Activity 1: Dynamic sitting balance will be encouraged on a peanut therapy ball while reaching for a preferred toy in order to

help strengthen Baby B.s postural control and stability as well as help him learn to reach out of his base of support (BOS)
safely. The therapist will provide moderate assistance to support Baby B. with points of control at the hips to encourage him
to balance on a therapy ball through weight shifting. The therapist will hold out a toy ring chain (or other preferred toy
item) in front of Baby B. to encourage reaching. Distance between toys and Baby B. will increase as stability increases. Activity will be modified if dynamic sitting is too challenging by having Baby B. only hold toy in front or on lap while on
therapy ball instead of reaching arms out for toys as needed. Activity can be graded up by allowing Baby B. to complete activities in prone.

Activity 2: Baby B. will sit on a mat while supported by his therapist for stability while completing a fine motor task. The therapist will actively support Baby B. at the hips in order for him to maintain stability to flex trunk forward to engage in play.
The therapist will lessen the contact as Baby B. increases stability. Baby B. will play with a noise making toy by exploring
the buttons which do not require high level grasps (can be activated using palmar pressing). As Baby B. increases stability,
the activities will be graded to include playing with a toy piano and/or completing a simple 3-5 piece peg puzzle which
would require a pincer grasp, object manipulation, and visual-motor integration. This activity can also be graded up by testing sitting balance on a sit-n-spin or in prone.

Activity 3: Baby B. will retrieve small objects hidden in Theraputty. Therapist will playfully ask for the items by describing the
colors and shapes while directing Baby B. to pick up the items. The items will include multicolored blocks and other figures; the therapist will use hand over hand (HOH) cues to promote pincer grasp and other appropriate object prehension
patterns. This activity will begin with the lightest resistance Theraputty as Baby B.s grasping strength is weak; item size
will decrease and Theraputty resistance will increase to modify for a just right challenge as appropriate. The therapist may
modify Baby B.s position to either be seated in a cube chair or eventually supported in a standing position.

Activity 4: Baby B. will place shapes into the shape sorter while using a radial digital grasp. The therapist will encourage Baby
B. by providing verbal, gestural and physical prompts to grasp shapes and release them in the appropriate opening of the
shapes sorter. Baby B. will require physical and verbal prompts to rotate items properly to fit into openings at his current
age. Baby B. will be seated supported by a cube chair or therapist for this activity. This activity can be graded by types of
cues, limiting or increasing the number of shapes and/or trials, and by promoting higher level prehension patterns such as a
pincer grasp. Puzzles can also be used to encourage similar functional goals.

Activity 5: Baby B. will spend time tolerating various textured chewies as presented through a Simon Says type song by
therapist. The therapist will play music in the background and sing as skilled introduction of the chewies is monitored
closely. This can be modified by first beginning with smooth chewies, then moving on to studded chewies; resistance of
chewies can be modified as well. The culmination of the song signals the end of the activity and/or a break from the chewie.
Time modifications can also be made by allowing Baby B. to utilize the chewie for longer time periods as his tolerance and
oral strength increase. Introducing Baby B. to various chewies will help build his oral strength and endurance as well as
provide sensory input which will all hopefully encourage him to feed by mouth in the future.

Activity 6: Baby B. will be able to accept a variety of spoons of different shapes, sizes, and textures orally. The therapist will
adapt to Baby B.s sensitivity with textures by slowly introducing smooth spoons that do not require as much effort to explore (i.e. fewer tongue movements to move over spoon); the activity will be gradually graded to include studded spoons,
spoons with ridges, and various shapes and sizes as tolerated. This activity will help familiarize Baby B. with utensils for
potential future oral feeding.

Activity 7: Baby B. will tolerate oral introduction of a bolus bag with a variety of food items. The bolus bag can be constructed
using non-dyed polyester organza or cheesecloth. Food tastes can be varied and different textures can be used to grade the
activity. A natural food texture progression to use in conjunction with a bolus bag may include the following (from softest
to most chewy): various pureed baby foods, applesauce, hummus, yogurt, potatoes, peanut butter, soft cheeses, tender proteins such as stew meats, and chewier proteins such as boiled chicken. Baby B. will need to be directly monitored in case
any attempt to swallow results in coughing, gagging, or aspiration as evidenced by food particles appearing during tracheostomy suctioning. Helping Baby B. to become familiar with various food tastes and textures will help him become less
orally defensive toward potential future feeding and will build chewing strength and tongue coordination.

Activity 8: Baby B. will orally accept a wash cloth and gum massage of varying temperatures (chilled, warm). Providing Baby
B. with a variety of temperatures will help him acclimate to sensory experiences inherent in oral feeding. By providing him
with cold (or frozen) and warm washcloths, the therapist can help Baby B. become familiar with oral temperature stimulation without directly having to introduce food substances as well. This activity can be graded to allow Baby B. to independently explore the temperatures and textures of the cloths or by providing him with a gentle gum massage which will
help organize and focus his sensory experience. This activity can be further modified by providing other temperaturevariant objects such as a frozen teething ring or a chewie that has been soaked in warm water.

Activity 9: Baby B. will participate in catching a small, light ball as it is rolled to him while interacting with his mother and
sister. The therapist will encourage mother and sister to model appropriate manipulation of the ball for Baby B. to see while the
therapist will be seated behind Baby B. to support him in ring sit if needed. Mother and sister will communicate using facial
and verbal expressions while playing with Baby B. The therapist will modify the activity by decreasing distances to roll the
ball and through the use of physical cues for Baby B. (i.e. helping him stop the ball with both hands and roll it back during
play). This activity can also be modified by using balls of different sizes or textures, by playing on various surfaces, or by having Baby B. play with both his mother and sister at the same time.

Activity 10: Baby B. will be able to play patty cake with direct caregivers. Baby B. will sit either supported by his therapist on
a mat or in a cube chair at the level of his mother, sister, or grandma. His therapist will facilitate play as needed to ensure playfulness during the interaction. Support from his therapist will also provide Baby B. with assistance with bilateral arm coordination needed to play patty cake.

Activity 11: Baby B. will attend a story time group at the local library. He will sit on the mat with other children attending story
time with seated support provided by his therapist, mother, or grandma as needed. This activity can be modified by varying the
time spent at the story time group or by lessening the physical support offered so Baby B. can actively engage postural control
independently during the mostly passive activity of listening.

Activity 12: Baby B. will attend a community based-playgroup to facilitate peer social interaction. Baby B. will be in close
proximity to peers to experience their verbal and nonverbal communication and to allow for opportunities to reciprocate the
interaction. Age-appropriate toys available at the playgroup may include balls, musical instruments, and ball pits to promote
play within the group. Baby B.s therapist, mother, or grandma will be nearby to facilitate and intervene as needed.