PAEDIATRIC THERAPY OBSERVATIONAL CHECKLIST

 

AADHIRAA PAEDIATRIC THERAPY SERVICES

CHILD NAME: ____________________ DATE: __________ AGE: _____


Gross Motor

Cross crawls____ Consecutive reps

Jumping jacks____ Consecutive reps

Throws ball at target__/ Accuracy

Catches small ball with hands__/ Accuracy

Hops on one foot____ Consecutive hops

Skips____ Consecutive skips

Balance

Stands on one foot (eyes open) ____ seconds

Stands on one foot (eyes closed) ____ seconds

Walks across balance beam____ step-offs

Balances on tiptoes____ seconds

Heel-to-toe walking____ steps

Core Strength

Prone extension

Supine flexion____ seconds

Maintains upright sitting posture

Performs sit-ups____ Consecutive reps

Holds plank position____ seconds

Bilateral Skills

Folds paper along target lines within____"

Weaves string through holes in lacing card

Strings beads on soft lace / pipe cleaner

Crosses midline spontaneously

Stabilizes objects with non-dominant hand

Claps hands together____ Consecutive claps

Opens and closes scissors____ Times

Fine Motor

Hand dominance right / left / mixed

Uses pincer grasp to pick up small objects

Puts pegs into pegboard

Translates objects between fingers & palm

Sequentially touches each fingertip to thumb

Pencil grasp static / dynamic

Hand strength WNL / decreased

Uses tweezers to pick up small objects

Manipulates small objects (e.g., buttons, beads)

Visual Motor

Colors within ____" of target lines

Draws recognizable ____ part person

Imitates/Copies lines

Imitates/Copies shapes

Stacks blocks into blocks Imitates / Copies towers

block designs

Traces lines and shapes

Completes simple puzzles (3-5 pieces)

Handwriting

Proper spacing between letters/words

Aligns letters along the writing baseline

Sizes/forms letters appropriately

Uses adequate pencil pressure

Writes name legibly

Copies simple words

Behaviour

Self-stimulatory

Self-injurious

Follows classroom rules

Takes turns with peers

Responds to social cues

Social Emotional Skills (SE Skills)

Name calling response

Eye contact

Greetings

Shares with others

Waits for turn

Shows empathy towards peers

Maintains personal space

Cognition & Behavior

Attention to task excellent / good / poor

Follows directions1-step / 2-step / 3+ steps

Sequences tasks efficiently in correct order

Regulates emotions WNL / decreased ability

Identification

Number

Objects

Color

Alphabet

Size

Gender

Shape

Family

Self-Care

Feeding

Manages fasteners

Toileting

Buttons

Bathing

Unbuttons

Grooming

Washes hands

Dons/doffs

Uses utensils properly

 

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