that their head is in the middle and encourage them to grasp your thumbs. Hold them around
the wrists.
__ Bring your child slowly up to the sitting position, letting them do as much of the work as they can.
__ You can help them to go down again in the same way.
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G5: Getting from lying to sitting: encouraging control of the head (4)
__ From lying down bring your child up to the sitting position by holding one hand.
__ Start by tilting them gently over to one side and let them push up with that hand.
__ Do This slowly so that your child can do as much of the activity as possible.
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H: Sitting Activities
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__ Sit your child on your lap, holding their hands. Let them grasp your thumbs.
__ Keep the arms forward and gently bob your child up and down, using your knees.
__ You can then try slowly rocking from side to side.
__ This all helps to develop balance in sitting, but needs to be done slowly, so that your child can move with
you.
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__ Let your child sit on the floor to play. Hold the hips to give support and encourage play with toys in front
of them
__ Later on, when balance has improved, you can encourage your child to reach for toys on either side and
keep their balance.
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__ When sitting on the floor to play, hold the child's knees to give support.
__ Try to keep the legs rolled outwards, that is with heels facing each other.
__ Encourage them to reach for toys to either side and to keep their balance.
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__ Try sitting on the floor with your child supported between your legs.
__ One leg can act as an anchor for the child's legs, and the other one as a cushion behind.
__ Encourage reaching forward.
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SECTION TWO
HOME EXERCISES
H: Sitting Activities
__ Sit your child on your lap and hold them at the hips.
__ Tilt them slowly to one side and then to the other.
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__ Sit your child astride the roll, feet flat on the floor and knees bent.
__ Encourage them to play with toys in front of them, either on a low table or on the floor.
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__ Support your child at their hips as they bend forward to reach for a toy.
__ Encourage them to come back up to the sitting position.
__ Use this position also to play with toys on either side of the roll.
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__ Sit the child on a roll between two boxes or chairs. Position these slightly forwards of the child.
__ Encourage them to reach sideways over to one box for a toy and then to the other.
__ Make sure the feet stay flat on the floor.
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__ Sit your child on a stool with their feet flat on the floor.
__ Play games involving reaching out in all directions: in front, on the floor, to the sides and behind.
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__ Sit your child on a stool or low table with their feet off the ground.
__ Encourage reaching out for a toy while keeping their balance.
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__ Bend one of your child's legs up and turn it slowly to that side.
__ Support the child at the hip and under one shoulder.
__ Encourage your child to move forward and take weight on their hands and then bring their other knee
forward.
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__ Hold the arms as shown, turned so that the palms face each other.
__ Bring the child's weight forward over their feet and then help them to stand up.
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__ Stand the child up, using their arms to bring their body weight forward.
__ Ask the child to sit down to one side and then to stand up again.
__ Do the same to the other side.
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Kneeling Activities
__ Place your child in the crawl position. Support their hips with your legs if necessary.
__ Tap gently down through the shoulders to encourage your child to take weight through their arms.
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SECTION TWO
HOME EXERCISES
J: Kneeling Activities
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K: Standing Activities
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__ Stand your child with their body flat up against knees straight. a wall.
__ Their heels should be back against the wall, their knees straight.
__ Encourage them to balance in this position.
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__ Find a surface that your child can use to help them to remain standing up, as shown.
__ Encourage them to keep their balance in this position.
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K: Standing Activities
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__ Stand the child in front of you, with one leg up on your lap.
__ Hold the foot that is on your lap and encourage the child to keep their balance.
__ Make sure their bottom is tucked in.
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L: Walking
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M: Miscellaneous
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For the baby with tightness on the left side of the neck (reverse for the other side).
__ Lay the baby on their side with their back flat against you.
__ Hold the left shoulder steady with your right hand.
__ Using your other arm, gently stretch the left side of the baby's neck by moving their head up towards you.
__ Hold this stretch position for a few moments.
__ Sit the child on your lap facing away from you.
__ Hold the left shoulder steady so that the body will not twist when you move their head.
__ Gently turn their head to the right.
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B
Bridging (1) 51
Bridging (2) 52
C
Carrying baby curled up 23
Carrying baby facing away from you 26
Carrying baby on your hips 24
Carrying in the 'aeroplane' position 25
Carrying your child to help strengthen the back 27
Correct standing posture 89
E
Encouraging balance when sitting 70
Encouraging head control when sitting 61
Encouraging reaching for the feet (1) 49
Encouraging reaching for the feet (2) 50
Encouraging reaching out from lying on a roll 39
Encouraging sitting, holding the shoulders 65
Encouraging standing balance 102
Encouraging standing: holding the knees 98
Encouraging the crawl position (1) 84
Encouraging the crawl position (2) 85
Encouraging walking, holding arms behind 107
Encouraging walking, holding arms up 108
Encouraging walking, holding the hips 105
Encouraging walking, holding the shoulders 106
Encouraging your child to take weight on the arms 41
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G
Getting from lying to sitting:Encouraging control of the head (1) 57
Getting from lying to sitting:Encouraging control of the head (2) 58
Getting from lying to sitting:encouraging control of the head (3) 59
Getting from lying to sitting: encouraging control of the head (4) 60
Getting from sitting to standing 80
Getting the hands together (1) 46
Getting the hands together (2) 47
Getting the hands together (3) 48
Getting up from lying on their front to the sitting position 56
H
Helping to separate the legs 21
Helping your child to sit (1) 62
Helping your child to sit (2) 63
K
Kneeling up against a surface 86
Kneeling up on one leg 88
L
Laying baby on their side 53
Laying baby prone on you 34
Laying the older child on their front 37
Lifting your child up from the floor (1) 28
Lifting your child up from the floor (2) 29
Lifting your child up from the floor (3) 30
Lying on their front to play (1) 31
Lying on their front to play (2) 32
Lying on their front to play (3) 33
Lying on their front to play (straight arms) 36
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M
Moving from sitting to the crawl position 79
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O
Opening hands and fingers 18
Over a roll with weight on the arms 38
P
Play over legs 35
Playing in the kneeling position 87
Putting on an AFO 112
R
Reaching out while sitting 64
Reaching sideways when sitting on a roll 75
Reaching up when sitting on a roll 74
Relaxing a tight arm 19
Relaxing baby 11
Relaxing baby on your lap 10
Relaxing over a ball (holding arms) 15
Relaxing over a ball (holding legs) 14
Relaxing the body 12
Relaxing the body by moving the legs 13
Relaxing the toes 22
Relaxing your child in the sitting position 16
Rolling over, holding one leg 44
Rolling over, holding the hips 42
Rolling over, using both legs 43
Rolling over, using the arms 45
S
Shoulder movements 109
Side sitting 69
Sitting astride a roll (1) 71
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The side-lying position for play 54
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Using a side-lying board 55
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SECTION 3
OTHER INFORMATION ON DEVELOPMENT
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__ If your child is not interested or gets irritable when you help them to play, do not become disheartened.
Try to think of any reasons for the play activity not being right for your child.
Toys and games are not a substitute for contact with other people. Make sure that your child's play draws in
other people, especially other children. Quite often disabled children are left out. Help them to notice others
and to be noticed. Help them to share, and encourage other family members to include them in their
activities.
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Do make sure that you use everyday experiences as much as you can to help your child play and learn. Let
them crawl into boxes or under tables to play as often as you would any child. Let them drop and scatter
toys, but do encourage them to pick them up once they are strong enough.
Be as keen and interested in small steps to progress as in those big experiences with special toys. Finally,
build in play times as part of the everyday routine. Talk and explain to your child while you play. Keep
going, keep to what is manageable for you and your child, and make it fun for both of you.
Your physiotherapist and speech and language therapist will be able to give more practical advice about the
sorts of activities that will help your child best at each stage of development. They can also advise on the
sorts of toys that will suit your child's needs and interests.
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Getting Started
From the start, it is important to watch and listen to your child. Your child is also learning to watch and listen
to you. Children listen to the sound of your voice long before they understand what you are saying. Playing
with sounds while you are handling your child can be very reassuring. Babies soon learn to enjoy this early
play and especially like their own sounds being repeated back to them; in this way they know they are being
listened to. Soon they begin to expect these games and may indicate that they want more by becoming noisier
or waiting expectantly at times when these games are normally played. Songs and rhymes combine sound and
movement and can be exciting or soothing to a child who is depending on you. They also help children learn
about the patterns of speech.
Some parents recognise at this stage that their child is not responding because they have problems hearing or
seeing. It is important that early help is available as hearing and visual impairments will affect the child's
development and interfere with speech and language learning.
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Show an interest in the things your child enjoys and always talk about what they are doing. Keep your
language simple and to the point. Use your hands and facial expressions to emphasise what you are saying.
Once your child begins to attempt to say or indicate words, give them lots of encouragement. Saying ''yes",
smiling and repeating the word back may be all that is required. It is not helpful to correct your child's efforts
all the time, however much you want them to progress. Once your child is using words regularly to draw
things to your attention, you can begin to extend what has been said. For example, you could respond to,
"Mummy bus" by saying, "Yes. It's a big bus."
Things to Remember
__ Listen to your child and watch what they are telling you.
__ Let your child know they are understood
__ Give your child opportunities to listen and develop their attention: for example, playing with sounds;
singing songs with actions; looking at pictures together; telling stories.
__ Use your face and hands to express yourself as you talk to your child.
__ Repeat your child's speech back to them and gradually add to their ideas
__ Make your child aware of your pleasure in their attempts to do and say things, even if they are not always
correct.
__ Help your child to feel successful, however they communicate.
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