Fig. 4: Activity-based therapy intervention.

Training activities on the treadmill: a–c, and training activities off the treadmill: d, e. a Step retraining at age-appropriate speeds with partial body weight support and trainer facilitated stepping via manual cues. b Stand adaptability training activity target active trunk extension with “letter spelling” with arms to the side and overhead. c Stand adaptability training to facilitate trunk rotation while swinging a tennis racket and aiming at a ball. d Sitting with balloons passed at or above eye level to emphasize upright sitting posture and activate trunk extensors. Note therapist’s hands providing support at mid-to-low ribs and activity challenging trunk control above the support. e Facilitated stepping activity with manual facilitated sensory cues provided at legs and pelvis with partial body-weight support and posterior walker. f Community Integration. Therapists worked with family to integrate activities in the home and community to increase practice of newly developed skills by her changing neuromuscular capacity. In this instance, child is playing ball toss at a community event reinforcing overhead reach, trunk extension, and trunk control in manual wheelchair.