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Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders

A Guide for Parents and Professionals
Sieglinde Martin, M.S., P.T.


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isbn# 978-1-890627-72-0
8 1/2" x 11"
238 pages
250 photos
Resource guide

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"Who hasn't heard the phrase, 'You have to learn to crawl before you walk?' This maxim helps everyone make step-by-step progress in learning new activities. For children with cerebral palsy and other movement disorders, it is absolutely necessary. And this book is a must read for parents who want to understand the sequence of gross motor development, what physical therapists do and why they do it.

There is an explanation of the different types of cerebral palsy, and a discussion of the medical conditions and developmental delays, which may co-occur. This book doubles as an easy-to-read guide for parents who want to participate in their child's gross motor progress. There are photos that illustrate positions, tips to make activities fun, and ideas that have worked for other families. There's also a comprehensive list of organizations that provide recreational opportunities for children with physical disabilities.
-Newsline, Summer 2009 (Federation for Children with Special Needs)

"The goal of this book is to provide families of children with cerebral palsy (CP) and similar movement disorders with a clear, easy-to-read guideline for performing home exercise programs. Martin has done an excellent job in accomplishing this goal. The book is easy to read, has plenty of illustrative, referenced photographs, and is organized logically.

I highly recommend this book for any new parent of a child with developmental disabilities. It provides parents with a clear description of what they can expect for their child's motor development in the years ahead."
-Physical Therapy, Volume 87, Number 7, July 2007

Author Sieglinde Martin, MS, is not only an experienced therapist but also the mother of a child with cerebral palsy.

"This book does a fine job explaining and demonstrating how children with cerebral palsy or other movement disorders may be assisted in learning basic sequential motor skills or missing skills and further challenged to advance to the next motor level.

Exceptional black-and-white photos on almost every page illustrate various positions and stability to promote manipulative play. Examples are given using laundry baskets, step stools, coffee tables and other everyday objects for gross-motor positioning. The manipulative activities promote fine-motor skills.

This resource would be particularly beneficial for preschool-or school-based therapists to share with teachers, parents and other staff to provide a visual and printed sequential reference."
-ADVANCE for Occupational Therapy Practitioners, February 18, 2008

"Author Sieglinde Martin, MS, PT, and publisher Woodbine House have provided a great service with Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders: A Guide for Parents and Professionals. This text is practical, caring, comprehensive, authoritative and reasonably priced.

Directed first to parents, the book appropriately treats them as key partners in their child's team of motor coaches. Martin puts in plain words why children with cerebral palsy can't do what their peers do. She describes how therapists and parents can train children to develop their maximal abilities--while emphasizing that the process may be tedious, slow and full of effort.

Martin introduces her Road to Independence Skills Guideline, a three-page photo summary of gross motor development, starting with bringing hands together in side-lying and concluding with stair climbing. All photos feature children with cerebral palsy or similar conditions.

Focus on Skills
The subsequent chapters are wonderfully organized. Each focuses on a particular skill or attribute (Flexible Muscles and Joints; Heads Up). Martin explains why the skill is necessary and what may happen down the road if the child doesn't master it. The rest of the chapter shows and tells, with photos of real children in real homes using everyday "equipment," how to develop the needed ability.

Most chapters end with frequently asked questions; one parent has told me this is her favorite part. For instance, when asked about W-sitting, Martin responds that the child should be corrected when playing with an adult, but constant reminders during free play do more harm than good. This allows the child some independence and frees the parent from worrying constantly while the child is playing.

Martin stresses that parents should address specific concerns with the child's therapist, yet she sets the stage early on for the vital role of home programs by stating, "the work done at home by the parents is most important, even more important than what the therapist does."

Current Motor Approaches
Martin's clear, no-nonsense manner, developed through more than 30 years of pediatric experience, will help therapists convince parents of the importance of the recommendations. Martin backs up her clinical reasoning with literature citations, and explains motor learning approaches in everyday language.

The overriding theme is, yes, this is hard work, but it is work that must be done, and you and your child can do it with the help of your therapist.

The final chapters, "Extra Strengthening and Having Fun," and, by Lisa Barnett, DPT, "Additional Interventions for Children with Cerebral Palsy," reinforce therapists' efforts to promote recreation and explain interventions from bracing to surgery.

The book's title states that it is a guide for both parents and professionals. I wish this publication had been available when I was a novice pediatric therapist. Even so, it's already taught me new techniques and better ways to communicate. Early interventionists, school personnel and students, as well as experienced physical therapists and PTAs will find it useful.

My suggestions include offering a looseleaf or DVD edition to make it easier to print or copy selected exercises, and to place chapter numbers on the page headers. (It's hard to find the reference in chapter eight when you have to go back to the table of contents to see where chapter eight begins). Although Martin cautions that some children will not master all skills, parents may find the exercises frustrating unless spasticity is first managed by one of the interventions listed in the last chapter."
-ADVANCE for Physical Therapists & PT Assistants, October 9, 2006

"Cerebral palsy is a neurological disorder that affects a child's coordination and ability to move. A child who has cerebral palsy often has difficulty in the various stages of motor development, including lifting his or her head, rolling over, sitting crawling and walking. This book provides valuable information as to how both parents and professionals can assist children with cerebral palsy or other developmental delays as they go through these stages of development.

Martin, an experienced physical therapist, explains cerebral palsy and discusses motor development, both in typical children and in children with cerebral palsy. She addresses the aspects of this disorder that make it more difficult for these children to move and provides an overview of physical therapy goals and treatment techniques. Many of the chapters in this book present exercises parents can do with their children to maintain flexibility or to develop specific motor skills. These chapters contain numerous helpful photographs that illustrate the exercises, with suggestions of how to incorporate the use of toys to interest the children. Most chapters end with a Frequently Asked Questions section that provides practical answers to questions that parents may have when they try to implement the suggested activities with their children. An additional chapter on other types of interventions for this population completes the book.

While this book contains much practical information, some of the discussions of why children with cerebral palsy move as they do or the theoretical background for some of the exercise may be too technical for some readers. However, the lack of information on this topic makes this book a valuable addition to most pediatric consumer health collections."
-CAPHIS Consumer Connections

"The author Sieglinde Martin, a pediatric Physical Therapist, summed up the reason for her book in her first sentence, 'I wish there was a book that explains to parents what we do and why we do it.' This book is exactly that, a guide for parents and professionals on basic physical therapy treatment principles and rationales. This book uses a variety of ways to meet its goal such as informational text, case studies, frequently asked questions, and outstanding illustrations. The introduction sets the tone of the book by stressing the importance of families building an open and trusting relationship with the child's rehabilitation team.

Chapter 1 gives a basic description of, the various types of cerebral palsy (CP). The descriptions of CP are written at an appropriate level for parents but also provide comprehensive information at the same time. Chapter 2 is on the gross motor development of children and first describes typical motor development with its key skill acquisitions and how they assist in further motor skill maturation. A comment in this chapter, however, is of concern. While discussing the importance of prone and side-lying positioning on motor development (page 8), the author states that 'side-lying is a good position for babies to rest or sleep in.' This statement is in conflict with the Academy of Pediatrics' (www.aap.org) guidelines on the Back to Sleep instituted to reduce the risk of Sudden Infant Death Syndrome (SIDS). Physical Therapist must also abide by these recommendations and reinforce the Back to Sleep program with patients and do not recommend sleeping in any other position other than supine. Therapy sessions and supervised playtime are good opportunities for children to work on their motor skills in prone or in the side-lying position.

In Chapter 3, the author describes obstacles to motor development such as abnormalities of muscle tone and primitive reflexes, in easy-to-understand terms for the reader. Chapter 4 focuses on the possible ways that children with CP learn and develop their motor skills. For instance, this chapter discusses aspects of neural plasticity and motor learning. I was pleased to see the author describe principles of motor learning and emphasize that it is an active process in which motivation plays an important part. The chapter also describes the importance of posture, controlled weight shifts, joint stabilization, and closed chain exercises in motor performance.

Range of motion exercises is a key component of the therapy plan of most children with movement disorders. Chapter 5 eloquently discusses their importance and gives great recommendation on how to incorporate stretching programs in the child's daily experiences. I found the photos in this chapter to be of great benefit for the reader. Chapters 6, 7, and 8 review skills and development in the supine and prone positions. Chapter 6 emphasizes the importance of developing head control, but also acknowledges the frustration many families have with the slow progress they see in this area. As therapists we are quite aware of the importance of the child's head control on their overall development, but families often do not see the impact it has on sitting, standing, and playing. Chapter 7 describes prone positioning and how to incorporate motor development activities in that position to facilitate motor skill acquisition. Chapter 8 titled Tummy Time expands upon the previous chapter on head control and shows the reader various ways to work on a child's ability to tolerate tummy time. Illustrations and case examples depict how the reader can challenge children in that position and help them learn how to do a variety of activities in and out of this position.

Chapter 9 delves into the topic of balance and how children learn how to protect themselves during falls. The author describes the development of protective reactions and why children with a movement disorder have difficulties with developing these reactions. I found the case example of the boy who did not want to touch the floor to be exceptionally relevant and I can think of a multitude of children that fit this exact scenario. Chapter 10 describes the typical development of sitting and the challenges of a child with a movement disorder. Illustrations in this chapter identify common sitting postures and how to use equipment found around the home to help a child learn how to sit. The author discusses the various types of sitting and describes to the reader the importance of limiting w-sitting. Illustrations in this chapter show examples of therapeutic techniques to help children at all levels of impairment develop their sitting skills.

Chapter 11 discusses crawling and mobility. The case example and illustrations show how to help children with CP learn to first get onto their hands and knees and then how to assist them in moving and playing in this position. The author shows multiple ways the reader can accomplish the same goals, depending on their child's response. Chapter 12 presents exercises of the lower extremity and to help the child learn to stand with arm support. Case examples and illustrations clearly demonstrate various ways to incorporate exercises into the child’s daily activities. I specifically appreciated the emphasis on the importance of learning how to stand with support regardless of the level of disability. The child with a severe disability who can assist in standing can ease care giving as they become adults.

Chapter 13 builds on chapter 9 and discusses balance in more depth. The author begins by describing why children with movement disorders have difficulty with balance and ways to work on balance in sitting, kneeling, and standing. In chapter 14 the author details therapeutic regimens to help children with CP develop standing without arm support skills. This chapter describes ways to integrate higher-level balance skills into the child's home-based program. Chapter 15 expands upon the previous chapter and shows ways to work on walking and mobility skills in all environments. I think the author does a good job with describing how walking can be expanded upon such as ambulating while carrying objects, walking outside and on stairs but neglects discussing alternative ways of mobility such as the introduction of power wheelchair mobility early in life. Too often therapists and families look at power wheel-chairs as a failure and use it as a last resort. Power wheelchairs can be used as an adjunct children become motivated to move and explore their environment. Strengthening is a major focus of all therapeutic programs and chapter 16 shows the reader how typical everyday activities such as playing on swings and riding a tricycle can be used need to help the child with mild or severe motor impairments strengthen their muscles. I specifically enjoyed how the author emphasized the importance of using age-appropriate peer activities. In chapter 17, Lisa Barnett describes common tone management medications, surgery, and casting procedures. She also describes the use of electrical stimulation and or those and how these can be incorporated in the therapeutic program I would like to have seen some information about common muscle and bone surgeries that these children may experience.

The author must be commended for her use of illustrations and frequently asked questions to help parents feel that they are not alone, and that therapists appreciate the family's perspectives. I asked a parent with whom I have been working for many years to read this book. She found this book to be a wonderful resource. In fact, the first thing she said to me was 'That is why you do those things with him.' She was able to identify with the multiple case examples and questions the author used in the book. After reading this book, she purchased this book for all members of her family as well as her son's teacher and paraprofessional. The author's style makes this book easy to read and enjoyable for all levels of readers. The authors have thoughtfully included a glossary of terms, list of recreational opportunities, and references for obtaining the pieces of adaptive equipment used in the photos. Overall, I feel this book is a valuable resource for families and I would recommend it to the families that I work with."
-Physical & Occupational Therapy in Pediatrics, Vol. 28, No. 1, 2008

"The author is a physiotherapist and the mother of two children with cerebral palsy so her advice carries over from therapy into play, socialising, learning and leisure. While equipment is mentioned and used, the programmes described are those that can be done in the home using the sofa, stairs or ropes a ball and a hoop. The emphasis is on giving the right amount of support and moving towards independence.

The book is clear about why children need to build skills that will enable them to problem-solve. 'True skill learning will only take place if your child also participates with problem solving.' The author explains that parents might believe that a good way to make sure their child learn how to get down off a chair is to help every time until she can do it really well. However the best way may be to practise until the child can do some or most of the movement then pad the floor with an extra mat, put a much wanted toy on the floor and let her try for herself.

Motivation and having fun are the most important factors to getting the baby or child to keep trying over the long period of time it will take many children to master a skill. Case histories talk openly of misunderstandings between parents and therapists and the importance of understanding why the child needs to keep on with things that he or she may find distressing. Each chapter has a 'Frequently asked questions' section and these are asked by parents and professionals and cover the concerns professionals may have over being asked to undertake movement learning programmes in the school setting. There is a section on stretching but the main part of the book is focussed on the child achieving skills in order to be able to do the things children want to do: interact, play and have fun.

There is a depth of understanding about the huge efforts children with cerebral palsy make to do the things we find simple, such as lifting our head. One photo illustrates a baby wrinkling her brow with the effort of maintaining head-up for a few seconds, the parent is advised to notice and reward such effort. The book is lavishly illustrated with black and white photographs throughout and the language is clear and simple for the non-specialist to understand. With a wealth of ways to promote good movement learning and many play ideas, the book is a must for parents and professionals alike and will be invaluable for any service wanting to include a child with cerebral palsy."
-SCOPE (Cerebral Palsy Association of UK)

"An excellent reference for daily intervention to help a child reach his motor potential and become more independent."
-DDNA NewsNetwork, Volume 14, Number 3, Summer/Autumn 2006

"The author provides a thorough yet clear explanation of cerebral palsy with its many ramifications including abnormal muscle tone and delayed development, as well as many activities to enhance the acquisition of motor skills. The school-based therapist will be able to use this book as an important resource for parents, teachers, aides and other school personnel to assist them in understanding cerebral palsy and their child's delayed motor development. The author also emphasizes how parents can and must actively assist their child in acquiring improved motor skills."
-Mary Kay Eastman, M.S., P.T.
Athens-Meigs Educational Service Center, Athens, Ohio
Co-Chairman of Ohio?s Institute for School-Based OT/PT Practice

"My daughter has had wonderful therapists who answer my questions and give good suggestions for follow-up activities at home. However, unless I take notes, I seldom remember what they have said after we leave the clinic. I plan to use this helpful resource as a reference to consult again and again and to remind me how to work therapy into playtime and even daily care tasks like carrying my child, diapering, and basic positioning."
-Lynne Fogel, parent of a 4-year-old with cerebral palsy
Founder, Cerebral Palsy Parent Support Group, Columbus, Ohio

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