Thoughts About Movement Therapy in Early Intervention for Infants at Risk

A collection of thoughts, new ideas, research updates 

  • Elethu is a alert and friendly 6 weeks old (corrected age) little boy. He was born preterm at 32 weeks and spent 5 weeks in the NICU. Elethu's mother Zuki has brought him to the early intervention clinic for his 6 weeks developmental check up.

  • Max 9m sitting blocks 4.jpgIn this blog I argue that any PT or OT  intervention should start with identifying what the infant is able to do, in other words, with her or his abilities, and use these as a the starting point for expanding the infant's range of abilities. 

  • A list of the factors that shape infant perceptual-motor learning

  • One of the most important principles of movement task training is the idea of task specificity which basically means that you learn what you practice.

    This is because the the task demands determine the just right and specific stability, alignment and balance adaptations needed to support the sequence of movements that are needed to complete a task.

    When an infant engages in intentional, goal directed actions they have the opportunity try different options for achieving a goal.

  • Below is a video clip from Amy Sturkey's You tube channel. 

    In this video Amy shows an exercise for training sitting balance. 
    Amy nicely illustrates how she adjusts to level of support needed for the infant to maintain the trunk erect. 

    Take a look and evaluate the training session with reference to the different factors that enhance motor learning.

  • Slowly but surely it is becoming clear that our options for delivering therapy in early intervention will continue to be shaped by the Covid-19 pandemic for a long time to come.

  • Everyday objects provide many different ways to make posting boxes for different skill levels.

    W posting rod.jpg

  • Activities using everyday objects found in the home  

    tubs 4.JPG

  • A common assumption, held by physical and occupational therapists, is that balance is a generic process that can be improved by a set of activities that challenge balance responses/reactions.

    An example is exercises standing on a rocker board to improve "balance" in a child who falls a lot. Therapists will often have favorite set of exercises to improve a child's balance. 

  • Each therapy encounter is an opportunity  to provide the infant or child with the very best possible environment to foster learning from experience and thereby promote function and participation, as well as confidence in their own ability to figure things out for themselves and  willingness to persist and ability. 

    Jacob sit throw_1.jpg

  • Two important questions

    What lies at the heart of every encounter between a therapist and an infant or child? And what is it that we as developmental therapists wish to achieve? 

    For me the answers to these two questions are quite clear and really quite simple.

    Firstly at the heart of each and every moment I spend with a child is a positive and enabling relationship based on trust that values and honours the infant's or child's feelings, needs and goals just as they are in that moment. 

  • Wallen et al (2017)  have published a commentary in the Australian OT Journal  on two papers (Hadders Algra 2017, Novak et al 2016) which reviewed the evidence for early intervention in cerebral palsy.

  • In a new series of TOMT 0-3 blog posts I would like to share with you some video clips of my three grandchildren that have led to Ah Ha!  moments, shifted my perceptions, challenged my assumptions or illustrated a  particular principle.  

    L 6m rolling 21_2.jpg

  • And motivation is essential 

    Infants and toddlers with movement difficulties (developmental delay, joint hypermobility, low muscle tone, developmental coordination disorder, autism, Down's) may need dedicated time and support for learning new hand (fine motor) tasks. 

    Poor fine motor development is often associated with low motivation and poor attention abilities, along with a tendency to avoid tasks that unfamiliar and appear to be difficult.

    R 9m graband pull 4.jpg

  • T 11m tin and blocks 7.jpgHow and when do exploratory behaviors give way to goal directed actions which require a sequence of movements adapted to the requirements of the task and characteristics of the object and environment to complete successfully?

  • 16m-attention-posting.jpgInfants acquire new abilities and skills through active experience; they learn by doing. Importantly, brain development is promoted when infants and toddlers engage in intentional, goal directed actions: they know what they want and use all their available resources to achieve their goal.   


  • Will8m2w standing with support 2_1.jpgIn this weeks video clip you see Will, aged 8 months, who is new to standing with hand support. I was particularly struck by how he "knows" how to lean on his forearms when he needs to increase his base of support and free his hands for exploring a toy. 

  • max 4m2w manual neck elongation 6_1.jpgActive mobilization and stretching use the same basic principle as PNF hold/contract relax: select a position that that lengthens the soft tissue structures that are restricted, and then maintaining the stretch on the elongated structures, encourage active movement that induces a contraction in the surrounding muscles. 

  • Toddler skittles 7_1.jpgBuilding the case for a principled, structured, systematic approach to early intervention one blog at a time 


  • clambering 3_1.jpgKaren Adolph, from the NYU Action Lab, has done a series of very elegant studies in which she demonstrates how infants learn through experience when it is safe to crawl or walk down a step, over a gap or down a steep slope. 

  •  W 32m step up 3_1.jpgCentral to any analysis of a child's goal directed actions is the interaction between the child, the task and the environment. 

    Successful performance of a task such as stepping up and down, depends on adapting the postural responses and patterns of movement to the structure of the environment, provided by visual information pickup.


  • After reading the study by Ragnhild Håkstad and colleagues research article Let's Play.  I thought it would be interesting to take a closer look at my own play skills and ability to play in a cooperative manner with infants and toddlers. 

  • In this TOMT Blog I will be looking at some of the ideas that have  influenced and challenged my own thinking, and show how I have integrated them into my clinical decision making. 

  • T 9m sit tip back 9.jpgTwo important questions
    What lies at the heart of every encounter between a therapist and an infant or child? And what is it that we as developmental therapists wish to achieve? 

  • Stepping up 20m step 11_1.jpgI am busy working on an article covering the assessment and training of stepping up and down in toddlers. To this end I was doing a frame by frame analysis of stepping up onto steps of different heights and was thrilled to find a wonderful example of how a toddler adapts the motor plan to suit the context of the task. 

  • Using enactive and phenomenological views on cooperation, attention and intentions  Hakstak et al (2017) investigated how PTs scaffold and use play in physical therapy interventions with preterm infants. 

  • M17 threading 3.jpgEach time I review a video clip of  one of my grandchildren engaged in a new manipulation activity I am impressed by how they use a combination of repetition and exploration. 

    In this video clip you see Max (16 months) exploring different ways to playing with a serviette ring and threader attached to a ribbon. 

  • Prone kneel hips abducted.jpgInfants with developmental delay, joint hypermobility, Down syndrome and preterm infants often lack the strength, flexibility, coordination and effective balance responses needed for active prone kneeling.

  • W 15m stand up 45_2.jpgRecently I was asked about the development of standing up from floor standing in toddlers and young children. This sent me trawling through my library of video clips to find examples of children rising from standing and here is my answer to the question. 

  • W 7m prone 11.jpgHow do infants develop the basic postural and movement abilities needed for pushing up into prone kneeling ready for crawling over the first 6-7 months?

  • Will4m2w sitting with caregiver support 1_1_1.jpgIn this video you see Will (4 months 2 weeks) sitting with support on my lap. He makes use of all the available support surfaces to allow him to continue playing with the toy in his hand. 

  • Stepping up 24.jpgToddlers who have recently learned to walk fall a lot.  Karen Adolph counted the number of  times toddlers fall per hour: 12- to 19-month-olds averaged 2,368 steps and 17 falls.

    Falls will usually decrease over time and with experience and most toddlers and young children fall infrequently.