OT RECOMMENDATIONS: OCCUPATIONAL THERAPY EVALUATION (CHECKLIST):

Transcription

1 CHILD S NAME: DOB: AGE: THERAPIST: DATE OF EVALUATION: OT RECOMMENDATIONS: OCCUPATIONAL THERAPY EVALUATION (CHECKLIST): Assessment Tools Utilized: HELP Strands (Hawaii Early Learning Profile) Clinical Functional Assessment Parent/Caregiver Report File Data Sensory Profile (Ages 3-10) PDMS (Peabody Developmental Motor Scales) Other GROSS MOTOR: Hopping/Jumping/Balancing Jumps clearing both feet off the floor Hops with both feet 3-4 foot distance Balances on 1-foot Balances on the other foot Walks a masking tape line in heel-to-toe pattern Jumps with both feet over a line Tip-toes (in place or walking) Climbs up ladder/slide Enjoys playground equipment Catching/Kicking/Throwing Catches a 10 ball thrown underhand Catches a 10 ball when bounced Throws a 10 ball underhand Throws a 10 ball overhead Throws a 10 ball toward a target/person Kicks a 10 ball with alternating feet Developed by Michelle B. Vest 1

2 Equipment (as applicable):. Postural Control Maintains posture in long-sit position Maintains posture in short-sit position Maintains posture in standing position Maintains posture in prone prop Maintains prone extension position Adequate chin tuck in supine flexion Shoulders elevated Shoulder s protracted/retracted Quality of Movement Range of motion WNL s Limitations Strength Sustained Brief Muscle Tone WNL s Low High Movement Slow/Labored Impulsive/Quick Un-coordinated/Awkward Coordinated FINE MOTOR: Right-hand preference/dominance Left-hand Eye-hand Coordination appropriate Bead stringing Pellets in bottle Able to twist/untwist cap off bottle Able to orient scissors on hand correctly Able to manipulate scissors Able to stabilize/rotate paper while cutting Visual-attention to task appropriate Grasp patterns Inferior/Superior pincer Raking grasp Lateral grasp (coins) Tripod grasp (static or dynamic) Internal Rotation observed? Finger Isolation/Opposition Voluntary Release Reach across Midline Right to Left Left to Right Reach against gravity while retrieving objects Developed by Michelle B. Vest 2

3 Able to use 2-hands together (bilateral hand use) Stabilize with one hand while manipulating with the other In-hand manipulation (object in palm to fingertips) Motor planning Adequate Delayed VISUAL-PERCEPTUAL: Basics: Stacking rings in order of size random order Block design imitation/copying (tower, 4-block train, 3-block bridge, 5-block gate) Nesting cups by order of size trial and error random order Places pegs Inset puzzles Interlocking puzzles Colors/Shapes: Identifies Shapes by name circle square triangle star oval rectangle heart octagon diamond Matches Shapes circle square triangle star oval rectangle heart octagon diamond Identifies Colors by name red blue yellow orange green purple pink black white brown Matches Colors red blue yellow orange green purple pink black white brown Able to sort by object similarity Able to sort by color Pre-writing: Able to imitate circle vertical line horizontal line cross Able to copy a circle square triangle Stencils Traces lines/shapes Identifies random letters in print Identifies Name in Print Identifies random numbers in print Developed by Michelle B. Vest 3

4 Able to write letters Able to write name Able to write numbers Body Awareness/Perception: Able to point to requested body parts on self eyes nose mouth ears head hair teeth hands arms legs feet fingers tummy Secondary parts? Able to draw a basic person Which Parts included? SELF-HELP: Toileting Independent Assistance Dressing/Fasteners Zippers Snaps Buttons removes clothing dons clothing Eating Independent Dependent Adapted Utensils Uses cup Uses straw Opens containers Washes/Dries Hands and Face Seeks out Adult Assistance, as needed SOCIAL: Interacts with peers Takes-turns/Shares Follows classroom rules and direction Favorite activities Playtime Participates in circle time SENSORY: Tactile Accepts textures/tactile input Craves textures/tactile input Avoids food textures or tactile input Dislikes light touch/ Unexpected touch Which types? Developed by Michelle B. Vest 4

5 Visual-Tracking/Scanning Able to track in vertical plane Horizontal plane Diagonal plane Converge eyes (moving object close) Diverge eyes (moving object away) Scans immediate environment to locate requested item/object Visually scans choices while sorting objects or making choices Eyes move symmetrically Eyes not coordinated during functional activities Child requires frequent visual breaks during fine motor/visual-perceptual and/or vestibuar (movement) activities. Proprioceptive Craves deep pressure input/firm hugs and squeezes Climbs on furniture/dare-devil, etc. Throws self off furniture etc. Enjoys weight on body/rough-housing Enjoys/seeks out upside-down positions/postures Vestibular (movement) Enjoys Avoids swings/slides Enjoys car rides Gets car sick? Prefers to keep feet on the floor versus being tossed in the air etc. High-motor drive at home/in classroom Developed by Michelle B. Vest 5