START-Play (Sitting Together and Reaching to Play) is an early intervention that targets sitting, reaching and motor-based problem-solving to promote development and readiness to learn in infants with motor delays or challenges.

Physical therapists deliver a perceptual-motor program centered on early cognitive constructs. Intervention occurs in infants’ natural environment, with caregiver social support to scaffold infant skills.

Our approach

START-Play is grounded in current evidence that suggests motor intervention is most effective when it includes:

  • Child-initiated movement
  • Task specificity
  • Environmental modification

Key ingredients

  • Cognitive constructs blended with motor challenges.
  • Opportunities for four critical concepts blended with social support:
    1. Object permanence
    2. Means-end understanding
    3. Body/object affordances
    4. Joint attention
  • Parents brainstorming and assisting directly with the “just right” challenge of blended motor/cognitive skills.

What are the benefits?

Improved cognitive development and school readiness are potential benefits of the intervention. Sitting and reaching are measurable skills that are critical to facilitate early exploration, interacting and learning. By advancing sitting and reaching skills, early building blocks of problem-solving, babies may be better prepared for preschool and later learning.

Why are sitting and reaching skills important for learning?

Research shows that early reaching and object exploration skills in the first year of life relate to future cognition. Sitting allows babies to orient themselves to important features in the world, and also frees their arms and hands for active exploration. These motor skills then scaffold their interactions with people and objects, which can be used in countless problem-solving play scenarios to build critical cognitive abilities.

Who’s involved?

Physical therapists and families work together to provide intensive, individualized, daily activities that advance babies’ reaching and sitting skills using small increments of challenge and support. A team of researchers interested in understanding the development of early movement and learning skills, and ways to advance these skills, is testing START-Play’s effectiveness.

Why is START-Play needed?

In the first three years of life, babies experience rapid brain development. The environment, social interactions, and movement opportunities children are exposed to all play a critical role in maximizing this developmental window. It can be challenging for babies with movement difficulties to learn from their caregivers, their environment and the objects within it, and through active exploration.

More research is needed to examine the effectiveness of early physical therapy on babies with neuromotor dysfunction. In addition, most early motor interventions have not been directly linked to learning, despite the clear association between motor activity and cognition during infancy.

Who developed START-Play?

START-Play was developed in 2015 by experienced physical therapists of the START-Play team who understand the important relationship between cognitive, social, and motor development — a concept known as embodied or grounded cognition.

How effective is START-Play?

The START-Play research team conducted a national randomized controlled trial to compare the intervention with business as usual intervention. Discover what we’re learning.


START-Play Consortium is comprised of a team of early childhood researchers and methodologists from academic institutions, along with many physical therapists who deliver the intervention in different parts of the U.S.

University of Delaware

Michele A. Lobo, PT, PhD

University of Washington

Sarah W. McCoy, PT, PhD, FAPTA
Lin-Ya Hsu, PT, PhD

University of Nebraska Medical Center

Sandra L. Willett, PhD, PT, PCS