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Physiotherapy In Early Intervention Program For Children With Special Needs



Early intervention programs supports the needs of the infants and toddlers with development delays and disabilities. Physiotherapist can helps the families with their child’s development and ability to participate in age-appropriate and meaningful activities. Physiotherapist provides therapeutic intervention to enhance the gross motor and fine motor development skills where they will work together with families, caregivers and other team members when necessary.

Early intervention should start early as possible so that it can improve the quality of the life of the children and reduce careers burden. Development delay describes the behaviour of young children whose development in moving, talking or playing is slower than other children of the same age. The delay can be in any areas of development such as movements, thinking, speech or self -care skills. Normally a child who is having development delay will have general lack of movement or does not move in a lot of different ways and even do not explore the movement.

Warning Signs Of Gross Motor Delay At Various Ages

Normal Gross Motor Milestone

Assessment Techniques

Warning signs / Needs to refer to the doctor

Head control at 4-6 weeks
  1. Put the baby into supine position.
  2. Then, pull the baby to sit.
  3. Observe the : head control : elbow slightly Flexed


Source : www.beyondbasicplay.wordpress.com


Gross head lag by 6 weeks

Observe for

  1. Gross head lag
  2. Both arms straight

Source: www.naturaltothecore.wordpress.com

Head control 6 weeks to <3 months
  1. Place the baby in prone position
  2. Observe for
  3. :ability to lift chin off couch momentarily                                               : bottom flat                                   : forearm support

source : www.photo.elsoar.com

  1. Inability to turn to one side, and no attempt to raise the head up.
  2. Not holding head and shoulders up when on their tummy

Source : www. philnews.ph

Roll over at 3 months to 6 months
  1. Baby’s position in supine lying.
  2. Observe for : any attempt to roll over

Source : www.secretsofbabybehaviour.com

Able to roll over

Source : www.pregnancyand baby.com

  1. Unable to roll over by 6 months
  2. Not holding head and shoulders up when on their tummy.
Sitting at 6 – 9 months
  1. Put the child to sitting position
  2. Observe the ability to sit with or without support

source : www.zenbabyyoga.wordpress.com

  1. Unable to sit even with support by 9 months.
Crawling at 8-10 month
  1. Put the child in prone position and observe his /her attempt to crawl.

Source : www. photo.elsoar.com

  1. Not moving eg creeping or crawling motion.
Stand with support at 9 – 12 months
  1. Put the child to stand
  2. Observe the child’s ability to stand ( with / without support)

WITH SUPPORT          



Source : www.modernmom.com       


Source  www.getty.images.com   

  1. Unable to stand with support by 12 months
  2. Does not take weight well on legs when held by an adult.
  3. Not even standing holding on to furniture.
Walking at 12 – 15 months Observe child’s walking ability Unable to walk a few steps by 15 months.
Running at 18 – 24 months Observe the child’s ability to run  Unable to run / run awkwardly by 24 months

Handling and Position

An early handling techniques and correct position are very much important for a child with disabilities. This will enhance the child to move correctly from one place to another place. The correct handling and proper positioning is to provide a good body support and balance and ensuring safety of the child. Besides that, it also can avoid aggravation of abnormal tone and posture and minimize and prevent further deformity and injuries.

A correct handling and positioning skills are important to be carried out all the time once the abnormality of the child is detected. This is done when the child’s condition is stable. Because it will keep the child in a comfortable position all the time.

Parental involvement is crucial in the management of this child. Through training the mother/carer, it is possible to overcome the problems.

Carrying / Lifting Techniques Explanation
Carrying a child

Source : wikieducator.org/Lession _20_disability _and _rehabilitation_part_2.

Carry him/her in a way which corrects abnormal positions and which brings both his/her arms forward. A more upright position helps him/her learn to hold his/her head up and look around.

carrying a spastic child whose legs cross, or a floppy child

Source : wikieducator.org/Lession _20_disability _and _rehabilitation_part_2.

Facing the child face while playing with both legs apart.

Carrying a spastic child.

Source : wikieducator.org/Lession _20_disability _and _rehabilitation_part_2.

Carry the spastic child or those having legs cross. You can swing him/her from side to side in this position.

Position a child to a sitting position with facilitating head movements.

Source : wikieducator.org/Lession _20_disability _and _rehabilitation_part_2.

Play with him/her, supporting his body firmly but with his/her head and arms free. Attract his/her attention with interesting objects and sounds, so that he turns his/her head first to one side and then to the other.

Positioning of neck, shoulder and arm

Source: wikieducator.org/Lession _20_disability _and _rehabilitation_part_2.

Position face down is a good position for a child to begin to develop control of the head, shoulders, arms and hands, and also to stretch muscles in the hips, knees, and shoulders.

Range Of Motion Exercises

Raising arm above head

Raise his arm so his hand is over his head with his thumb pointing up. 

Keep his elbow straight


Raising arm to side

Move his arm to the side away from his body until it is straight out to his side. 


Move shoulder in circle

Bent elbow at 90° angle and move shoulder in circle. 


Bending elbow   

Bend his elbow and then straighten the elbow.


Rotate forearm up and down 

Turn his forearm and hand up and then down


Bending wrist

Move his hand forward and then move his hand back.


Closing and opening hand 

Bend his fingers and then straighten his fingers


Leg lift

Lift the leg straight up while holding the hip and bottom in place.

Gently hold for 3 seconds and take leg back down. 


Bend and straighten hip and knee

Bend the hip and knee up toward the belly and hold. (Figure B)

Then straighten the leg down and hold ( Figure A)


Bend foot down

Bend the foot down and hold for 3 seconds. Then return to the starting position.

Source : Leg Range of Motion – baby (Wexner Medical Center)  : Exercises Upper Extremities infant (Nationwide Children’s Hospital)

Important points to remember when carrying-out the range of motion exercises

  1. Do the exercises very gently. Closely watch the infant’s face for signs of pain or discomfort.
  2. Do each motion 10 to 15 times and NOT to the end of the range of motion. Move into the range until mild resistance is felt and hold there for 30 seconds. Do not bounce into this stretch.
  3. Do one joint at one time.
  4. Never Force the movements. Range of motion exercises may cause some discomfort but should NOT be painful.


Development delays should be identify and treated as early as possible, as children’s brains can change easily and also can respond to training that will help them learn the skills that are lacking. Co-operation from parents and therapist is needed to determine full success.


  1. Family health Development Division Ministry Of Health Malaysia, 2001, Manual on the management of children with gross motor delay.
  2. www.drnathbrachialplexes.com
  3. www.specialeducationalneeds.co.uk/global-developmental-delay.
Last Reviewed : 23 August 2019
Writer/Translator : Kogilavani a/p S.Krishnan
Accreditor : Se To Phui Lin
Reviewer : Halimah bt. Hashim