Formation of motor skills in children with Down Syndrome. Practical Guide for parents by DownsideUp

DOWNSIDE UP Early Intervention Centre for children with Down Syndrome Pole E.V., Zhiyanova P.L., Nechaeva T.N.

Formation of motor skills in children with Down Syndrome Practical Guide for parents

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Children with Down Syndrome 1 and features of their development

The first edition of the handbook was published in the framework of the project “Development of speech and socialization skills in young children with Down Syndrome”, financed by the fund “Support of children in a difficult life situation”. The second edition was published on the means donated by the state as a grant of National Charity Fund according to the order of the President of the Russian Federation № 216 on May, 3rd, 2012.

Pole E.V., Zhiyanova P.L.,Nechaeva T.N. Formation of motor skills in children with Down Syndrome: Guide for parents/photos by Grosman E.G. – 2ed – M; – Charity fund Downside Up, 2013-68p-(child with Down Syndrome and features of his development) ISBN978-5-904828-14-1. This book for parents along with the description of the features of the development of children with Down Syndrome includes illustrated recommendations for game activities with infants, which parents might use during the period of the formation of basic motor skills. When making this book we used the materials by doctor P.Lauteslager, a Dutch doctor and the author of kineziotherapy method which promotes motor development in children with Down Syndrome. Dr Lauteslager has been cooperating with Downside Up Centre for more than 10 years, having taught the specialist of the Centre his unique approach and kineziotherapy method as well as the methodology of teaching this method. Working on this book the authors, relying on P.Lauteslager’s experience and method, used their own experience of work with infants with Down Syndrome. This edition is for parents of infants with down Syndrome of first years of life, however it may be useful to specialists working on motor development of children with special needs.

Series “Children with Down Syndrome and features of their development”

Pole E.V., Zhiyanova P.L., Nechaeva T.N.

Formation of motor skills in children with Down Syndrome Practical Guide for parents P.Lauteslager’s works were used while making this handbook

Charity fund Downside up, Moscow, 2013

CONTENTS

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 FEATURES OF MOTOR DEVELOPMENT OF CHILDREN WITH DOWN SYNDROME. . . . . . . . . . . . . . . . . . . . . . . . 8 BASIC MOTOR SKILLS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 HOW CAN PARENTS HELP THEIR CHILD IN HIS MOTOR DEVELOPMENT AT HOME . . . . . . . . . . . . . . . . . . . . . . 19

Position of a baby when in the arms. . . . . . . . . . . . . . . . . . . . 19 The upright position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The belly hold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . With his back to an adult in a sitting position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . With his back to the adult vertically . . . . . . . . . . . . . . . . . . . . . . . . . .

19 20 20 21

Positions of an adult and a baby for games and development. . . . . . . . . . . . . . . . . . . . . . . . . . 21 Lying on your back / a baby is lying on his stomach and on the chest of an adult face to face. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lying on his stomach face to face with a child . . . . . . . . . . . . . . . . . . . SITTING with raised knees / a baby is on the raised adult’s lap. . . . . . Sitting cross-legged / child “in the saddle” . . . . . . . . . . . . . . . . . . . . . Sitting on the floor with the legs stretched. . . . . . . . . . . . . . . . . . . . . . Kneeling / an adult is playing with a baby kneeling. . . . . . . . . . . . . . . . The ability to raise legs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22 22 22 23 23 25 26

CONTENTS

First stage. A baby is lying on his back. . . . . . . . . . . . . . . . . . 26 The ability to stretch arms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Raising the head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Lifting the head. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

The second stage. A child is lying on his stomach . . . . . . . . . 31 A child lies on his stomach resting on his elbows. . . . . . . . . . . . . . . . . . 33 Weight transfer in the prone position, resting on the elbows. . . . . . . . . 34

The third stage. А baby rolls. . . . . . . . . . . . . . . . . . . . . . . . . . 36 The fourth stage. А baby sits.. . . . . . . . . . . . . . . . . . . . . . . . . 38 The fifth stage. А child moves on the support surface.. . . . . . 43 The sixth stage. А baby’s learning to sit.. . . . . . . . . . . . . . . . . 46 The seventh stage. А baby stands up. . . . . . . . . . . . . . . . . . . 49 The eighth stage. А baby stands up.. . . . . . . . . . . . . . . . . . . . 53 The ninth stage. A baby walks.. . . . . . . . . . . . . . . . . . . . . . . . 55 A few words in conclusion.. . . . . . . . . . . . . . . . . . . . . . . . . . . 58

INTRODUCTION We are very pleased that we have the opportunity to write the foreword to this important book by our colleagues from the Early Intervention Centre DSU, who we respect and appreciate. For almost ten years, we have been honored to work with the authors of the book â&#x20AC;&#x201C; Elena Pole, Polina Zhiyanova and Tatiana Nechaeva who are the experts in early childhood development and licensed Russian coaches of kineziotheraphy method of promoting motor development of children with Down syndrome, developed by P. E M. Lauteslager. We are professionals representing different countries with different cultural traditions and different possibilities, but we are equally convinced of the necessity of providing early intervention for children with Down syndrome. The basis of this belief is our practical and research experience, and in addition â&#x20AC;&#x201C; our confidence in great potential of children with Down syndrome. We firmly believe that children with Down syndrome are able to live successfully in the community, and they need to live in a family to fulfil this ability. They need love, care and support of their parents, brothers and sisters, as well as other people around them. We work in order to let people know about the possibilities of children with Down syndrome, to help these children fulfil their great potential, as well as to help parents of families brining up such unusual children. Honestly, you should not consider us naive. We know that children with Down syndrome do have specific problems and, especially they are typical of a special motor profile. Each stage of motor development is hampered by insufficient sense of balance and postural control, that generates a lot of functional difficulties which are clearly visible in the game, and in everyday situations. Parents of infants with Down syndrome really need the explanations of these specific features of motor development of their children, and scientific literature around the world insists on how important and necessary their timely interaction with experts in the field of child development is. Motor competence of a child is a clear tool for his intellectual development and social interaction. Implementation of the motor potential extends the possibility of the development of a child, because it creates the basis for the development of self-help skills, successful stay in kindergarten and school, and in the future successful integration into society. Influence of the level of motor development on the overall development of a child is particularly important during the formation of the basic motor skills, that is, between the age of 0 to 3 years. It is the time to lay the foundation for the entire motor development.

We, the experts from the Netherlands, have developed an efficient method of early intervention for children with Down syndrome, which corresponds to modern views on care and education of children with special needs. Shortly, we called it BMS-method (method of the formation of basic motor skills), and it should be noted that it is the «family-centered» approach. Following the recommendations of a specialist of this method, parents can bear the responsibility for motor development of their child and promote it. Scientific research, which studies the efficiency of using BMS-method, indicates that its use significantly promotes the formation of functional motor skills in infants with Down syndrome. That is why we are glad that this book has been published. The authors wrote it specifically for parents, and it is a great practical guide containing both general information about the features of the motor development of children with Down syndrome and recommendations, which help stimulate the development of these skills in the process of caring for the baby and games with him. The book contains many photographs showing positions for game activities and development of the baby, as well as techniques, which help promote baby’s motor development. Comments explain how you can use these postures and techniques at home. The book “Motor development in young children with Down syndrome. Problems and Solutions” by Lauteslager describes the history of the development of BMS-method, progress and results of scientific research in the field of motor development of children,the description of BMS-method itself and possibilities of its use. P.Lauteslager also pays a lot of attention to home exercises with a child, but neither the author nor his closest associates ever transformed his description of scientific work into a practical guide for parents. It was made by our Russian colleagues – Helen, Polina and Tatiana, who developed such a guideline, based on the situation in Russia concerning early development and their extensive practical experience. We recommend this book not only to parents, but also to professionals. We think it is useful for every specialist in early development, that it should be in the library of every rehabilitation center or early intervention services, where people come with their children with Down syndrome. Dr. Peter E.M. Lauteslager, a physical therapist, The Netherlands E. Bert Bakker, a physical therapist, The Netherlands

1 Features of motor development of children with Down syndrome Down Syndrome is a special genetic condition that causes a number of features in the development of children. Kids with Down syndrome do not develop as normal children, and their motor development is slower and certain skills develop later. In addition, motor development is influenced by specific difficulties due to the presence of this genetic condition. If you watch children with Down syndrome of two to three years, you will notice that they do not move very confidently, often seem clumsy, stumble, their gait has some features, it takes them noticeably longer to learn to run and jump, throw and catch a ball, etc. Long-term studies suggest that babies with Down syndrome do not just lag behind in terms of their motor development, but they have their specific order and the profile of the development of motor skills. The story about the features of motor development should start with the fact that the biological desire to move and explore the world in the movement is typical of every child, regardless of the presence or absence of a particular genetic abnormality or other features of his development. This is a biological pattern, and the task of adults is to understand the reasons and consequences of motor difficulties, to provide their baby with conditions for realization of his motor skills potential, maintaining and developing the desire to natural movement. Currently, there is no doubt that the vast majority of children with Down syndrome can learn all the necessary motor skills, (with the exception of perhaps, only children with extra complex medical problems ), but this requires much effort from parents and relatives of a toddler, together with the experts in early development, who must pay special attention to a child and together with him master more and more motor skills and abilities. So what are the features of the motor development of children with Down syndrome and the reasons for a particular way of their motor development? Pic.1 on page 8 illustrates the characteristics of the motor behavior of a child with Down syndrome of first months of life, which is necessary to know.

Pic.1

The picture on the left shows a baby in the prone position. Unlike a usually developing baby, a baby with Down syndrome, lying on his stomach, is lying “flat” on the surface. It is difficult for a baby to arch and straighten his back, he still cannot lift his head resting on his hands and stay in such a position, his legs are widely moved apart. The middle picture shows the so-called Landau reaction in a child with Down syndrome. If ordinary children in this position raise their head, straightening the body and legs, a baby with Down syndrome, “folds in half,” his head, arms and legs hang down. If you put a baby with Down syndrome on the back and try to pull him be the hands, it is easy to see how difficult it is for him to lift his head. In the right picture, you can see that the head of a baby with Down syndrome remains tilted backwards, whereas a normally developing child will bend the neck and torso, lifting the head off the surface. Growing up, a baby gradually learns to walk, to move his body from one position to another. During this period, the specific features of motor development are also clearly visible. Let’s look at another picture (Pic 2).

Pic.2

The top left picture shows a baby with Down syndrome on all fours. His legs are still too far apart, while he crawls at first they move apart and glide over the surface, while learning this skill it is difficult for him to keep them in position, and properly distribute weight and keep balance. When a child with Down syndrome begins to walk (top right picture), he may provide a “wide base” for himself for a long time, when he moves his strained legs apart very widely. The torso of a toddler is still when walking, at first it’s hard for him to keep balance, and balancing, he raises his arms high. In the lower left picture there is a baby with Down syndrome trying to stand up. This baby has difficulty keeping balance when changing his body position from one to another and he compensates it by trying to stand up leaning on his hands, and putting his hands close to the feet, at the same time shifting his body weight on his feet. It may be noted that typically developing children also undergo this

stage of development of the skill of standing up, but a child with Down syndrome uses only this way for a considerably longer time, without changing for a better one, if he is not specifically trained. During the transition from the prone position to a sitting position (right bottom picture) the child widely and symmetrically moves straightened legs apart (sits from the split), also “pushing” the body up with his hands. In this case, a baby with Down syndrome uses typical of him physical feature: extremely elastic cords and, thanks to this, very movable joints. It is important to realize that in doing this he avoids more complex, in terms of keeping balance, positions of the body, which are necessary for free and diverse movements in the future. In all the cases illustrated above, it is easy to highlight the same problems that do not allow motor development develop as usual. We list these features bellow1. Reduced muscle tone. Almost all children with Down syndrome are born with various degrees of muscular hypotonia, which decreases as they grow older, but muscle tone does not reach norms. This feature is the main reason hampering the formation of movements, and it should definitely be taken into account, promoting motor development of any child with Down syndrome. 2. Lack and sameness of balance reactions. A sense of balance in a child with Down syndrome develops longer and this kid needs a much more intensive training aimed at improving balance, especially the balance in motion, or as experts say, the dynamic equilibrium. If you do not pay attention to this problem, the child’s motor behavior will be constrained and monotonous, because he will not be able to do the movements requiring bending and twisting (rotation) of the body, and after all, these movements are needed to feel free in everyday situations, for a beautiful gait, sports or, for example, dancing. 3. Insufficient stabilization of joints. Children with Down syndrome of first years of life cannot properly stabilize the joints in the necessary position. The stability and mobility of the body is provided by a coherent work of different muscle groups, which is necessary to stabilize not only joints of the limbs, but the spine as well. Studies have shown that people with Down syndrome have a reduced ability to manage strengthening or relaxation of the muscles around the joints and, in addition, they are often unable to fullyuse these muscles and their ligaments are too elastic. For this reason, the movements of children with Down syndrome are often “blurred”, these kids may seem awkward at times, not clearly and accurately moving the legs, or trying to take an object. When typically developing children are getting older, there is a gradual decrease in the mobility of the joints (the older the child, the less movable the joints are), but in case of Down syndrome due to reduced muscle tone, a decrease in joint mobility occurs only between five and ten years. 4. Distorted proprioceptive information. Hypotonia, which tops the list of reasons of a special motor development, influences the ability to feel your body.

Proprioceptors which are all over a human body, constantly inform the brain about the muscle contraction or relaxation, of the position of the body in space, making it possible to control it. In children with Down syndrome due to muscle hypotonia, proprioceptive information is distorted, it is more difficult for them to manage the body, so, for example, they may not have time to stretch or relax the legs, making a jump, or stretch out their hand for support. These features cause violations in the so-called system of postural control, that is in the process of coordinating various systems of the body, providing the opportunity to take and keep the body in some positions when at rest and in motion. Exactly these violations in the system of postural control lead to the features illustrated in the pictures above. Usually a baby with Down syndrome, despite certain difficulties, fulfils his motor abilities, and to cope with these difficulties uses compensatory ways of movement. For example, it is difficult to sit down, turning into a side sitting position and helping yourself with the hand, as we usually do, so a baby with DS, using the hypermobility of the joints, spreads his legs wide apart and pushes himself into a sitting position with his arms without bending the body and losing his balance. It is difficult to rotate the torso to roll from his back to his stomach, and he helps himself to do it, arching the back, pushing his head off the supporting surface and moves into position with the whole body, trying to avoid asymmetric postures, which are difficult for him. Proper activities with a baby, taking into account the knowledge of the features of his development prevent the formation of a childâ&#x20AC;&#x2122;s strong static and symmetric movement patterns. Otherwise, further development of movements will be impeded by the existence of irregular (â&#x20AC;&#x153;pathologicalâ&#x20AC;?) motor patterns, while in fact, we expect this intermediate stage to turn into quality and varied movements that allow a child to fully realize his motor potential. For adults, it is important to understand that lost sight of the difficulties of keeping the posture and underdeveloped sense of balance present in a child in the first years of life, may seriously affect his further development. So, in the development of the motor functions of children with Down syndrome there are two main problems. Firstly, these children have difficulty maintaining the desired posture of the body, and secondly, they need special training, aimed at not only the development of new motor skills, but also at the improvement of the quality of movements, as well as the expansion of the motor variety. As different periods (phases) of motor development are inseparably linked, it must be borne in mind that each successfully learnt stage lays the foundation for further development, and vice versa, violations left unattended at one stage, influence the development of motor abilities of a child at later stages. In other words, if left unattended, for example, the development of asymmetric postures at the age when a child can only lie on his back or stomach, in the future he will have difficulty using necessary asymmetry when sitting, standing and walking.

2 Physical therapy and kinesitherapy In the previous section we briefly talked about special features of motor development typical to children with Down syndrome. We now turn to the story of what kind of help can be given to your child. We all know the word physiotherapy. The usual Russian association is connected with electro, light, hydro or thermotherapy. Often our doctors recommend to consult not only a physiotherapist but also a therapeutic physical training doctor, who in turn, proscribes treatment of patients, based on the use of massage and physical exercise. In contrast to Russia, in more than 70 countries now there is a specialty of “Physical Therapy”, and this concept combines both physical therapy in the usual sense, and exercise therapy. Physical therapy treats functional, especially motor, violations. Physical therapist is a specialist who in his work uses not medication, but physical (natural) methods based on movement, manual therapy, massage, reflexology and therapeutic use of heat, light, high-frequency ultrasound and water. The section of physical therapy, which uses exercise as treatment is called “kinesitheraphy”, ie treatment with the help of movement. A specialist in this field is called kineziotherapist. Since the movement restrictions may occur due to different reasons, for example as a result of injury, disease, congenital features, kinesitheraphy uses a wide range of methods and approaches, providing specialized assistance to athletes, to people after stroke, various injuries or brain surgery, amputation and so on. Kinesitherapists work with both adults and children. Children’s kinesitherapy is a separate direction of physical therapy, which also has a direction of work with young children, as in most cases, such children mostly do not need to restore motor skills but to form, develop and improve them. Children’s kinezitherapist helps parents of a young child who are using a special development program, which solves the following problems: • sensory development and the formation of understanding of his body in a baby; • normalization of muscle tone; • training of the equilibrium reaction • development and improvement of specific motor movements and their sequences; • an increase in motor activity; • development of attention and communication skills.

Kinesitherapy program for a baby with the features of motor development is aimed not only at teaching motor skills, but it takes into account the fact that the level of motor development is directly related to the primary research activities of a baby and takes into account his needs in communication and involvement of a baby in everyday life. Helping your child to master motor skills, a kinezitherapist and parents are working to eventually provide a child with a certain level of independent existence, which over time will allow him to consistently learn everything that ordinary children can do: sit, crawl, walk, run and jump, eat, play, go to kindergarten and school, communicate with family and friends, and so on. The task of a kinezitherapist working with young children is that in the process of communicating and playing together, drawing attention of a baby to interesting toys, to give his body a certain position and to provide him with the necessary physical support, creating in this way conditions for fulfillment of one or another movement or motor sequence. As a baby develops every motor skill, you can proceed to the next step, not forgetting to develop what has already been achieved. It also changes the course of interaction: first, the adult provides a child with the maximum physical assistance, then this assistance is gradually reduced unless the child learns to make the necessary movement himself. Working with children, kinezitherapists or motor development experts use the so-called active type exercises. What kind of exercises are they and how does “active type” differ from usual complexes of physiotherapy, which practicing massage therapists use? Exercises of active type are organized to let a baby do the degree of physical activity for which he is capable of at the time of practicing these exercises. An adult gives a child only the most necessary assistance: if necessary he helps him to take the right position, interests him (experts tend to use the term “motivates”) in attractive toys, another object or the possibility to communicate, and makes it in such a way that the kid wants to do the necessary movement. If necessary, an adult helps a child physically, holding his body, arm or leg. He can “demonstrate” to a baby which movement is necessary, and also “takes” the child’s body through the right motor sequence by moving, for example, his limbs, helping to make the turn, sit down or stand up. Then he gives a child the opportunity to do that movement again and again, advising his parents to continue such games at home until this motor ability or skill is automated or mastered by their child. There are several important points that define this method of work. 1. taking into account the general laws of motor development of the child (in this case – a child with Down syndrome). 2. taking into account the physical condition of a child and the individual characteristics of his motor development. 3. establishing and maintaining contact with the child, emotive interaction with him. 4. using toys, games, or other types of activities that are appropriate to the age and level of development of a child. 5. Encourage all motor activity of a baby. 6. If necessary, provide verified physical assistance, which should not be excessive, but sufficient. Help decreases as a child develops and masters skills.

7. repetition of the movement and allowing a child to improve this skill on his own at home. 8. Cooperation with a child’s parents. The active position of parents, their involvement in the process of regular motor games with their child, providing the child with regular assistance to his motor development in everyday situations. In this book, we are talking about the motor development of children with Down syndrome and that special kinezitherapy assistance that parents with the help of a specialist can provide them with during the development of basic motor skills. Research in the field of motor development of babies with Down syndrome and programs to facilitate this development is done by Peter Lauteslager. He is a childen’s physical therapist, who heads the Dutch Institute Division S Heeren Loo MiddenThe Nederlands. Since 1990 he’s been working on the problems of specialized care and assistance to children with Down syndrome. After years of research activities Doctor Lauteslager has developed a method of evaluation and development of motor skills in young children with Down syndrome. In 2000 he defended his thesis on the subject and received his degree at Utrecht University (The Netherlands). Currently, his method is standardized and recommended for practical use in Europe. His book “Motor development in young children with Down syndrome. Problems and solutions “ was translated and published in Russia in 2003. In a joint project of the Charity Fund Downside Up and the Dutch Institute Heeren Loo Midden, The Nederlands, the implementation of which began in November 2002, P. Lauteslager with his colleague B. Bakker conducted a special training for the specialists of the Early Intervention Center Downside Up teaching methodology aimed at motor development of children, and then there was a sustained training for the three experts on motor development, which resulted in the legal license for teaching his method in Russia and the neighboring countries. While working on this book, the authors, relied on both the research of Dr. Lauteslager and their years of experience and practical work with young children with Down syndrome. The method of our Dutch colleague suggests that parents should be involved in the process of forming the necessary motor skills of their baby, and we, the specialists in The Centre DSU completely agree with him. Necessary everyday parental involvement in the development of a baby is required by life itself, because a child spends most of the time exactly at home with his parents, and those games and exercises that contribute to his motor development, most often fit well into the process of everyday care and routine of normal family life. A kineziotherapist or a specialist in motor development can only help parents by defining what and is necessary to teach child, showing them how to do it, explaining why they must act exactly so, and discussing how to better organize daily games and activities for a child to successfully master and use his motor skills. The contribution of parents in this process is invaluable, and for a child with Down syndrome it will be difficult to do without it, because daily activities are always linked with emotional and language development, as well as with the development of cognitive activity.

3 Basic motor skills Helping your child in his motor development, it is important not only to understand the basic level of his motor development, but also have an opportunity to trace his achievements in this field. The method of assistance in motor development of children with Down syndrome, developed by Peter Lauteslager, based on specially conducted research and practical study includes the test “Basic motor skills” (shortly, BMStest), that is “a tool for measuring” the level of a child’s motor development, and kinezitherapy, taking into account common and individual features of a child’s motor development. During the development of his method Dr. Lauteslager took into account the following reasons: 1. kinezitherapy is better to be carried out during the development of the main (basic) motor skills, as they lay the foundation for all subsequent motor development, that is, from the first months of a baby’s life, and up to three to four years. In the future, the task of a kinezioterapist is the work on the quality of basic motor skills and the development of complex and hard-coordinated movements. 2. The test should take into account the features hindering children with Down syndrome to develop their motor skills. 3. The test should be available and easy to apply in practice. It should serve as a basis for practical work with a child and allow to easily understand the sequence of formation of basic motor skills. 4. the test takes into account individual features and differences in motor development of any child with Down syndrome, regardless of the presence or absence of additional medical problems, of individual rates of development, and so on. In the course of special studies of the motor development of children with Down syndrome, Dr.Lauteslager identified fifteen basic motor skills, which eventually formed the scale of motor development of children with Down syndrome. The test, which is a full scale of motor development, can be used from the beginning of any casual movements of the baby and until the main (basic) motor skills are mastered, that is, until the time when a child can easily take upright position and act in this upright position. There is a list of these skills from the description of the BMS-test. 1. Raises his legs, lying on his back.

2. Raises his hands, lying on his back. 3. Raises his head, lying on his back. 4. Relies on the elbows, lying on his stomach. 5. Rolls from his stomach to his back. 6. rolls over from the back to the stomach. 7. Sits. 8. moves on the support surface. 9. â&#x20AC;&#x153;cruisesâ&#x20AC;? leaning on his hand along the support. 10. stands by the support. 11. Rises to the support. 12. Stands without the support. 13. sits down in the prone position. 14. Independently walks. 15. Stands up on his own. As each child has to master a number of body positions, and also learn to feel free while sitting, crawling, standing, each of the fifteen sections of the test is divided into successive levels (stages) of the development of the skill, that allows to determine the level of skill which at the moment a child posses and exactly to plan and conduct activities with him to help him move on to the next level. To understand what is the stage (level) of the development of the skill, letâ&#x20AC;&#x2122;s consider for example, one of the major motor skills - the ability of a child to sit. Pic. 3 shows the course of the development of this skill, divided into successive levels (I -VI).

Pic.3

At first, on the first two levels (I, II), a child is just beginning to master this skill, and sits leaning on hand. On level III, his sense of balance and muscle strength already allow him to take his hands off the support, but he still sits with a bent back. On levels IV and V, he already knows how to sit on his own, without backing himself up with the hands, and besides, he can straighten his back in a sitting position. On level

IV a toddler sits with his back straight and on level V his muscular system and sense of balance allow him to arch his back at the waist when he raises his arms high. The highest level of this skill is level VI. It differs from all the previous ones in the fact that a baby feels completely free when sitting on a support surface. He can not only take a toy from the floor but also play with it at chest level, and not just reach for a toy forward and upward, but easily take it from side and top, and to do this it is necessary for a baby to tilt to the side, bending the body, and then return to his initial position. Such actions require a good dynamic balance and this is the so-called functional level, i.e. fluency in the body in a sitting position. Keeping balance in the sitting position, that is having mastered the last sixth level of this skill, a child can easily change his position on all fours and sit down again when he finally crawls to where he needed. Now, using the example of a sitting position, letâ&#x20AC;&#x2122;s see how each stage of development of this skill is described in the BMS-test.

SECTION 7. Sitting position (sitting skill) INITIAL POSITION

Place a child on a horizontal surface without support. It is necessary to encourage him to sit leaning on his hands, and then straighten the body, stretching up, and bear the weight of the body to the left or right. SCALE 0. You correctly stimulate a child, but he does not show any kind of motor behavior, as described below. 1. When stimulated, a child sits on his own leaning on both hands for 5 seconds. 2. When stimulated, a child for 5 seconds sits on his own leaning on one hand. 3. When stimulated, a child sits without leaning on his hands for 2 seconds. The back is bent. 4. When stimulated, a child for 2 seconds sits without leaning on his hands, with his back straight without lumbar lordosis. 5. When stimulated, a child can sit without leaning on hand. As he straightens the back lumbar lordosis appear, which is maintained for 2 seconds. 6. Upon stimulation, a child can sit without leaning on his arms. As he straightens the back and shifts the body weight to the left or to the right, there is a distinct lumbar lordosis and flexion of the trunk in the appropriate direction.

It is worth noting that each successive level of development of the skill is actually a program of development. If on level 2, for example, we note that a baby can sit for 5 seconds leaning on one hand, the description of level 3 suggests what we should continue to strive for. In our example, it is to ensure that a baby not only increases the

time of maintaining a sitting position with support on one hand, but also learns to take both hands off the support in this position. If you regularly pay attention to certain points, that will encourage him to reach out for the toy with both hands, some time later, he will learn to do it and you can proceed to the next level of development, in which a baby learns to sit with a straight back. Lauteslagerâ&#x20AC;&#x2122;s test allows professionals to concentrate on the quality aspect of each skill and discussing with parents plans for exercises to be done at home in the near future, just to select the types of activities that will help your child to master consistently all stages of development of each skill. According to the test results the expert can determine the overall assessment allowing in the future, after repeated testing, analyze motor development dynamics of a particular child. For parents it is important to understand that the test itself helps only to determine at what stage of development of each skill the baby is at the time of testing, and to realize what steps should be consistent aimed at further development of this skill. Following the assessment of the level of motor development, there must be regular kinezioterapy activities that require active participation of parents.

4 How can parents help their child in his motor development at home We all know that every kid grows up and develops gradually mastering increasingly complex skills. If at the beginning of his life he can only lie on his back, then later he consistently masters other positions of the body, which require to overcome the force of gravity: learning to hold his head when he is lying on his stomach, rolling over, sitting and crawling, then standing and walking. We should not forget that, mastering new body position, the baby must also learn to use them to communicate and play, that is, every position of the body should be dynamic and allow the child to carry out a lot of the necessary in his life movements. In this section of the book there are nine so-called functional stages of motor development that reflect the gradual development of motor skills by the child. Each stage gives parents recommendations and briefly describes the simple and affordable games and activities, which parents can use at home to assist their child in his motor development. Before proceeding to describe the activities and games with your child, letâ&#x20AC;&#x2122;s discuss some important points that should become the rules of everyday care for a baby with Down syndrome. Itâ&#x20AC;&#x2122;s about how to carry a baby and what position is useful during the games and activities with them.

Position of a baby when in the arms As children with Down syndrome have certain features of development, parents need to know how to carry a baby so that during daily care it will promote his proper development.

The upright position This position is familiar to all parents, as it is recommended to be used after each feeding. But in other situations, carrying a baby in the upright position is convenient and useful for his development. In terms of motor development this position will help your child learn to hold his head upright if his head is not below the shoulder of an adult. The belly and the chest of a baby are tightly pressed to the body of an adult and the adultâ&#x20AC;&#x2122;s hands are holding the baby securely by the bottom and shoulder girdle and the head of the baby is slightly above the shoulder of the adult. If necessary, at first the adult can help the child keep his head upright, just holding it with his fingers behind his head.

The belly hold Photo 1 shows the position for carrying a baby, often called “airplane.” Being in this position, a baby practices arching his back and tilting the neck, learns to hold his head in the necessary position, turning it from side to side. Photo 2 shows another variant of holding him in an “airplane” position, in which the body of a baby is held in the asymmetric position: the upper part of his body is 1 slightly turned regarding his bottom part of the body (it is twisted) that trains the rotation of the body needed in the future. A child, being in the hands of an adult in the position shown in photo 3, has a good overview. At the same time it is convenient to exercise the muscles of the neck, his arms and legs can move freely, and, in addition, being in such an asymmetric position creates important motor skills for further development.

3 With his back to an adult in a sitting position

Photo 4 gives an idea about another position, which is useful for a baby when his mom or dad carry him at home. This posture is symmetric, the baby is hold tight, it is convenient to reach for a toy, and he has the possibility to not only coordinate his hands reaching for something attractive, but also learn to keep his head upright and straighten his back.

With his back to the adult vertically Photo 5 and 6 show a very comfortable for adults and a baby posture, which allows you to group your baby, not symmetrically but asymmetrically, which additionally gives the child the opportunity to train the body rotation. Please, note that the legs of a baby are brought together, and an adult is supporting them with his hand.

SS positions of an adult and a baby for games and development There are techniques and positions of the adultâ&#x20AC;&#x2122;s body, which firstly allow to use his body as a good support for the baby, placing him in a certain way, and secondly, stimulate perfectly both motor development and communication skills of a child. For the successful development of a baby it is very important that both he and the parents during the game receive mutual pleasure. Adults need to take a stable and comfortable position to have the possibility to be entirely included in wonderful moments of a game with their baby without interruption due to an uncomfortable posture. Letâ&#x20AC;&#x2122;s speak about the most commonly used and effective postures of an adult and aÂ child that can be successfully used at home.

Lying on your back / a baby is lying on his stomach and on the chest of an adult face to face Prepare a suitable pillow and lie on your back on the floor or bed putting a baby on his tummy on your stomach and chest. Help your child take a functional position on the stomach: gently move his bent arms forward, holding his shoulders (photo 7). In this position, a baby will be able to see your face, and you have a possibility to call him by the name, gently talk to him, smile at him, gently blow on the head to make him raise it and learn to hold it.

Lying on his stomach face to face with a child Put your baby on his stomach on the floor or on a large bed and take a position of face to face with him, that is, too, lie down on your stomach in front of him. Make sure that a child is lying correctly (photo 8); if necessary, help him stretch his arms forward and lean on his elbows. This position gives more or less the same opportunities for play and interaction with a child, as well as the previous one.

SITTING with raised knees / a baby is on the raised adultâ&#x20AC;&#x2122;s lap The essence of this position of an adult and child (photos 9, 10) lies in the fact that a baby is put on his back on the bent and raised lap of an adult with babyâ&#x20AC;&#x2122;s feet on the

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chest of an adult. This position allows not only to communicate with a baby, but also to actively assist his motor development and game development skills. There are variations of this position – it can be used while sitting on the floor, on the couch, armchair or chair. In the last three cases it is recommended to use a small stool because it will be comfortable for an adult to hold them in the raised position.

Sitting cross-legged / child “in the saddle” This posture of an adult (sit on the floor, bend your knees and cross your legs) allows you to create a saddle recess in which it is convenient to put a baby learning the skills of sitting. You can use different options of this position for playing (photo 11, 12): a baby can sit on the ankles of an adult, feet resting on the floor, take a face to face position or his face away from the adult’s.

Sitting on the floor with the legs stretched In this position, it is convenient for an adult to use his body as “equipment” to stimulate child’s transition from a sitting position to the position on the knees and then back, as well as games that promote a sense of balance. A baby can be placed between the legs of an adult - it is safe and convenient for him to stretch out for his toy, making the neces-

sary movements. An adult in his turn may physically assist the baby and at the same time to communicate with him, supporting, approving and encouraging his efforts.

Photos 13, 14 and 15 show different variants of the baby’s positions – he can sit with his back to an adult or face to face, and photos 16 and 17 demonstrate how to protect a baby from falling on his back. Having taken this position, an adult can put a baby on his leg and play “horse-riding” which is good for developing the sense of balance in a baby.

Kneeling / an adult is playing with a baby kneeling This position of an adultâ&#x20AC;&#x2122;s body is useful if you need to help your child, being behind him, when a child is learning to stand up to the support and sit back on the floor, or when it is necessary to insure a baby, so that he does not fall backwards (photo 18). There are, of course, options for this position, e.g. when an adult in a sitting position on his heels is face to face with the baby, as in the photo 19.

Now letâ&#x20AC;&#x2122;s consider all nine functional stages of motor development, and talk about what you can do at home to help a baby successfully advance in his motor development. The description of exercises and games in different functional stages is made for parents to clearly understand why, what and how they can help their child every day. We provide a detailed description of the games, as well as give one or two examples, but parents, of course, need to use some imagination, to diversify the game with a toddler, making it interesting for both. In addition to the descriptions, we present a series of photographs and we hope that they will help to better imagine how to organize the game with a child, and most importantly, demonstrate that children play and interact with adults with pleasure, while developing their motor skills.

First stage. A baby is lying on his back. Lying on his back, a baby must learn to: • lift his legs; • reach for a toy with his hands; • raise his head.

The ability to raise legs

WHY? When children with Down syndrome lie on their back, it can be difficult for them to raise the legs and keep them in this position, as for such a movement they do not always have the stability of the torso and hips.

WHAT FOR? A familiar to all babies skill of lying on their back and raising their legs, grabbing them with their hands to play with them (Photo 20) is very important for the subsequent phases of motor development, because this game strengthens the muscles, which in turn, develop stability of the entire body. Since the very first months of the life of your baby, he has the “base” for the development of more complex motor skills. 20 The better a child is able to lift his legs, the more he will be able to make movements with his torso not only in this posture, but also when he sits, crawls or walks.

HOW? When lying on the back a child raises his legs, it is necessary to bend his body. If he has not yet learned how to bend his own body, an adult should help, gently holding it in a bent position attracting a baby’s attention to his raised feet (photos 21 and 22).

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Take a position with your lap raised. To do this, sit in a comfortable chair, put your feet on the lower chair or on the floor, bending your knees and raising your lap (Photo 23). Place your baby on your lap so that he is lying on his back, neck to your knees, and his feet are placed on your stomach and chest. In this position you can easily look at each other. Draw a baby’s attention to his feet (photo 24): lift them a little, help him stretch his arms to the legs or move his feet to his mouth. Tickle the baby’s feet or blow on them. A little sounding toy attached to the foot of a baby can help: you can, for example, firmly sew a small bell to the sock and put it on the baby’s foot.

When a baby is lying on a flat surface, place a neat folded warm napkin under his bottom, you can also use a small rolled towel or a couple of folded diapers. This “cushion” will help a child raise his feet and look at them, and later play with them. As shown in Photo 25, a bent leg of an adult can serve as a “cushion”.

The ability to stretch arms

WHY? As children with Down syndrome have a weak ability to stabilize the shoulder girdle, it is difficult for them to reach for a toy lying on the back, and later it can hamper fine motor skills development. The smallest children with Down syndrome often stretch up only their forearms and hands lying on the back and the shoulders are pressed to the body to give more stability to the arms. In order to grab a toy from the side or to move the hands for an object from side to side, good stability of the shoulder girdle is important and it is necessary to develop it.

WHAT FOR? It is very important for a baby to learn how to stretch his arms in differ-

ent directions, reach for objects and take them (Photo 26). The ability to confidently and consistently stretch the arms and move them left and right develops and strengthens the muscles of the stomach, which increases the stability of the body that is necessary for further motor development when a baby starts to sit up, crawl and walk. To develop the ability to reach for toys and to make precise movements with the arms, manipulating objects, that is to play, dress and undress, eat definitely requires fluency in his hands. It is necessary to remember that when a baby reaches for his 26 feet, he also strengthens abdominal muscles and back muscles, and stretching out their arms to the right or left, develops the ability to bend his torso.

HOW? Your baby is undoubtedly interested in others, he likes to look at and touch your face, grab you by the nose or hair. You should not be angry with him for doing it, try to turn it into a useful for his development game.

Use the described posture (sitting with raised lap) when a baby lies on his back on your raised lap, his neck is on your lap and his feet are on your stomach and chest. Gently take a baby by the shoulders, i.e. the arms between the elbow and shoulder joints, and gently move his forearms and hands forward so it will be easier for him to reach for something with his hands. He will be glad to reach for your face, or will try to grab you by the hair. Reduce the extent of your assistance as a child learns to act with his hands. If a kid is interested in a toy or wants to touch your face, make sure that, reaching for this toy or your face, he moves his arms in different directions. You can help your child reach out for a toy if you stabilize his body, putting your hand on his chest, as in photo 27. In photo 28 the adultâ&#x20AC;&#x2122;s hand is not on the chest but on the stomach of a baby, encouraging him to move his arms and hands free, better mastering this essential skill.

28 28

Raising the head

WHY? For children with Down syndrome it is very difficult to lift their

head Lying on the back, and then hold the head in the raised position. Therefore, we must very carefully take a baby out of the crib or from the table on which you change his clothing so that his head does not tilt back.

WHAT FOR? It is important that a baby learns to control the position of the head.

Babies with Down syndrome cannot immediately learn to stabilize the position of the head. Developing the ability to control the position of the head is necessary for all the subsequent stages of motor development – when he sits, crawls, stands or walks, that is, while maintaining any vertical posture.

HOW? When an adult helps a child lying on the back to learn to lift and

hold the weight of the head, it is very important to catch the child’s attention, and then, in addition to physical care, to try to “manage a baby with your eyes” holding eye contact with him.

In this case there is no problem pulling a child by the hand, put it, as is often done by masseurs. It is necessary to only help a child to let him raise the head off the surface and hold it in the position by his own muscles. You only pull a baby by his hands gently, and then stop, waiting for his response motor reaction (photos 29, 30 and 31). Using the position in which a baby is lying on his back on your bent legs, take a baby with both hands under the shoulders and gently pinch them forward, so that the child’s body is slightly bent. Trying to see you, he will try to raise his head. You can help him, holding his head slightly on both sides, as in photos 32 and 33. Using the same body position, attracting the attention of a child to your face, gently take

31 29

him by the forearms, pull him toward you a little. Pause, waiting for his own movement forward. In the same position let your child grab your index fingers, and with your other fingers take him by his wrists (photo 34). Do the exercise, similar to the previous one. Sitting on a chair, put your feet on the high support for a baby to almost sit on your lap (the babyâ&#x20AC;&#x2122;s head is directed toward your knees, and his legs lie on your stomach and chest). This position helps to stabilize the head. Carefully watch out for those motor reactions that occur in the baby in response to the head movement.

When taking a child out of the crib or stroller, you can also encourage him to every time lift his head. To do this call a baby by the name, wait until he looks at you, and stretch your arms to him. Maybe a 33 baby will stretch his arms towards you, too. If he still does not know how to do this, gently grab his arms and pull them, giving him the opportunity to lift his head off the surface at least a little. Then gently releasing his hands, clasp his back and turn a baby on the side, turning him stomach down. Raise a child so that he firstly raises his head, and then his torso (Photo 35). Do not forget that it is necessary to take him out of the crib from the right and the left sides! If necessary, ask a specialist how to take and hold your baby. Pay attention to the motor reactions of a child, remember that you only stimulate them, not do these movements instead of your baby!

The second stage. A child is lying on his stomach In the prone position a baby must learn to: • raise his head and hold it in the raised position; • keep his head resting on his arms bent at the elbows; • turn his head from side to side, tracing the movement of an interesting object; • bear the weight of the body from side to side, with one hand resting on the surface, and the other reaching for toys and grabbing them.

Lifting the head

WHY? Due to the lack of stability of the body and weakened sense of balance

it can be difficult for children with Down syndrome to hold the head in the raised position and turn it from side to side in order to keep track of different objects and look around.

WHAT FOR? Lifting the head is the start of developing the ability to straighten his

back and legs, in the future it is necessary to develop vertical body positions, that is, to feel free when a child sits, stands and walks.

HOW? You can help your baby lying on his stomach, lift his head, holding his chest.

You can use the following methods. When a baby is lying on his tummy, place your hand under his chest, helping him to stretch his arms forward, as in photo 36. Instead of the hand you can put under his chest a rolled towel or baby blanket. A child must see something interesting in front of him: an adult or an attractive toy (photos 37

38 31

and 38). Do not forget that in this case it is convenient to use face to face position lying on the stomach. If it is difficult for a baby to lift his head, you can help him, holding his chin in your hand. Do not forget that the arms of a child must be stretched forward, not stretched along the body (photos 39 and 40). If necessary, you can gently hold the babyâ&#x20AC;&#x2122;s hands in the right position.

Put a baby to his chest facing your face, fixing the arms so that they are stretched forward. Call a baby by the name, Blow gently on his head, and when he raises it, praise his efforts with a friendly smile and tender words. Additionally, you can stroke a child along the back, then hold your hand on his bottom to help him keep this position (photo 41). Put your baby on his stomach on the gymball (ideally, not more than 70 cm wide) and gently Push it forward (Photo 42). Doing this a baby will need to keep his head raised. Do not hurry! Make sure that a baby has time for the motor response!

Sit on the floor or on a chair, having a stable comfortable position, and put a baby across your lap (the childâ&#x20AC;&#x2122;s arms are withdrawn forward!). If you slowly lift the leg on which there are the shoulders and chest of a child, itÂ will help him raise his head (photo 43). You can encourage a child lying on his stomach to look around, if you attract his attention to a toy, slowly moving it in front of him from side to side (Photo 44). Tracing the movement of the toy the baby will turn his head.

44 32

A child lies on his stomach resting on his elbows

WHY? A baby with Down syndrome at first cannot confidently rest on his

elbows in the prone position. The reason for this is the lack of stability in the shoulder girdle, a weakened sense of balance and underdeveloped capacity to bend his torso.

WHAT FOR? The prone position with support on his elbows is a good position for

games (photo 45). In this position, the ability to develop and straighten his back and legs is very important for further motor development for example, in order to learn to stand. When a child learns to raise his head lying on the stomach, make sure you let him hold his head long enough in this functional position so that he gets the ability to straighten his shoulder girdle and bend his body.

HOW? If your child is not able to hold his head resting on the forearms and

elbows, you can help him by placing rolled towels or blankets under his chest. The arms of a baby must be stretched forward. At first, a baby cannot be in this position for a long time, but gradually the time spent in this position will increase. In addition, it should be borne in mind that at first a baby will be able to raise his head resting on his elbows, looking only forward and only after a while he will start to learn to turn it from side to side.

Put a baby on his tummy so that his arms are right-angle bent at the elbows, and the hands stretched forward. If you lie down on your stomach next to a baby, or in front of him, you can keep his elbows on the support surface (Photo 46). Put an attractive toy in front of a child, so that he looks at it and tries to take it. If you show your child an attractive toy lifting it above his eyes, he will need to raise his body to look at it.

Weight transfer in the prone position, resting on the elbows

WHY? Due to the underdeveloped ability to maintain balance a child with Down syndrome needs to learn to transfer his body weight from side to side as he lies on his stomach.

WHAT FOR? When a child has mastered the position with symmetric support

on bent arms, he must learn to transfer his body weight from side to side. This will give him the opportunity, leaning on one elbow, to take and hold a toy with another hand. To learn this, a baby needs to develop stability and the ability to maintain balance. Resting on the hands in the prone position, a baby learns to straighten his back and thigh muscles, which will be necessary when the time comes to stand and walk. When a child is learning to crawl, the ability to rest on his stretched arms become absolutely necessary, as well as, when he starts to sit down and stand up. The prone position with leaning on the outstretched arms allows a baby to see a lot, but also prepares his hands to later stand on all fours.

HOW? It is important for parents to understand that in a prone position a child needs to learn to lean on his elbows to play freely, and lean on the hands to sit down, stand up on all fours and crawl, and later - to stand up on his feet. To reach for a toy, a kid needs to shift his body weight on one side, lean on his elbow and release the other hand to grab the toy.

Place your baby on his stomach making him lean on his elbows. Show a baby lying on his stomach an attractive toy and then make sure that a kid is interested in it, slowly move it left or right to make your baby look both ways (photo 47). turning his head right and left, a baby begins to learn to bear the weight of the body corresponding to the direction of rotation of the head. Try to put a rattle 47 in the babyâ&#x20AC;&#x2122;s hand and help him, leaning on one elbow, shake the rattle. For the first time, it is permissible to use rolled sheets or towels and you can also support the elbow of a kid with your hand. Putting your baby in the correct position on the stomach (his hands are outstretched forward, elbows bent, a child is leaning on them), invite him to make simple actions: touch a tumbler toy, slap on

a small tower of bricks, hit the surface with a rattle. If necessary, demonstrate your child how to do it, manipulating with his hands, as in photo 48.

When a child has learnt how to shift his body weight, raise a toy a little higher and move it so that the baby can reach for it leaning only on his elbow and lifting the other hand (Photos 49 and 50). The higher the object, which the child is reaching for lying on his stomach,, the greater stability is required in his supporting arm. The same can be achieved if a child lying on his tummy, tries to get to the items that are on the small eminence, such as a pack of diapers or a thick book. In this case, a baby needs to arch his back more, as well as more stabilization and rotation of the body is required. That is how a child develops movement of the trunk, which is important for the next stages of motor development, such as sitting, crawling and walking.

Sit on the floor, straighten your legs and put your baby on his stomach across your lap (photo 51). In this position you can control his ability to lean on his hands. Moving your knees a little, raising or lowering the upper part of your legs, you can change the support and give a child the opportunity to lean on his hands with different force.

The third stage. Đ? baby rolls. WHY? It may be difficult for babies with Down syndrome to roll on their stomach and back, as they rotate (rotate at the waist,) the body during the roll. In other words, when a baby turns over, his shoulders and hips do not move one after the other, but they move simultaneously.

WHAT FOR? The development of the trunk rotation is extremely important when

turning over, since the ability to twist the body is important for the futher development of motor skills, such as learning how to sit, stand and walk. If you do not teach a baby to twist his torso at this stage of motor development, it will then be difficult to take and hold the asymmetric posture required for normal and fluent movements.

HOW? When a baby is learning to roll and twist the torso, it is necessary that

the lower part of his body remains still, but the upper part has already begun to turn, or, on the contrary, the upper part remains almost motionless, and the bottom one has already begun to turn. If baby is able to roll over, but does not twist the body, you can help him learn this move, slightly holding at the time of the roll either the bottom or the arms of the baby, when he turns, his shoulders and hips should move consecutively but not move simultaneously. Following this, you can change the way the baby rolls.

Practicing rotation of the body is possible when you dress and undress a baby or change his diapers. Usually, when we change a diaper, a baby is lying on his back, and we raise both his legs, raising his bottom off the surface of the table. But if you lift one leg and put it diagonally on the second leg, the trunk will twist (rotation will take place), and the bottom too, is lifted. Take advantage of this! Sit in a chair with your feet on a low stool. Place your baby on your legs so that he is lying on his back, neck to your knees and his feet are placed on your stomach and chest. Hold a baby by the shoulders, slightly move one of his shoulders forward, keeping the second one in the starting position â&#x20AC;&#x201C; this way you will initiate the turn (rotation) of the torso. It also encourages a baby to turn his head. Do not forget that this exercise should be done alternately from the left and then from the right side. You can teach a child to roll over when he lies on the floor or on the changing table. To encourage the roll from the back to the stomach, bend his knee and, holding it by the hip and the knee, move it upwards and diagonally above the second leg (52 photos) just as what you did when the kid was on 52 your lap.

To stimulate the rotation of the body in the roll, help a baby by holding his bottom with your hand, and with the other, helping him turn his trunk in the right way (Photo 53). At the beginning of the development of this skill, a baby can “stop halfway,” that is to lie on the side. Some children like to play in this position, but if we are at this moment practicing the roll, it is to show your child how to complete it (Photo 54 and 55).

To stimulate the roll from stomach to back, you can use a reverse movement: bend the knee and move it back diagonally. You can attract the child’s attention to a toy or other interesting objects which he wants to reach for as it is a stimulus that can also help your child turn over. First, show the toy to your child in the midline, and then slid sideways and slowly move it along the body of a child. As soon as a baby reaches for the toy, he’ll start the roll (photos 56-61). Once you notice that a baby can already turn over without the help of your hands, be sure to use an attractive toy to stimulate the roll showing it to a baby and moving it in the direction of the roll.

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The fourth stage. Đ? baby sits. WHY? For children with Down syndrome it is difficult to keep their balance

and straighten their back in a sitting position due to the underdeveloped ability to straighten the body. They often sit with a â&#x20AC;&#x153;roundâ&#x20AC;? back, or help themselves to sit, pushing themselves against their legs or the surface with their hands. As the sense of balance is reduced, a baby cannot immediately feel confident in a sitting position. it is necessary to develop his ability to reach for a toy from the side, and then return to his initial position, that is to use asymmetric postures that require the maintenance of a dynamic equilibrium.

WHAT FOR? The ability to confidently keep balance in a sitting position is import-

ant for every child, because it is more convenient to play with objects in a sitting position. If a child does not learn in time to sit with his back straight, his hands will be busy not playing but providing additional support. Such a situation will hinder the development of fine motor skills.

HOW? It is important for parents to understand that a baby needs to develop

his muscles to begin to sit . You were making such a â&#x20AC;&#x153;muscular corsetâ&#x20AC;? helping your child develop the ability to straighten his back in the prone position and helping him to strengthen the abdominal muscles when he raised his head and legs lying on his back. However, we should not think that a child is able to sit only when he learns to sit without support. A child with Down syndrome will likely learn to sit much later than maintain sitting posture, because in order to sit (i.e. move from a prone position to a sitting position), he must learn to use the transitional asymmetric posture. To introduce a baby with the sitting position, first time you can use a baby chair with a reclining back. But to put a baby on the sofa or on the floor, propping him on every side with the cushions is not advisable in this case, as his muscles will not work correctly. Offering baby toys when he is in a sitting position, you need to properly evaluate his abilities, if he has just started to learn to sit without additional support (ie, for a few seconds he may sit with his back against the back of the chair), it is too early to encourage him to do even simple manipulations with toys, because his hands are busy supporting his body. After some time, when a child learns to keep balance in the sitting position without additional support with his arms, you can offer him a toy at the level of his chest. It should not be raised too high because a baby has not learned how to raise his arms above shoulder level, and it should not be lowered too far, not to make him sit with a bent back. And only when a baby feels confident in this position, you can offer him toys at his head level or just a little above, and then at the top on the right or at top on the left. This sequence is associated with a consistent development of balanced and asymmetric body positions and the development of the ability to keep a dynamic equilibrium.

Place a baby on the floor in front of a low table (a bench can be used instead of a table, or a couple of thick books or just a pack of diapers). Put an attractive toy on the table so that a baby wants to take it (Photo 62). This position will help a child to straighten his back and take toys with his hands. Make sure that the level of the table top is about the chest level of a child, otherwise it will be difficult for him to stand up straight! You can offer your child to put large bricks on each other, or, conversely, drop them

from the table. It is important to understand that the higher a baby will raise his arms, the more he will have to straighten his back. To improve the posture in which a baby is sitting, you can put a little flat or wedgeshaped pillow under his bottom (Photo 63). In this case, he will bend forward and his back will be straightened. Sit on the floor, cross-legged. Sit a baby in the “saddle” so that he is sitting as if on the

63 pot. At first, he may support himself with his arms on your legs, and then learn to sit without support. When this happens, you can complicate the task a bit, moving your legs a bit so that the baby starts swaying from side to side and learnt to keep balance. Photo 64 shows another variant how to use this position.

Sit on the floor or on a chair, and put a baby on your lap, turning his face to yours or face away from you. Carefully shift your legs to the right and to the left or in turn lift or drop your knees (remember the game of “going to grandma, going to grandpa ...”) so that a baby needs to maintain balance. Shake a baby slowly, your goal here is not just to amuse him, but to train his reaction of balance in this game. Shifting your feet, make a pause, giving a child an opportunity to straighten up, and only then shift your legs in the other direction.

It is very important to do it carefully, because you need to encourage correct reaction of balance in response to your action and not to drop a baby on the floor not to scare him! The amplitude of the wiggles should

increase very gradually, making a baby enjoy this game. For a child to feel safe, hold his body with your hands. At first, your hands must be above the thighs, as in photo 65, and when a child feels more confident, the hands should be below supporting his thighs or lap, as in photo 66. Sit on a chair, and put a baby on your lap face to face or with his face away. Slowly lift and drop alternately one or the other leg. A child in this case will tilt alternately left and right (photo 67). Do not forget that this game must be carried out at a slow pace, always waiting for the motor response of a baby, otherwise he will not have time to feel how he needs to straighten and balance.

You can put a baby on a gym-ball, holding him with your both hands (Photo 68). If a baby likes it, gently move the ball, stimulating reaction of balance. Do not hurry and carefully observe a child and making a pause, for a baby to straighten himself after you have tossed the ball. Your hands should be placed at the bottom of a child. His upper part of the body in this case will be free and he will actively practice the ability to maintain balance. If a child is afraid to sit on the ball, try to tightly support his torso. You can blow off the ball a little bit, then it will be possible â&#x20AC;&#x153;drownâ&#x20AC;? the bottom of the baby a little which will strengthen his sense of support.

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Photos 69 and 70 show how the hands of an adult should be placed if he is kneeling (sitting on his heels) behind and slightly to the side of a child.

A sense of balance in the sitting position can be developed using many different games. Swinging on a baby horse or on a swing, a child also develops the sense of balance. Children with Down syndrome are at first sometimes afraid of such games. Therefore, take care of the security of a baby, do everything not to let him fall down or hurt himself, and the time of this kind of motor activity should be increased very slowly (photo 71). For practicing the sense of balance in the sitting position parents can use a balancer. In photo 72 to train the sense of balance there is a dais to let a baby straighten his back reaching for a toy. When choosing a chair, a foam cushion or bench, which a child can use for sitting, it is important to take into account its height. The feet of a baby sitting

on this dais, must always stand on the floor. If a baby has not yet learned to place them correctly, you must help him, placing his feet correctly. Once a baby starts to at least for a few seconds sit without support, you should make him sit more often. Slightly change his position so that he will use reaction of balance, trying to maintain a sitting position. When a child is sitting on floor and playing, you have plenty of opportunities to practice his sense of balance.

Put toys so that a child needs to use the reaction of equilibrium, reaching out for them. When a baby feels more confident in a sitting position, start stretching him toys, placing them above the level of his shoulders, for him to reach for these toys by tilting his body (photo 73) and then taking the toy, straighten it. It is very good to train a child’s ability to maintain balance in a sitting position during daily activities, such as dressing or undressing. It is important to understand that when a baby is sitting and you put on his socks or shoes, lifting his feet, you train his ability to maintain body balance.

The fifth stage. А child moves on the support surface. WHY? For babies with Down syndrome it is difficult to learn to move on the floor, because it is difficult to hold back straightened and lean on hands and knees. In addition, they are not very confident at pushing off with their legs.

Until a kid learns to walk, he can move across the surface in different ways. The most common is crawling. In order to crawl on all fours, it is necessary to use his own sense of dynamic equilibrium, i.e. to use asymmetric body positions. Since kids with Down syndrome are not good at mastering asymmetrical positions of the body, they often move in a peculiar way – so that their movements are symmetrical. For example, they can move forward in a sitting position, making symmetric leg movements as if “raking up” their body forward or pushing off the floor with their hands. Children can crawl on their tummies long and quickly stretching forward their both hands and pulling on them (sometimes referred to as the “belly crawl”). Sometimes kids for a

long time move with the help of rolls, using the already developed skill to roll from back to stomach and stomach to back or move “like rabbits” – that is, on the knees, they simultaneously throw out both hands and leaning on them, they pull both legs at the same time. Parents should understand that all these special ways of crawling – are physical activity of their babies which definitely has to be encouraged but never be prohibited because a child himself has learnt to do it!

WHAT FOR? The ability to move around on the floor is very important not only

in terms of motor development, but also for the overall development of a baby. As soon as a baby learns to move himself, he will have an opportunity to actively explore the surroundings independently and get to a toy or to an adult. Parents should definitely encourage the activity of a child, and never discourage his movement, even it does not at first look like a “classic” crawl (photos 74 and 75). However, besides the method of movement that a baby has mastered himself, you should still try to teach him to crawl on all fours. The fact is that the position on all fours and moving the body in this position develops not only the child’s ability to maintain a dynamic balance, but almost all his muscular system.

75 In addition, the “classical” crawl on all fours stimulates hemispheric interaction of the brain. All this is important for further motor, intellectual and language development of a child. From this position a baby can sit down and stand up. It should also be understood that before he starts to crawl, he must master the static posture on all fours. Often parents, wanting to help a child quickly “budge” and crawl, try to move a baby’s hand forward or gently push his legs. As a rule, a kid “flops” on his stomach and of course, it is not possible for him to crawl. Do not rush your child, let him get comfortable

with his new posture! Let him get up on all fours and wiggle as much as he needs to feel how to shift the weight of the body, how it feels to lean on his hands and knees. Bear in mind that the period of “standing” in such a position can be quite long, it can take from a week to a month, and sometimes more. To encourage a child to move forward, it is better not to try to rearrange his hands and legs but gradually attract his attention using an interesting toy, putting it on the front top, so that reaching for it, the baby tears off his hands from the surface. This will be the first step to the development of a classical crawl.

HOW? Once a child begins to move across the surface in any way - on his

stomach or back, with the help of the roll or sitting on the bottom, parents need to make sure that he is able to move around the house, that is, to organize the day so that the baby can move on the floor, but not be the whole day in bed or a small play-pen. Show your child an interesting toy, play it to interest him, put this toy a little distance away, encouraging your baby to move nearer it in any way that he is currently capable of . It is important that, after reaching the toy, a kid gets the desired result, that is to play with it. At the same time, you can teach a child to crawl on all fours. Motor “prerequisites” necessary for this are the ability to lean on the arms and legs, straighten his back and push off with the legs . You’re already familiar with the games that help your child develop these skills, and at this stage should continue to play with a baby lying on his stomach.

For a baby to crawl properly, it is important to learn to push off with his hands and feet. We have already mentioned that children with Down syndrome often choose to push off (symmetrically) with two hands or two feet. There is nothing wrong with that, but as we are aiming at the baby mastering asymmetric body positions that require the skills of keeping dynamic balance, we need to help him feel how he can alternately lean on his limbs. If you give your child the opportunity to crawl over the cushion (photo 76), to move across the threshold, it will help him to do asymmetric movements of the arms and legs. If you lie on the floor, and a baby will move over your body, it is not only an interesting game for a baby, but also it will let you slightly push a baby in the right direction.

For these exercises, you can use a variety of objects (photo 77): rollers, cushions, a ladder or sofa, putting an interesting toy, for example, on the third from the bottom rung of the ladder. Do no forget about safety precautions!

The sixth stage. А baby’s learning to sit. At this stage of the motor development a baby must learn to sit from the prone position and reverse. Necessary in this period movement sequences are called “transitional positions”.

WHY? For babies with Down syndrome it can be difficult to sit out of a prone

position, since it is not easy to learn to use the position of half-sitting on the thigh (the position in which both legs are bent and “look” in one direction, the trunk is bent in the same direction, but the hands are on the floor on the opposite side from the toes). To learn how to sit in this position, a child has to have well- developed movement of the trunk. Trunk stability and a good sense of balance are needed. Most often children with Down syndrome try to sit in symmetric ways to avoid difficult for them asymmetric body positions.

WHAT FOR? Besides that every person should learn to sit, this functional stage of motor development provides a baby with training the ability to keep a dynamic balance that is needed to freely walk, run, jump, and so on.

HOW? First of all, it should be noted that, starting to sit on their own,

children with Down syndrome often “invent” their own ways to do it. Unconsciously using excessive mobility of their joints, they can sit down, holding both legs symmetrically through the side split. Or, trying to avoid to break the balance of the body and avoid asymmetric positions, push their body into a sitting position with their hands. It is important to remember that there is nothing wrong with that, because it is the independent motor activity, which a baby shows developing new movements and new motor skills. Do not prohibit

your child to sit in this â&#x20AC;&#x153;unusualâ&#x20AC;? way, it is much better and more efficient to teach him to sit in an asymmetric way. It is important to understand that the task of adults is not to re-teach the child, discouraging his own wish to move in a comfortable way, but to help him to diversify the motor repertoire, adding more complicated, in terms of balance and muscular effort movements. Make him try to get a toy over your leg taking a half-sitting position on the thigh, and then the position on all fours (the babyâ&#x20AC;&#x2122;s stomach must be on the legs of an adult). Help a baby by directing the movement of his hips, legs and torso. After the baby stops playing, you can help him return to a sitting position. To this you need to slightly raise your leg, on which the child is lying. It will help him to firstly sit on the thigh, and then straighten the body and sit up straight. If is necessary, help him bend his leg and straighten up (photos 78-84).

Make sure you let your child play with a toy when he has sat up straight. Then, repeat the same actions on the other side. There is your second leg between a child and a toy now, and you can train the transition from the half-sitting position to the position on all fours and back to a sitting position. Help your child take a

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sitting position, as he stands on all fours. To do this, you can pull him by the thighs in the right direction (backwards and sideways) and help take a sitting position (Photo 85). When a baby can sit on the floor, show him a toy and move it so that it is on the side and a little behind him. In this case, in order to reach for the toy, he will have to lie on his stomach. At first, help him to correctly do all desired movements â&#x20AC;&#x153;directâ&#x20AC;? his bottom, legs and torso. Do not forget to give him the opportunity to play with a toy that interests him, when he changes the position of the body!

The seventh stage. А baby stands up. WHY? For children with Down syndrome it may be more difficult than for

usually- developing kids to learn to stand on their feet and keep a standing position. This is due to the lack of stability in hip and knee joints, as well as difficulties with keeping balance. Therefore, at first, to save vertical posture they need a fairly intensive physical support of an adult.

WHAT FOR? Standing is the initial stage of training to walk. The ability to maintain balance while standing influences both the ability to walk, and the “quality” of walking, i.e. the quality of gait.

HOW? At first a baby, of course, has to learn to stand by the support,

leaning on it with his both hands. Moreover, the development of the skill to stand begins at the moment when a child leaning against the support with his whole body will be able to stand on his feet for a couple of seconds.

Exercise on the ball. It is very good to use a large inflatable gym ball to develop the ability to stand and straighten the legs. Put a baby with the tummy on the ball and sit conveniently on the floor behind him. The child’s feet should be shoulder width, hips and knees straight. Gently pull the ball towards you, holding the baby by the hips (Photo 86). At the end of the exercise, the child must stand on his feet. At first, his feet can rest on your knees, and later he must get up on the floor (Photo 87).

Keep up the pace! Do not forget that the objective is not to roll a baby on the ball, but to let him feel the support with his feet and the body in an upright position! Pay attention to the position your hands, which help the babyâ&#x20AC;&#x2122;s joints take and hold the right position. At first, a baby during exercises on the ball just learns to stand on two legs, but then when he is already good at it, he will have to learn to transfer his weight from one foot to the other because it is necessary to walk. Slowly and gently pushing the ball from side to side, you can encourage the child to shift his weight from one foot to the other. The exercises on the ball are convenient to carry out in front of a large mirror because a child can see himself and the adult. It is good if there is a possibility to pay with a child together with another adult: one adult is on the floor behind the baby, helping him to get up and stand properly, and the other is in front of the child, so you may not just talk to him, but also give him an attractive toy or object. Using fixed support. As an additional support that a baby needs to learn to stand, you can use a sofa or a stable chair, a coffee table or bench suitable to his height. The support should not be too low, so that the child does not bend the body when standing, and not too high, so he does not hang on his hands, lifting them up. Later, of course, a child will learn to lean over any support( object) suitable to his height, but at first, the support surface must be located approximately at the level of his chest. To make a baby interested in using the new body position it is necessary to use an attractive toy or object (Photo 88). Parents should be aware that a baby who is just starting to stand by the support, for example, cannot put the ring on a pyramid or do other complex manipulations with objects. All his efforts at this time will be connected to keeping a challenging for him position, thus it is best to offer him simple bright rattling (sounding) toys which he can slap with his hand, or use toy bricks that can fall from the couch when he hits them. Put a baby in front of a sofa or other suitable support. Take a position behind him on the floor, kneeling (sit on the heels). Do not forget that it is required to put something attractive for a child on the support surface as it encourages him to reach for and take this interesting object or toy. Holding the baby by the buttocks and knees, you will not allow him to bend his knee and hip joints 88 and â&#x20AC;&#x153;settleâ&#x20AC;? on the floor. At first, the child will stand, leaning on the sofa with both hands and chest. The task of an adult is to gradually ensure that the baby leans over the support only with the hands - first with the forearms and then with the hands but does not lean over it with the whole body. To do this, slightly push the child standing by the couch, so that he can transfer his weight to the feet.

By adjusting the place where you put a toy, you can teach a child to lift one hand off the support and transfer the body weight on one leg. Keep up the pace, your baby must always see this attractive object!

Encourage your child by placing a toy, for example, on the right. To get it, he will need to lift the right hand off the support and stretch towards the toy. You can hold the toy higher or lower, and thus, develop sense of balance in a standing position (photo 89). After a while, try to play with your baby changing the position of the toy so that the baby makes a faster response. Train transfer of the body weight in a vertical position in everyday situations as well, for example while getting dressed. When putting on trousers or putting the baby’s feet into the shoes ask him to raise his legs in turn allowing him to use the support. If a baby does not fall down on his bottom, you can assume that he has mastered another posture: he is able to stand by the support. Now it is time for a baby to learn to stand without support, that is, stand on the on the floor on his own.

Put your baby with his back to the support (a sofa, chair, or simply to the wall) and offer him a toy so that reaching for it, he tears his body away from the support. The body weight in this case is transferred to the legs and his back will not be leaning over a table or sofa. Encourage your child to stand, holding bulky but not heavy objects: cardboard box, light inflatable toy and so on. (Photo 90). Teaching a child to keep balance in a standing position without additional support or props you can use a variety of games. Offer him toys, which he will need to thoroughly reach for, let him play “volleyball” with a balloon or hit it with the rolled newspaper. A little later, you can complicate such games putting a baby on a low stool. When a baby is stable standing

on both legs, try to teach him to stand on one leg. Encourage active games, during which a baby puts one foot on a stair or standing on one leg, kicks a ball with the other. In photo 91 there is an idea to practice standing position using a gym ball and a toy suitable for a child which he may hold on. Photo 92 shows another variant of the game to develop balance in a standing position, in which you can use a trampoline.

The eighth stage. А baby stands up. WHY? When children with Down syndrome learn to stand up, it can be

difficult for them to straighten their legs and keep balance, so they often use their hands to pull themselves up and stand up. To sit independently a baby needs to learn a lot concerning his motor development. The main “preconditions” for getting up are footwork and balance. Feet movement develops during crawling on all fours, and when a child learns to stand and walk. Body movement and the ability to maintain balance develop in a sitting position, when standing, or moving from a prone position to a sitting position, and while walking

WHAT FOR? It is hard to imagine anyone who is unclear why a person needs the

ability to stand up. However, you can stand up in different ways. There are easier ways to do it, and children with Down syndrome prefer to use such methods. Just as in a sitting position and when moving on the supporting surface such a baby will avoid asymmetric positions requiring the retention of dynamic balance. But for a child to feel confident asymmetric body positions are needed, so you should pay attention to training this important skill.

HOW? If a baby is able to stand with a little extra support leaning on your hands or a crib railing, then soon he will want to get up by himself.

Of course, first of all it is necessary to master the initial stages of development of motor skills, and then he will have the opportunity to learn to get up in better ways.

Kneel in front of a sofa or a table (sit on your heels). Place a child on your lap with his back to you and his face to the supporting surface. His feet must stand firmly on the floor, legs bent at 90 degrees, so straightening the legs he could stand up. Do you remember that we have already used this position when playing with your baby, sitting on the dais? Put a toy on the sofa, put the baby’s hands on the sofa and draw his attention to the toy. When the baby tries to stand up, help him, pushing him forward and upward. The lower your child is sitting, the more difficult it will

be to get up. You can help him if you rise slightly from the heels in a low position, thereby pushing the baby slightly forward and upward (photos 93-96). In addition, this movement will help your child keep his balance. You may not use your knees, but a new pack of diapers, a pair of thick books or childrenâ&#x20AC;&#x2122;s low bench to teach the child to get up from them. It is easier for a baby to get up if he strengthens both legs. As soon as a baby learns to stand up in such a way, it is high time you teach him to get up as people usually do. Put a baby on his knees in front of a sofa or a small stable table, and kneel behind his back. Put your hands on the hips of the baby and push him to the right a little, this way you shift the weight of his body on the right leg. This will allow your child to bring forward his left leg and stand on it, standing on his right knee.

Then, pushing the baby forward, up and to the left, you help him get up, straightening the left leg and, at the same time, raising from the surface his right one. To understand the sequence of these movements, try to do them yourself with an appropriate support. Do them slowly enough to feel how to bear the weight of the body from side to side when standing up, and remember what movements you are doing and their sequence, then it will be easier to help a baby.

You still should remember that a child needs only a little support and assistance, give him an opportunity to do everything that he is capable of at the moment. Photo 97 shows the position of the adultâ&#x20AC;&#x2122;s hands. After a baby learns how to stand up leaning on his hands from the position on the knee, you can move on to the next step - trying at this stage to minimize the support of the baby on the sofa. Try to give him a toy in one hand, then he might be able to get up leaning on only one hand. Offer your child to get up using different ways of support. For example, he can lean on the mobile support, eg. your hands. After a while, a baby learns to stand up on his own. It is likely that doing this, he will stand on the hands and feet, lift up his bottom, and then push his hands off the floor. This skill is quite normal and natural, but still worth trying to improve. Give your baby toys in both hands, then he will have the opportunity to try to get up keeping dynamic balance without leaning on his hands.

The ninth stage. A baby walks. WHY? Children with Down syndrome begin to walk later than usually developing children because of their difficulties with maintaining balance while walking. In order to learn to walk, it necessary to learn to straighten the back, keeping the torso upright and shift the weight from one foot to the other, without losing balance.

WHAT FOR? The day when a baby makes his first independent steps is one of the happiest in the life of any family. This event is one of the most important milestones of his motor development. The number of the babyâ&#x20AC;&#x2122;s steps gradually increases, and the time comes when it is necessary to pay attention to the quality side of this skill, because it is very important not only how far a child can toddle, but also how he can walk: carefully or fluently moving his legs with a difficulty in maintaining balance.

HOW? You will notice the first attempts to walk when a child starts to cruise along the sofa or the play-pen, leaning on his arms and chest. Your task is to maintain and develop this desire.

Put a baby by the couch or a table of a suitable height, put a toy on the support so that the baby could reach for it, and, if necessary, help him fidget his feet, holding him by the hips (Photo 98) and slightly shaking him from side to side. To walk you need to bear the weight of the body from side to side, and fidget from foot to foot. When a child cruises along the support, try to assist him as little as possible. Slightly pushing his body away from the edge of 98 the support, you can help him to keep the weight of the body on the feet. Eventually he will learn to walk slightly holding the edge of the surface with his hands. When the child learns to lean on the sofa or table not with both hands, but with only one hand, you can try to encourage him to walk to the further chair (another support). It is important to use that support of the same height as the baby or slightly higher. At first, the distance between the supports should be very small for safety reasons, since in the process of walking a child will need to constantly hold by the surface of the support (Photos 99 and 100). In the future, the distance between the supports, which the child is holding by, must gradually increase.

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At this stage of learning to walk a steady baby carriage with an oval handle is useful (photos 101-103) because a baby can push it in front of him (Photo 104). Some children are happy to walk moving a small chair or their own pram. But to use the so-called “walkers” is not advisable, because, being in them, a baby does not walk himself, but he is in a half-sitting position, just “going” around by moving his feet and shifting the weight of the body from side to side. In such a walker the body weight is distributed incorrectly, and a baby does not feel that he keeps his body in an upright position, standing on his feet. Our experience shows that this device does not develop the ability to walk if not to say slows down its development. As soon as a baby can walk long distances without your support, try to gradually increase the distance that he must toddle. Offer your child games that encourage him to walk. For

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example, you can squat a bit away from the child, stretch your hands, call out to the child, and then catch him when he reaches you. Call the baby out from the back to make him turn around and change direction and walk in the opposite direction. Encourage your child to carry light bulky items from place to place (Cardboard boxes, soft toys, pillows, and so on.) It will make his both hands busy and he will not “be tempted to” crawl on all fours again. It is very helpful to teach a child to overcome obstacles while walking. To do this, you can put various safe items on the floor, such as large soft toys, cushions, foam bricks, and so on. As soon as a baby is able to cover relatively long distances, walk holding toys in his hands and confidently change direction, start using walking in different situations. For example, offer him to walk on the curb or go for a walk in the woods, where he will need to walk over branches lying on the ground. At first, you will probably need to hold your baby by the hand, but in the end he will have to walk on the rough surface himself.

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Walk up and down the stairs. It should be borne in mind that it is easier for a baby to go up the stairs than to go down. Start with one or two stairs and gradually increase the number of the stairs that a baby goes up and then down. Do not forget that no matter a baby goes up or down the stairs, an adult should always be below the child – it is a security requirement! Playing football with you, a child practices a lot, because he needs to lift his leg and kick the ball, while maintaining balance. Let a kid walk as much as possible, run a lot, even backwards. At the playground do not forget about ladders, swings and other different “climbing equipment”. It is very useful for babies with Down syndrome to walk on the sand or on the grass, and in deep snow in winter.

A few words in conclusion. So, your child has mastered the basic motor skills that are necessary for every child to successfully move in space, explore the world, play, participate in household daily routine and learn more. Those motor skills referred to in this book are called basic because they lay the foundation for further development and improvement of motor abilities of a child. It will take some time, and the current skills will allow him to learn to run and jump, and after two or three years -to ride a skateboard and go skiing, swim and ride a bike. In addition, it is very important for parents to understand that well-developed basic motor skills are a prerequisite for the successful development of the fine motor skills without which it is impossible to learn self-help skills and graphic skills. Any motor skills require a long perfection in the course of daily life in kindergarten and on the playground, at home and on vacation. Find out if there is a gym somewhere near, where you could go with your baby? And during walks you will have many opportunities to stimulate motor development of your child. In conclusion of this book, we want to offer you some photos of daily lives of our children. The photos are taken during regular group classes at Early Intervention Centre DSU, as well as during the tree planting by our graduates, on the playground and yoga classes. In our opinion they perfectly illustrate the fact that children with Down syndrome have good motor potential, developing which we help them to consistently acquire more and more skills in order to live a varied and interesting life.

Dear reader! We are very pleased that you are interested in our books. All scientific and methodology literature in the Centre DSU is free. But we are always grateful for donations which enable us to continue our work to provide the families raising children with Down syndrome with the necessary literature. You can make a donation through our website http://www.downsideup.org Even a small amount will be very useful!