5-year old boy with cerebral palsy

Mobility prior to first intensive. GMFCS Level IV

First steps with improved alignment using visual motor system

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Improving gait quality and speed during intensive. Now fitted with AFOs  and TheraTog

At the end of this intensive he is a GMFCS III

Begining to work on walking with forearm crutches

Amazing progress over a few short months!

This 5 year old boy with cerebral palsy came to Step by Step for an initital 3-day intensive in May of 2015. His only form of independent mobility was crawling or walking when placed in a fully braced walker system (hart walker).  In the course of those first 3 days a plan was developed for spasticity management and subsequent bracing. Through the therapy he received during the 3 days he was able to take his first steps in a posterior walker.

He came back in October for a two-week intensive where he received PT for 3 hours per day addressing alignment, awareness, recruitment and strength. He had now had Botox injections and had been fitted with bilateral AFOs.  During the first week he used  the body weight support system to learn to take consistent steps and to utilize the increased range of motion that was gained with Botox injections. By the end of the intensive, he was fully ambulatory in a posterior walker on level surfaces.

In December he came back for a period of daily therapy to continue to use the momentum of progress and he now began gait training with forearm crutches. After a few weeks he was able to take independent steps with the forearm crutches with an adult close by.



We originally came to the clinic to "check it out". During this three day intensive we met only with Pia. I was amazed by her ability to align my son's body. I had never seem him looking so tall and that alignment led to the most amazing results. I was taught a whole new method for treating cerebral palsy. My son was treated not as a child, but as an active component in this process and he responded so well to the knowledge that was given to him about his body, what was required of him, and why. By the end of the three days we knew we had to come back and booked a two week intensive to start as soon as we could complete the homework we had been given.

Following our visit I was amazed by the support that was provided. Every phone call and email was responded to very quickly. Every concerned was addressed and Pia bent over backward many times to provide letters and recommendations that we needed to get the components my son needed in place.

I was concerned upon our return, as I had been told that my son's sessions would be shared between Pia and two of her physical therapists. I was so impressed with Pia and could not imagine that sessions with others would be profitable. Much to my surprise I found that not only were Amy and Michelle extremely qualified and energized to see my son succeed, but the communication between the three therapists was amazing. Each one knew what the other had done and what part they were to play......and their ideas and creative spirits seemed to feed off each other. This is truly a magical team.

The most surprising thing I experienced at Step by Step was their desire to teach to me. The goal of each therapists was not only for my son to make rapid progress during his intensive, but I would go home prepared to help him continue on this path that he had started.

Sadly, many therapists are unwilling to teach the parents to provide carryover and this unwillingness severely limits the child they work with.

There are really no words to describe my feelings for this team. The skills they have taught my son have been life changing! Every child should have this kind of support. As we complete our second intensive we are already looking forward  and planning another one in the future. My son has been given his independence and it is priceless!

13 year old girl with hemiparesis - the power of improved awareness

 This 13 year old girl attended a 3 day Step by Step Intensive receiving a total of 9 hours of therapy. The goal of the intensive was to improve left foot control thereby improving the quality of her gait. The other goal was to create a training program for her to use after returned home.

She presented with spasticity in her posterior tibialis muscle, which draws the foot down and in towards the big toe side of the foot.

She worked extensively with EMG Biofeedback  and we used massage, stretching and sensory techniques to help her learn to activate her dorsiflexors and the muscles that lift the little toe side of the foot (peroneal muscles). Once she learned to recruit those muscles, she was able to significantly improve her gait pattern.

Her mother reports that now, 3 months after the intensive, she has maintained her dorsiflexion and she works out with a trainer on a regular basis. At a recent neurology check up, the doctor was very surprised and impressed to see how well she now activates her dorsiflexors. 

10 year old girl with hemispherectomy resulting in a hemiparesis

This video shows the progression of hand control as a result of the intensive therapy.  There is also a segment where she uses EMG Triggered Stimulation and a segment where her arm and hand is supported with bracing.

This girl attended a 2 week Step by Step Intensive. She received 2 hours of therapy per day addressing function of her left arm and hand and 1 hour per day addressing gross motor needs.

The goals for the intensive were to improve left hand control as well as improve gait and gross motor skills.

This child had significant difficulties opening her left hand and was rarely using the hand functionally.

As with all Step by Step Intensives intervention focused on Alignment, Awareness, Recruitment and Strength.

During the intensive the child worked with EMG Biofeedback and EMG Triggered Stimulation extensively in order to help improve her ability to activate weak muscles and relax spastic muscles. A vast variety of sensory techniques were used to improve awareness of her left arm and hand as she presented with neglect.

At the end of the intensive, the child was able to pick small items up with her left hand and we started to notice that she was spontaneously using her left arm and hand during self help and fine motor activities.



Pia and her team are absolutely amazing! She was able to access movement in my daughter's arm that I have not seen for over 3 years. The support both before we went to the intensive and after we returned home is top notch. Every email is answered, every phone call returned. Quite a welcome change compared to every other appointment I have made at different facilities.

The staff is friendly and professional and even helped find activities out in the community when we were not at therapy.

I will do everything in  my power to get my daughter back to Step by Step. Pia made more progress with my daughter in 2 weeks than local therapists have made in 2 years. She has definitely found the right technique.

I strongly recommend that you call Pia and see if she can help your child too!

Change in posture and awareness allows Mason to begin to focus on improvements in movement control and gait

 16 year old boy with cerebral palsy



Mason completed a 5-day intensive at Step by Step. He received 3 hours of physical therapy per day focusing on Alignment, Awareness, Recruitment and Strength. The goal for the intensive was to create a "train like an athlete" program that he could continue to work on at home. In addition to creating a training program, he would like to be able to walk with just one cane.

At the beginning of the intensive, he was able to walk with two canes and he showed significant overall weakness. He was fitted with an AlignMed shirt to improve trunk alignment and awareness. The shirt immediately gave him a "base" to work from.

Over the next 5 days he worked very hard at improving his balance and movement control while also working on creating a training program.



My son, who is almost 16 years old has been doing intense therapy sessions since he was 3.

Step by Step Intensives provided a different type of intense therapy, which we were not familiar with.

Dr. Pape and Pia have a different thought process: Alignment, Awareness, Recruitment and Strength. These 4 factors bring EVERYTHING together to get the function that my son, and YOUR child are capable of!

Mason's posture improved, he was able to rely on his legs vs. his canes to walk, he disclosed "I have control over my body" on day 2 and we were all able to see how certain strengthening exercises help with certain functions and why. The therapists were able to get him to understand that what he does and doesn't do will impact his life. He became more responsible, and willing as he saw results and saw the potential to accomplish more with harder work. We saw results on the first day and by the end of the week we are absolutely thrilled and ready to go home and take the "train like an athlete" program on! Exhilarating!

Cannot thank Pia, Michelle and Amy enough! They are Angles on Earth.


.....A year later

Mason went home and continued his traning with a personal trainer as recommended during his intensives. He had realized what was possible and a year later his is fit, happy and he has made incredible changes in his mobility

This child completed a 5-day intensive at Step by Step. She received daily PT, OT and Speech Therapy.

The goals for PT was to improve balance and gait. At the initial evaluation, she was walking with a posterior walker and she was able to stand alone briefly. She frequently collapsed in standing. It was clear from the initial evaluation that she had significant trunk weakness and poor proprioceptive awareness. A spio garment was ordered for her.

On the first day of the intensive, she wore the Spio garment which increased her ability to stand unassisted from 10 seconds to over a minute. She was taught a sequence of strategies to help her maintain balance and improve movement control. By the end of the intensive, she was standing unassisted for more than 90 seconds and she walked 30' without assistance.

The goal for speech was to improve her speech intelligibility. The Spio garment improved her breath control significantly allowing her to begin to string several words together.

The goals for OT centered on improving fine motor control such as using a pincer grasp effectively to pick up small items as well as to improve her ability to write. Spio gloves were used to improve proprioceptive awareness.  By the end of the week she had improved the speed by which she picked up small items by more than 50% and she significantly improved her hand writing.


5 year old girl with athetoid cerebral palsy

This video shows the child needing support for walking before her Step by Step Intensive and walking independently on the last day of her 5 day Intensive

Child age 10
Diagnosis: Cerebral palsy. Right hemiparesis


This 10-year old boy completed a two-week, 3 hours per day, Step by Step Intensive. His program consisted of strength training, balance training, coordination training, gait training, visual motor rehearsal as well as management of leg length discrepancy. He also worked with EMG Biofeedback and EMG Triggered Stimulation to improve dorsiflexion and hand control.


The child also worked on his right upper extremity control using EMG Biofeedback, EMG Triggered Stimulation and he received a splint for his hand.



  • 71% increase in distance walk on 6-minute walk test

  • 21% increase in gait speed

  • Able to activate dorsiflexors of right ankle

  • Significant improvement in overall muscle strength

  • Significant improvement in coordination

  • Significant improvement in posture and postural control

  • Able to hold right wrist in extension while opening and closing fingers


Testimonial from child's mother:


The intensive at Step By Step was one of the best decisions we’ve made for our son. We all learned a great deal and have seen improvement in his gait, posture and strength in just two weeks. His regular PT and several friends have all commented on the change. The information and technology that we came home with all help to continue his progress and incorporate what was learned into his daily routine. We are very happy to have found Pia Stampe and her staff and would highly recommend them to anyone who is interested in this program!


















Erik, age 49. Spastic diplegic cerebral palsy


Erik completed a short intensive at Step by Step. The goal of the intensive was to complete an overall assessment and create a home program. Erik was experiencing increasing difficulty with mobility and he had debilitating pain in his back. He was falling frequently and had difficulty walking on uneven surfaces or in crowds.


Erik's assessment revealed that he had significant tightness in spastic muscle groups combined with overall weakness in his legs and hips. The tightness and weakness impacted Erik's gait, balance and coordination.


The intervention focused on creating a home program that would help Erik regain range of motion, strengthen weak muscles and improve overall balance and coordination. Erik's home program included a water training program and he was placed on Threshold Electrical Stimulation to address his weak and atrophied (wasted) muscles.


Note from Erik, July, 2014:

I'm approaching ten weeks since the three-day intensive session with Pia. It's become clear that for me to experience significant change, my mind has to be right. My mindset cannot be that of a victim, but must be that of a believer in the process.  I have to believe in the incremental change that takes place every day without being able to see the changes every day.


 Since meeting Pia, I have had the belief that something very significant was  happening to me and  my mind was ready for that. What was so helpful was getting significant evidence  in the first couple of days of working with her.  There is so much that is different now with my daily routine.  I don't know day to day what is having more impact, but I have to believe I am doing the right thing.


Some of my disciplines are not new.  I still go to the gym most mornings and ride the bike and lift weights, I still eat well and drink lots of water. There are however, lots of things that are different.  There are moments where certain parts of my new regimen seem to be having the most impact and times when other practices seem more significant.  Some parts of the routine are rewarding and others are an inconvenience. My thought is that it does not matter what is having the greatest impact; what matters is that I believe in the entire protocol.


I sit through assisted stretches that allow me to stand straighter than I can ever remember.  I sit daily in the Nada chair for 30 minutes. I go to the warm water pool regularly, with a specific program I follow when I get there. I wear a TES stimulation system to bed. This allows the front of my shins and thigh to be stimulated with a purpose while I sleep. I am getting a massage every couple of weeks and a pedicure once a month. There is also an increased awareness of how my body works.  I'm aware of how my shoes squeak differently when I slow down and make a conscious effort to make quality steps.  I'm thrilled to report that I have not fallen down since the intensive almost three months ago, something I used to do around every other week.


 Meeting Pia and learning what I did during the intensive is a gift that has been given to me. 

Erik's posture and balance changed drastically in a very short time.

Read Erik's blog post and see pre and post intensive videos on Dr. Karen Pape's blog:


Before and after posture photos

Erik and his wife talk about Erik's Intensive at Step by Step

Gait on day 1, day 5 and day 10. In the day 5 video, the child uses posture control and visual motor rehearsal to improve gait control

TW, age 7. Cerebral Plasy, right hemiparesis, hydrocephalus

TW completed a two-week intensive consisting of 1 hour of PT and 1 hour of OT per day for two weeks. The PT goals for the intensives were to improve TW's ability to transition from the floor to a bench, from bench to walker as well as to improve his gait control, speed and endurance. The OT goals were to improve TW's right hand and arm control through a Constraint Induced Movement Therapy program.

Following the pre-intensive assessment, TW was fitted with TheraTogs in order to improve his trunk control and and ultimately strength. During the intensive it was determined that the solid AFOs that TW had been using were limiting his mobility and the therpist initiated fitting for articulated AFOs.

TW made excellent progress and he mastered independent transfers from floor to bench to walker, his gait speed and control improved significantly.

TW learned how to use his right hand to pick up smaller items and his family noticed a signficant increase in spontaneus use of his right hand.

TW was given a home program to continue to work on mobility and right hand and arm use. He will continue therapy in the Step by Step outpatient clinic.






























Child, 18 month, brachial plexus injury

The child was seen for a two-week (6 days per week) intensive with 3 hours of therapy per day. The goals of the intensive was to improve range of motion of the shoulder and elbow and to improve the child's ability to use her right hand functionally.

At the start of the intensive, the child had significant limitations in ractive and passive range of motion and use of the involved arm was limitied.


The child gained significant range of motion and function following the intensive:

•Shoulder external rotation from 0 degrees to 50 degrees

•Elbow extension from –20 degrees to 0 degrees

•Supination from neutral to 40 degrees

Movement control:

•From using several fingers to pick up small items to a perfect pincer grasp

•From no supination to 20 degrees of supination

•General improvement of fine motor skills

•Support of shoulder forearm and hand

•Supportive shoulder alignment garment

•Support of forearm supination

•Taping of wrist and thumb


The family went home with a comprehensive program that allowed them to maintain function



We spent two weeks at the Step by Step with our daughter who has a Obstetrical Brachial Plexus Injury. We have worked with therapists since day 3 of her life but only now did we finally get to work with Pia who is an expert in BPI. It was such a relief to finally find answers and learn techniques that actually help our daughter to achieve her potential. Plus she was mostly happy during the therapy sessions. She was allowed to choose her favorite activities but was still challenged to learn and make progress. I would absolutely recommend this center and Pia to anyone whose child is affected by BPI.

Ability to transition from floor to bench pre and post intensive

Instant improvement in sitting posture and balance by just addressing alignment, in this case in the form of  Spio garments.

4-year old girl with cerebral palsy

This child was first seen for an intensive over the summer of 2015. In her first intensive the focus was on her gait. At that point she walked on her knees or in a Rifton Gait Trainer. We first focused on alignment, making sure that her trunk and legs were in the best possible alignment. Once alignment was accomplished, she could begin to work on learning good movement patterns.

Within the first few days of the intensive, she took a few independent steps and by the end of the two weeks, she was an independent walker!

In her second intensive over the summer of 2016 the focus was on teaching her to independently drink from a cup and to feed herself. This time she was in therapy during 2 meals a day. Again, the intensive proved very effective and at the end she had met her goals of eating and drinking independently and was ready to start Kindergarten!

Prior to the first intensive, this child's only form of mobility was walking on her knees or in a Rifton Gait Trainer

A few months later: independent walking and ready to learn new skills

First independent steps shortly after alignment was accomplished


As a parent you weigh every option, every treatment, every opinion to help your child. The intensive program at Step by Step was the best and most beneficial decision for my daughter. I highly recommend pursuing this opportunity; you won't regret it!!

Call to schedule an evaluation


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Rochester, NY 14623

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