These children can usually roll independently by age two. By age four, these children can sit when placed, but are need both hands on the floor to maintain their balance. These children need adaptive devices to accomplish sitting and standing. They are able to roll and creep, but do not use reciprocal leg movements. By their sixth birthday, these children can sit independently in a chair, but require truncal stabilization to maximize hand function.
Transfers require minimal adult assistance.
Ambulation is accomplished using assistive devices for short distances, but adult supervision is required and difficulty persists in negotiating turns and uneven surfaces. These children use wheeled mobility systems in the community and may achieve independence using a powered mobility system. By age twelve these children may accomplish higher levels of function but may still rely on wheeled mobility systems. Before their second birthdays, children functioning at this level have limited voluntary control of movement. They are unable to hold up their head or trunk against gravity and require adult assistance to roll.