Awareness of the effects of gravity allows them to hold an object that is placed in their hand or rolled to their hand. They will also notice when it falls out of their hand, but may not be able to tighten their grip to prevent the fall. Precautions about size, cleanliness, etc., need to be taken because anything that goes into their hand may also go into their mouth.
Hand-over-hand assistance with a bean bag and a metronome is the beginning of activities that need to be created for these people. We need more.
Going outside to experience the weather for a few minutes may be appreciated. Taking a lap tray to put flowers, leaves, rocks, etc., on can provide variation and a connection with nature that is enjoyed.
Supplies are essential and the battle with corporate greed may be difficult. Individualized treatment cannot be provided without a well-stocked supply closet. Time will need to be allocated for procurement, inventory, organization, transportation and distribution of supplies. We have a tendency to underestimate the time and knowledge this requires. Just finding all of the supplies suggested in ACL 1 will take a lot of time and will cost more than you might expect. Keeping them clean and where they belong requires constant attention that must be a part of your daily schedule.