Their attention to doing seated activities can be sustained for 30 to 45 minutes. At least three different hand-over-hand activities will probably be needed and frequent rest periods should be expected. With nothing to do, their attention drifts away and they slump down and start to slide out of their chairs in about 10 minutes.
Upper extremity range of motion (UE ROM) exercises are bilateral and require hand-over-hand assistance, as described above. One hand / arm may be exercised with hand-over-hand assistance and an attractive object.
The risk of falling can be reduced by using a lap tray or pushing their chair to a table during seated activities. These are not restraints when they are resting between seated activities. They become restraints when the person refuses to continue to do seated activities because they want to stand up.
The objects used during hand-over-hand assistance are a distraction from the persistent need to stand up. Engagement in seated activities uses up their energy and satisfies the need to be in an upright position without the fatigue of being in a standing frame too long. The objects need to be special to the person, i.e. attractive, colourful, and personally appealing. Boring, cheap and ugly objects tend to be ignored. Even within ACL 2, the striking aesthetic standards of beauty and cost are noticed.