Leckey Squiggles Early Activity System User manual

Squiggles Early
Activity System
User Manual
Supporting
Children
English

p2 Early Activity System User Manual
The Squiggles Early Activity System is
designed to offer a range of therapeutic
positions and activity suggestions for early
intervention. This manual shows how you
can quickly, easily and safely make use of all
the functions. The instructions on safety and
maintenance will ensure that you will enjoy
the use of this product for a long time.

Early Activity System User Manual p3
CONTENTS
01 Intended Use p.03
02 Declaration of Conformity p.03
03 Terms of Warranty p.03
04 Safety Information p.05
05 Cleaning & Care Information p.06
06 Product Inspection and Servicing p.07
07 Important Guidelines p.08
08 Re-issuing Leckey Products p.08
09 Instructions for Use p.09
10 Sizing Information p.18

p4 Early Activity System User Manual
SECTION 01:
INTENDED USE
The Squiggles Early Activity System has
been designed for special care babies
from birth to 36 months for Early
Intervention use at home or in the care
environment.
SECTION 02:
DECLARATION OF
CONFORMITY
James Leckey Design Ltd as
manufacturer with sole responsibility
declares that the Leckey Advanced
Bath Chair conforms to the
requirements of the MDR EU 2017/745
Guidelines and EN12182 Technical
aids for disabled persons, general
requirements and test methods.
The warranty applies only when
the product is used according to
the specied conditions and for the
intended purposes, following all
manufacturers’ recommendations
(also see general terms of sale, delivery
and payment). A three year warranty
is provided on all Leckey manufactured
products and components.
SECTION 03:
TERMS OF WARRANTY
SECTION 04:
PRODUCT HISTORY
RECORD
Your Leckey product is classied as
a Class 1 Medical device and as such
should only be prescribed, set up
or reissued for use by a technically
competent person who has been
trained in the use of this product.
Leckey recommend that a written
record is maintained to provide details
of all setups, reissue inspections and
annual inspections of this product.
Your Leckey product is a prescribed
Class 1 Medical Device and as such
Leckey recommend that parents,
teachers and carers using the
equipment should be made aware of
the following sections.
SECTION 05:
PRODUCT TRAINING
RECORD
Leckey recommend that a written
record is maintained of all those who
have trained in the correct use of this
product.

Early Activity System User Manual p5
1. Always read instructions fully
before use.
2. Users should not be left
unattended at any time whilst
using Leckey equipment.
3. Only use Leckey approved
components with your product.
Never modify the product in any
way. Failure to follow instructions
may put the user or carer at risk
and will invalidate the warranty
on the product.
4. If in any doubt about the
safe use of your Leckey product or
if any parts should fail, please
cease using the product and
contact our customer services
department or
your local dealer as soon as
possible.
5. Always ensure the user is secure in
the product.
6. Always use the product on a level
surface.
7. Always use the Floor mat as
a base of support and never use
the other components on their
own.
8. Always ensure the hooky Velcro®
components are faced away from
the user at all times.
SECTION 06:
SAFETY INFORMATION
9. Leckey products comply with re
safety regulations in accordance
with EN12182. However, the
product should be kept away from
all direct sources
of heat including naked ames,
cigarettes, electric and gas heaters.
10. Clean the product regularly.
Do not use abrasive cleaners.
Carry out maintenance checks
on a regular basis to ensure
your product is in good working
condition.
11. The product is designed for indoor
use and when not in use should
be stored in a dry place that is
not subjected to extremes of
temperature. The safe operating
temperature range of the product
is +5 to +40 degrees Celsius.

p6 Early Activity System User Manual
SECTION 07:
HOW TO UNPACK AND ASSEMBLE
Check parts
Congratulations on purchasing your
Squiggles Early Activity System. When
opening the box, take care not to cut
through the box as you may damage
some of the parts contained inside.
All of the parts will be contained in
polythene bags with each one clearly
labelled. Carefully remove them from
the box and check you have all the
parts you have ordered.
Components
All the components will arrive ready for
use. Simply unfasten the mat and fold
at, remove the rolls and wedges from
the Squiggles bag and you are ready to
start using the product.
The activity suggestions within the
ve key positions, back lying (supine),
tummy lying (prone), side lying, oor
sitting (long sitting) and hands and
knees (four point kneeling) describe in
detail how to setup and make full use
of the system.
Keep polythene bags away
from children
1. The Early Activity System
Designed to have an innite
number of combinations, the
interchangeable positional
supports are listed with some of
their most common uses. All the
postural supports are contained in
a compact Squiggles carrier bag for
easy storage.
2. Cushioned Floor Mat
Covered with “uffy” Velcro so that
all the supports can be quickly and
easily attached and removed, this
comfy oor mat also has Velcro
on the underside for additional
positioning options.
3. Four Flexible Rolls
The rolls, in two sizes, can be used
on or below the oor mat, and on
their own or with the other support
elements to provide just the right
level of postural support.
4. Positioning Straps
Use these versatile straps in
addition to the rolls for extra
support when needed at the front,
sides or back. Alternatively, use
them on their own for a reduced
level of support when the rolls are
no longer required.
5. Head Support
Contoured to cradle the head,
this support can be used on its
own, or with its removable lateral

Early Activity System User Manual p7
pieces. While particularly useful
in back lying or side lying, the
lateral supports can also be used
with other components for extra
positioning possibilities.
6. Trunk Wedge
Primarily designed for use in
tummy lying to provide trunk
support, this wedge can also be
used below the head in back lying
to encourage chin tuck, or below
the bottom in oor sitting (along
with the sitting support) to give
a slight forward or rearward tilt,
depending on the
position desired.
7. Sitting Support
This proled cushion is designed to
give your child lower back support,
while allowing the hands to be free
for activity and function. When
used in conjunction with the other
elements additional front, rear or
side support can be increased.
8. Fabric
The fabric used on the positional
supports is a high grade textile
which is almost 100 times more
resistant to wear than standard
vinyls.
The fabric has permanent anti-
fungal and anti-bacterial properties
which greatly minimise the risk of
cross infection. Bacteria such as
MRSA cannot grow on the fabric.
The soft touch fabric is easily
cleaned using alcohol wipes so
machine washing is not required.
6 5
23
7
4

p8 Early Activity System User Manual
SECTION 08:
CLINICAL SETUP FOR POSTURAL MANAGEMENT
A typical baby’s development
Every baby comes into the world with
limited abilities. That’s why the rst
three years of a child’s life is widely
regarded as the most important period
of development1. During this time their
nervous system and senses, muscles
and joints, together with thoughts
and actions mature and learn to work
together. Generally, these skills happen
in a seamless progression. Each skill
attained provides a building block for
the next more complex skill. So for
example, a baby will learn to hold his
head up before he will learn to sit. He
will swipe randomly at toys before
learning to open his hand and pick
them up. He will focus on things close
up before he learns to turn his head
and eyes to follow moving objects.
When development is delayed
For some babies, their newborn
limitations are not easily overcome by
time alone. If a child’s development is
delayed for whatever reason, it means
he is likely to acquire skills more slowly,
or the extent to which he masters a
skill may vary. But it is very important
to remember, that regardless of
a child’s abilities, the sequence of
development follows largely the same
pattern. So head control will still come
before independent sitting, swiping
before grasping, focusing close up
before following moving objects.
The brain’s ability to change
At birth, a baby’s brain is not fully
developed. It is growing, changing and
making new connections. It is possible
that new brain cells learn to take on
the functions of damaged cells – to
some extent the brain may learn to
compensate for its damaged areas.
Therapists refer to the ability of the
brain to change as “neural plasticity”2.
However, this capacity to change slows
down as brain growth slows down. This
helps us to understand why the early
years are so important for children.
Early intervention –
benets to children and families
We now appreciate why the rst years
of a child’s life are crucial to their
overall development. However the
brain does not develop these new
connections entirely on its own.
Training and practice are also needed.
When children need extra help to
achieve developmental goals during
their rst three years, this help –
usually occupational therapy and/or
physiotherapy and/or speech therapy –
is referred to as “early intervention”.
Early intervention is supported by
many research studies which identify
its benets. For some children these
can include less irritability3-5, and
improved physical, sensory and
independence skills5,6 For some

Early Activity System User Manual p9
families these can include improved
bonding and interaction with their
child3,5,7 decreased anxiety3,5 and
better information, resources and
support4,8,9,10
Parents and therapists in partnership
Therapists alone are not able to
provide the level of extra help that
developmentally delayed infants
may need – simply because it is
parents and relatives who provide
24-hour care for their children. But
therapists do play a vital role in
assessing children’s developmental
needs and recommending activities
which will help them reach their next
developmental goals. And research
has shown that early intervention
programmes which combine a parent
and child focus have a greater impact
on the developmental outcomes of
the child11. So parents and families,
working together with therapists
towards agreed developmental goals
for their child, have the potential to
achieve the best results possible.
Playing with a purpose
So far we have talked about children’s
development, early intervention and
therapy. It can all sound very serious so
it’s easy to forget that the
“intervention” and “therapy” we are
talking about is simply play with a
purpose. Children with developmental
delay, just like any other children,
learn through play – in fact children
work harder on therapy goals when
they are having fun through play. So
don’t worry – as a parent, grandparent,
sister or brother, friend…..the list is
endless…..you will be able to help your
little one achieve his potential just by
understanding why you are playing
certain games in certain positions. We
will look at this in more detail later on.
The Early Activity System
At Leckey we have worked with
experienced therapists, used evidence
from published research studies, and
our own experience to develop the
Early Activity System. This modular
oor-based system is designed
to assist your child to improve his
physical, cognitive and sensory
abilities by encouraging play in ve key
therapeutic positions. These are the
main positions in early development
which form the basis for later abilities.
The Early Activity System* is designed
to allow you to “mix and match”
positions and activities for your
child, ensuring the best possible
developmental start. Changing
positions is important, as this is
what allows your child to progress
independently at a later stage. The
aim is to allow your child to develop a
variety of movement skills, as well as
building strength and coordination.
(*Patent Pending)

p10 Early Activity System User Manual
The Five Positions
The Early Activity System supports
purposeful play in:
1. Back lying (supine)
2. Tummy lying (prone)
3. Side lying
4. Floor sitting (long sitting)
5. Hands and knees (four-point
kneeling)
You may nd your child likes some
positions more than others, or some
positions may not be medically
advisable for your child to use. It
is important for you to take advice
from your therapist(s) about the best
positions to place your child in. This
may depend on whether your child’s
muscles are tight (high tone) or oppy
(low tone), his level of development or
tolerance for certain positions. Some
positions may need to be avoided for
medical reasons, and others will need
to be encouraged, even if your child is
not keen at the start!
Transitions
Transitions are the positions or
movements needed to get from one
position into another. For example,
rolling is the transition needed to
get from tummy lying to back lying
and over again. To be able to change
position independently, your child
needs to learn to shift their body
weight, then support that weight with
one part of their body while moving
another part of their body. Some
activities will be recommended by your
child’s therapist to work specically on
transitions.
Position versus activity
The position that you place your child
in and the activity that you choose for
your child in that position are equally
important. However your child’s level
of ability in a certain position will
determine how difcult an activity he
can manage. For example, if he nds it
hard to sit up, most of his energies will
be going towards sitting up – so choose
a simple activity for him. But if your
goal involves a more difcult activity,
then you will need to choose an easier
position or provide more support. That
way, your child is not over-loaded and
is more likely to experience success.

Early Activity System User Manual p11
Some points to remember about how
your child learns new skills
Regardless of the position you place
your child in, or the play activity you
are carrying out, there are things you
can bear in mind to help the process2.
Learning is an active process –
encourage your child to do as much
as he can on his own. Even at a very
early stage this active exploring is the
foundation for problem solving.
Motivation is the key – use toys and
activities which you know your child is
interested in, especially if the position
is not a favourite one. Use small
achievable steps to motivate your child.
Practice makes perfect – it seems
obvious, but think about typically
developing children – they repeat tasks
over and over until they have mastered
them. It may not be easy for your child
to achieve a new skill, so be patient
and don’t worry if the skill doesn’t
come quickly. Check with your therapist
about the frequency and length
of your play sessions.
We do not yet understand fully
whether learning transfers from one
activity to another2. Therefore, don’t
be worried if an activity which can be
accomplished in one position needs to
be practised again when a new position
is introduced.
Feedback helps learning – at early
developmental stages this includes
your facial expressions, clapping, etc.
Later on it may include spoken praise,
but be cautious that your enthusiastic
feedback doesn’t distract your child!

p12 Early Activity System User Manual
Clinical reasons for back lying
This is the most fundamental of
developmental positions. When a child
lies on his back, his full body weight
is symmetrically supported by the
surface. This makes it a very secure
position from which to work on the
physical, cognitive and sensory skills
that provide the building blocks to
more complex skills. The following
sections explain a little more about
each skill area.
Physical goals
Baby will benet from strengthened
neck, tummy, shoulder and hip bending
(exor) muscles because he has to lift
his head, arms and legs up against
gravity. It may also help to break up a
pattern of straightening (extension) if
muscles are tight. Foot development
can be encouraged in back lying –
kicking and bringing the feet to the
mouth helps strengthen the foot
muscles which are needed for weight
bearing later on.
Cognitive goals
From this position, baby may be able
to reach and accidentally swipe at toys
dangling from a gym or held above his
face. With practice, this random action
gradually becomes more deliberate,
developing a realisation of “cause
and effect”. Likewise, he may learn
to kick musical toys placed near his
feet. When baby brings his hands and
BACK LYING (SUPINE)
feet together to explore, he is learning
about his own body parts and their
relationship to each other. This forms
the basis of body awareness and co-
ordination.
Sensory goals
When lying on his back it is easiest for
baby to focus his eyes on a dangling
object. First he learns to follow it
through quarter of a circle using just
his eye movements, then through half
a circle moving his head as well as his
eyes. As he becomes aware of his own
hands and feet and takes them to his
mouth, his eye-hand co-ordination
and ne motor skills are developing.
Even the sensations that baby receives
through the back of his body will be
helping him to develop a sense of
front and back. Likewise, the feedback
that baby receives through the joints
and muscles in his limbs (known
as proprioception) gives important
information about his body position in
relation to his environment.
Transitions
Rolling is the skill which enables a child
to move from back lying into tummy
lying. It develops in two stages. Some

Early Activity System User Manual p13
children with developmental delay
“log roll” - their whole body moves
as one piece. The aim is to develop
“segmental rolling” - when the head
turns rst, followed by the shoulders,
then trunk, hips, legs and feet. This
rotation of the trunk is an important
building block for the movements
needed for later crawling.
Positioning guidelines
For back lying activities your child
should be placed on his back with
his head supported on a wedge to
encourage chin tuck. Place a roll under
his knees and smaller rolls at either
side of his chest to keep him stable.
Try to ensure that his head starts
and nishes in the midline position.
Remember this is just one positioning
example - your therapist(s) will give
you specic advice.
Activity Suggestion 1
Hold a brightly coloured object (such
as a scarf or pom-pom) about 12-15”
above baby’s face. Move the object
from left to right through a quarter
circle, then back, going slowly enough
so baby’s eyes can follow it. Make the
task a little more difcult by holding
the object 15-18” from baby’s face
and moving it through a semi-circle to
encourage head movements.
Most activities can incorporate a
sensory component with a little
thought to the toy or the surface
used. Use rattles, squeaky toys,
brightly coloured balls, crackly
paper etc to encourage baby’s
vision, hearing and sensation. If
your baby will tolerate it, let her
carry out her activity sessions in
her vest to allow the maximum
amount of sensory feedback
possible. Your occupational
therapist can advise you best
about your baby’s sensory
tolerance.

p14 Early Activity System User Manual
Activity Suggestion 2
Encourage your child to bring his hands
together on his chest. Place your hands
behind his shoulders to encourage his
arms to come forward.
Activity Suggestion 3
With the same set-up as described in
the positioning guidelines, use the hip
positioning strap to stabilise baby’s
hips. Encourage her to reach across
her body with her left hand to a toy
on the right side, and vice versa. Place
your hand behind her shoulder to
assist if necessary. To make this a bit
more difcult, remove the pelvic strap
and move the toy a little further out of
reach. Your child should need to shift
her weight at her hips to reach the toy.
This is a building block for the transition
of rolling later on.
Activity Suggestion 4
Hold onto baby’s feet and help him to
kick or “bicycle” his legs. This helps to
strengthen tummy, legs and feet, and
the reciprocal movement is one which
is needed for later weight bearing or
movement.
Activity Suggestion 5
Bring baby’s hands and feet together.
This midline position is good for
symmetry, and baby is beginning to
learn to use both sides of his body
together. This movement is also a
building block for rolling later on.

Early Activity System User Manual p15
Activity Suggestion 6
To encourage rolling from back lying to
tummy lying, place baby on his back
and bring his hands and feet together
in midline. Encourage him to roll to one
side into side lying. From this position,
help baby’s hips to turn slightly.
Supporting his hips, use an exciting toy
placed near his head to encourage him
to turn his head and reach for the toy.
Once baby’s head and shoulders turn,
baby will roll onto his tummy. Help him
prop onto his elbows to make sure his
airway is clear.
Activity Suggestion 7
Make rolling a little more difcult by
holding the lower half of the body
steady using your hands or the
positioning strap. Encourage the
child to roll leading with her top half.
Position toys just out of reach of baby.
As her top half turns, allow her lower
half to follow.

p16 Early Activity System User Manual
Clinical reasons for tummy lying
Research has shown that about one
half of typically developing infants
show some delayed development
by six months of age if they are
never placed on their tummies
when awake12. In addition, the
back muscles (extensors) of children
with developmental delay tend to
be weaker2. This makes it especially
important to have some daily tummy
time. It is a more difcult position for
baby, because to see around her, she
has to lift her head up clear from the
surface. Babies’ heads are bigger in
proportion to the rest of their bodies,
so to lift them up against the force of
gravity is really hard work! Remember
to use simpler activities at rst.
Physical goals
The therapeutic and developmental
benets of lying in this position
have been reported in research
studies as improved upper body
strength, shoulder girdle strength and
improved extension (straightening)
movements13,14,15. Lifting baby’s
head and shoulders up against gravity
helps to strengthen the straightening
(extensor) muscles of the trunk. This
is helpful for children with oppy (low
tone) muscles. It is also an important
foundation for the development of
sitting. Hand development is promoted,
as the weight taken through the bones,
joints and muscles of the hand are
TUMMY LYING (PRONE)
strengthened. Foot development can
also be encouraged in this position,
with carefully placed rolls or toys – see
the activity suggestions later on.
Cognitive goals
In tummy lying, baby needs to have
developed reasonable head control
before she will be able to prop on
her forearms to play with a toy in
midline or reach out with one hand at
a time. Otherwise, tummy lying will
be difcult and tiring. As baby learns
to hold her head up and prop on her
forearms, her shoulders and arms are
giving sensory feedback about their
position in relation to her body and the
environment. As this works together
with her eyes and her environment
when she is reaching for toys, her
spatial awareness is also developing.
Sensory goals
When lying on her tummy, baby can
gain a sense of security. She continues
to develop her visual focusing and
tracking, and her sense of body
awareness. With reasonable head
control, baby will be able to play for
some time in this position, continuing
to strengthen her muscles, while

Early Activity System User Manual p17
exploring her environment and looking
around.
Transitions
Rolling is the skill which enables a child
to move from back lying into tummy
lying. It develops in two stages. Some
children with developmental delay
“log roll” - their whole body moves
as one piece. The aim is to develop
“segmental rolling” - when the head
turns rst, followed by the shoulders,
then trunk, hips, legs and feet. This
rotation of the trunk is an important
building block for the movements
needed later for crawling.
Positioning guidelines
Place a small roll or wedge under your
child’s chest. Support her whole body
so her trunk and legs are stable. Use
the pelvic positioning strap to stabilise
her pelvis if required. Remember this
is just one positioning example - your
therapist(s) will give you specic
advice.
Activity Suggestion 1
Encourage your child to lift his head
up – use a favourite toy to motivate
him. To make this a little more difcult,
try moving the toy slowly from side to
side, so baby has to turn his head to
follow it.
Most activities can incorporate a
sensory component with a little
thought to the toy or the surface
used. Use rattles, squeaky toys,
brightly coloured balls, crackly
paper etc to encourage baby’s
vision, hearing and sensation. If
your baby will tolerate it, let her
carry out her activity sessions in
her vest to allow the maximum
amount of sensory feedback
possible. Your occupational
therapist can advise you best
about your baby’s sensory
tolerance.

p18 Early Activity System User Manual
Activity Suggestion 2
Encourage baby to “push-up” on
straightened (extended) arms with
open hands. This will strengthen
her shoulder and upper trunk, and
encourages weight bearing through her
arms – a building block for four-point
kneeling. It is also a very early building
block for ner motor skills which
depend on stability at the shoulder for
the control needed.
Activity Suggestion 3
While baby has his head lifted up,
encourage him to reach and grasp with
one hand, then the other. This helps
to develop trunk and lower spine
extension – the start of the lumbar
curve. The weight shift involved when
using one hand at a time uses more
complex muscle control – this helps
later for sitting up and using the arms
against gravity.
Activity Suggestion 4
Place your child in a curled up position
on her tummy, ensuring her airway is
clear. Make sure her hips, knees and
ankles are bent (exed), and place a
roll rmly behind her feet. Show her
an exciting toy, and she should start
kicking, pushing herself forward. Tickle
baby’s feet, and place them against the
roll to encourage movement. This is a
building block for commando (belly)
crawling and four point crawling.

Early Activity System User Manual p19
Activity Suggestion 5
To encourage rolling from back lying to
tummy lying, place baby on his back
and bring his hands and feet together
in midline. Encourage him to roll to one
side into side lying. From this position,
help baby’s hips to turn slightly.
Supporting his hips, use an exciting toy
placed near his head to encourage him
to turn his head and reach for the toy.
Once baby’s head and shoulders turn,
baby will roll onto his tummy. Help him
prop onto his elbows to make sure his
airway is clear.
Activity Suggestion 6
Make rolling a little more difcult by
holding the lower half of the body
steady using your hands or the
positioning strap. Encourage the
child to roll leading with her top half.
Position toys just out of reach of baby.
As her top half turns, allow her lower
half to follow.

p20 Early Activity System User Manual
Clinical reasons for side lying
Side lying is not, strictly speaking, a
separate developmental stage of its
own. In typical development, children
tend to pass through side lying during
transitions from back lying to tummy
lying and vice versa.
However, for children with
developmental delay, sometimes
back lying or tummy lying present too
many challenges. Where children have
uneven muscle tone (one side of their
body may be different to the other) or
strong reexes which interfere with
their ability to use both sides of their
body together, it can be difcult for
them to bring their hands together in
the midline.
This position particularly allows the
development of ne motor (arm and
hand) skills, cognitive and sensory
skills.
Physical goals
Side lying allows a strong extensor
pattern to be broken (when back lying
can’t achieve this). Gravity helps bring
baby’s arms together in the midline. If
possible, the sides should be alternated
to maintain symmetry. The side
chosen for lying will also depend on
the condition of the child and the aim
of the activity. For example, for some
children with hemiplegia (a form of
cerebral palsy where one side of the
body doesn’t work as well as the other),
SIDE LYING
lying on the affected side may help
to control unwanted arm movements
and improve two-handed play.
Alternatively, lying on the unaffected
side may encourage the use of the
affected arm. Your therapist will help
you decide which side is best for each
therapeutic goal.
Cognitive goals
Like back and tummy lying, side
lying helps baby to develop cause
and effect play, body awareness
and co-ordination. The stability
that this position gives also allows
concentration to develop because play
is less interrupted by unwanted body
movements.
Sensory goals
Because asymmetrical muscle tone
and/or reexes can affect baby’s
symmetry, side lying reduces the
effects of these, meaning that baby
is able to experience more usual
movement sensations. He can also
use his eyes more efciently to follow
objects when his head position is more
central in relation to the rest of his
body.