Fine motor skills and independence with activities of daily living (ADL) often are impaired. Initiate training early to compensate for these deficits and progress along the developmental sequence as closely as possible. Upper extremity stabilization and dexterous hand use require adequate postural control of the head and trunk. In the first year of life, encourage development of these postural mechanisms or substitute passive support, if necessary, to promote eye-hand coordination and manipulatory skills. When adequate fine motor skills have been achieved, the occupational therapist provides instructions for use of adaptive equipment and alternative methods for self-care and other ADL for preschool and school-aged children (Liptak, 1998).