Selecting Activities

Individual movements to be targeted in the intervention should be identified for each child. Up to four target movements are suggested, to keep practice manageable and focused. Target movements should be reviewed every four weeks, and updated as required based on child progress. These target movements should consider COPM and GAS goals, typical development, and individual impairments.

Movements that are often challenging for children with CP are:

Finger extension
Thumb extension/abduction
Index point
Elbow extension
Forearm supination
Wrist extension
Shoulder flexion

Below is a list of activities that may be useful to practice target movements. This list is not exhaustive. Activities have been grouped by skills for easier review, but many activities can be used for multiple target movements.

Reaching

Position objects and toys above shoulder, out to side, in front
Pop bubbles
Play with different sized balls: rolling, throwing, catching, bouncing
Toss bean bags
Roll an extra-large ball
Knock down block towers
Hat on and off
Knock over bowling pins on the floor or off the table

Holding objects

Shake rattle or O ball
Hammer toys or xylophone
Self-feed finger foods
Drumming on pots with a wooden spoon
Wave a large ribbon in the air (it can be attached to a stick)
Wave a flashlight to watch the light move
Hold bubble wand and wave or blow bubbles
Move a toy underwater in the bath or a large container
Play with a toy wand
Colouring or painting with a crayon/marker/paintbrush/cotton balls
Fill Tupperware with noisy objects to rattle
Shake tambourine

Squeezing objects

Squeeze putty, play-dough, or squeeze ball
Squeeze sponges filled with water
Use rubber stamps with a post to grab.
Squeeze squeaky toys

Pushing

Press keys on a piano
Push down on a toy with a large push buttons
Push down a pop-up toy
Pushing stamp into an ink pad and then on to the paper

Grasp & Release

Put small objects in an empty tissue box
Drop objects on cookie sheet to make a noise
Hold and release kitchen utensils
Drop objects in muffin tin
Play with chunky puzzles
Play with shape sorter
Stick and/or remove magnets on fridge
Fill laundry bin with objects, pull out one by one
Turn pages of book

Stacking objects

Stack blocks
Stack cones or nesting boxes
Place large pegs into pegboard-like toy
Place rings on a post
Stack Tupperware, board books

Bimanual Activities

String beads (large or small)
Throw a large ball that requires two hands, like a beach ball
Tug of war with a scarf, rope, towel, sheet.
Open a food container
Flip a lid on a container
Twisting cap of bottle
Remove wrapper from food
Clapping games like patty cake
Rip wrapping paper, can wrap child’s stuffies to be opened
Hide objects, like small animals, in a cloth bag or small box

Sensory Activities

Fill a container with dried beans, rice, pasta, etc. with small toys hidden inside. Let child move his/her hand around in the box to find their toys.
Draw in shaving cream on mirror or bathtub wall.
Scoop water using a cup (something easy to hold) and pour the water into another bucket.
Touch different materials: silk, satin, pinecone, feathers etc.
Touch ice cubes
Water plants, dig in dirt
Touch texture books

When selecting activities for the home program, the child’s age and skill level need to be considered. Children with CP may not achieve milestones at the same age as typically developing peers. Assessments provide important information for determining the skill level of each child, and determining what activities are appropriate.

Development of fine motor skills may occur in a sequential order, but not all children develop these skills in the order or at the ages listed in the table below.

0-3 months old

Fisted hands
Random arm movements
Looks at own hand
Bring hands to mouth
Uses whole arm to swing at targets
Begins to hold objects in hands
Fingers close around object in response to light pressure on palm

3-6 months

Hands are open most of the time
Grasps rattle with palm
Holds rattle for 1 minute
Brings toys to mouth
Shakes rattle
Bangs 2 toys together
Uses both arms to reach for toys
Begins to move objects from one hand to the other
Holds hands together

6-9 months

Begins to grasp and hold objects
Uses all fingers (‘raking grasp’) to move objects
Uses index finger to poke objects
Removed objects from containers
Begins to hold a bottle
Rotates wrist when shaking a rattle
Squeezes objects with a fist
Plays with their hands

9-12 months

Can poke or point with one finger
Turns pages in a book, a few pages at a time
Begins to put small objects in a container
Starts using index finger and thumb to grasp objects (‘pincer grasp’)
Moves objects between hands
Uses a fisted grasp to hold crayons/markers
Can hold two objects in one hand

12-18 months

Claps hands
Waves goodbye
Stacks two blocks
Scoops objects with a spoon/shovel
Puts small objects in a container
Scribbles on paper
Begins to fit shapes into a puzzle
Uses a pincer grasp
Holds a marker in an upside-down position, thumb down

18-24 months

Puts rings on pegs
Begins to hold crayon with fingertips and thumb
Marks or scribbles
Stacks 3-4 blocks
Opens packages
Turns pages one at a time
Strings 3 beads on a lace
Begins snipping with scissors

For ease of practice, ensure the home program doesn’t require any special toys or objects. Household items are often great objects for therapy. All toys/objects need to be safe (not choking hazards).

Discuss toys and objects with the caregiver to identify things that are appropriate and interesting for their child. Suggest that the caregiver collect a bin of these things to keep handy for practice times. Reserving selected toys for therapy sessions (and not free play) is one way to maintain engagement as toys remain novel longer. As their child grows and learns new movements, toy preferences will change. Update toy suggestions based on the child’s current skills and developmental preferences.

A list of possible toys and objects can be found here.