Table 4.

Factors that interfered with participation during initial sessions of ASI intervention.

Factor	Impact on function observed at the outset of ASI intervention
Gross Motor: Poor weight-shifting and trunk rotation	Unable to transition self from floor sitting to standing, and vice versa Unable to crawl Walking not fluid, starts and stops every few steps Full assistance needed to get on/off therapy/playground equipment and to transition from floor sitting to standing and vice versa Poor balance reactions; body became rigid when balance was challenged The above contributed to gravitational/postural insecurity when moving on level and uneven surfaces
Sensory Processing	Gravitational insecurity contributed to:  Hesitation or fear of getting on/off or playing on movable therapy/playground equipment, stepping onto elevator, going up/down stairs.  Hyper-vigilance navigating busy/crowded hallway. Severe dyspraxia interfered with her ability to imitate or initiate new motor actions; Could not follow verbal or gesturing prompts
Fine motor: Hand stereotypies	Unable to sustain grasp on objects for more than one second, such as toys, school materials, clothing, food/eating utensils, etc. Reflexively releases Sometimes caused skin breakdown due to hand clenching and fingernails Needed full assistance to participate in self-help, school and play activities.
Communication and cognition	Non-speaking. Unable to follow verbal or gesturing prompts Required alternative means of communication to choose activities she desired and to ask to continue or stop activities, eg,: eye gaze at yes/no and picture icons, changes in affect, etc. Could not imitate Needed alternate means to teach her how to play on equipment and interact with toys/activities, eg,: taking arms/body through practice motions then pausing and waiting for her to replicate or continue the motions
Medical: Frequent upper respiratory infections and GI discomfort	Sometimes affected school attendance and/or full participation in some therapy activities Management of gastrointestinal discomfort (venting G-tube) sometimes interrupted or delayed treatment.