Adapted Physical Education Skills Tests

Student

DOB

Assessor

Assessment Date (s)
Ambulatoy

Power

Manual

Walker

Braces

Other

Transfer w/Asst

Crutches

Transfer w/o Asst

Surgeries
Health Related Disorders
Reflex Actions
Contractures
PA

Task

Fitness

Run, Walk, or Push 50 yds

Fitness

Run, Walk, or Push 220 yds

Fitness

Run, Walk, or Push 440 yds

Fitness

Run, Walk, or Push 1 mile

Fitness

Bent knee curl-ups

Fitness

Sit Backs

Fitness

Wall Push Ups

Fitness

Bent Knee Push Ups

Fitness

Straight Leg Push Ups

Fitness

Shoulder Rounds

Fitness

Arm Circles

Fitness

Static Passive Leg Stretch Exercises

Fitness

Static Passive Arm Exercises

Fitness

Static Stretches for Legs

Fitness

Static Stretches for Arms

Fitness

Sit and Reach Test

Fitness

Overhead Arm Stretch

Fitness

Roll into Ball w/Back Convex, Rounded Position: Prone

Fitness

Roll into Ball w/Back Convex, Rounded Position: Supine

Perceptual Motor

Focus Eyes on Object

Perceptual Motor

Follow Object with Eyes

Perceptual Motor

Rotate Head: Forward

Perceptual Motor

Rotate Head: Backward

Perceptual Motor

Rotate Head: Sde to Side

Perceptual Motor

Rotate Head: Look over Shoulder

Mobility

Move Forward

Mobility

Move Backward

Mobility

Move Right

Mobility

Move Left

Los Angeles Unified School District

Data

w/Assist

Page 1

Adapted Physical Education Skills Tests
PA

Task

Mobility

Push Forward

Mobility

Push Backward

Mobility

Rotate Side to Side

Mobility

Perform 180 Degree Turn

Mobility

Perform 360 Degree Turn

Mobility

Start & Stop Agility: 5 Designated Spots

Mobility

Wheelchair Slalom

Mobility

Ambulatory Slalom

Mobility

Navigate Obsticles

Transferring

Stand Independently

Transferring

Stand Holding onto Person or Object

Transferring

Transfer from WC to Walker

Transferring

Transfer from Walker to Wall

Transferring

Transfer from WC to Walking Bar

Transferring

Transfer from WC to Floor

Transferring

Transfer from WC to Chair

Balance

Sit Upright in wheelchair

Balance

Sit Upright in chair

Balance

Balance on Two Feet

Balance

Balance on One Foot

Balance

Balance on right foot (timed)

Balance

Balance on left foot (timed)

Balance

Walk a balance beam on floor

Balance

Maintain balance on obstacle course

Locomotor

Walks w/Walker

Locomotor

Walks w/ Horizontal Bar

Locomotor

Walks w/ WC for Support

Locomotor

Slalom Walk w/Support

Locomotor

Walk w/o Apparatus Support

Object Control

Stop a Rolled Ball

Object Control

Roll Ball to Target from WC or on Floor

Object Control

Roll Ball to a Partner

Object Control

Throw Ball to Target

Object Control

Throw Ball to Partner

Object Control

Throw Overhand

Object Control

Throw Underhand

Object Control

Pass a Ball to a Partner

Object Control

Catch a Bounced Ball

Object Control

Catch a Ball from a Partner

Los Angeles Unified School District

Data

w/Assist

Page 2

Adapted Physical Education Skills Tests
PA

Task

Object Control

Lift and Release an Object from the Foot

Object Control

Kick a Ball Left Foot

Object Control

Kick a Ball Right Foot

Object Control

Kick toward a Target: Right Foot

Object Control

Kick toward a Target: Left Foot

Object Control

Kick a Ball to a Partner

Object Control

Strike w/Hand

Object Control

Strike w/Object

Object Control

Stikes a Ball Off a Tee

Fine Motor

Grasp Object

Fine Motor

Release Object

Fine Motor

Unilize Pincer Grasp

Fine Motor

Stack Objects

Fine Motor

Place Objects in Container

Fine Motor

Transfer Objects from Hand to Hand

Fine Motor

Transfer Objects to Another Person

Fine Motor

Push Object Off the WC Tray

Fine Motor

Move Object from One Point to Another

Fine Motor

Initiate Hand Movements to Push

Cognitive

Point Up Using Fingers

Cognitive

Point Up Using Eyes

Cognitive

Plays Board Games

Cognitive

Matches Puzzle Pieces

Cognitive

Matches Colors

Cognitive

Matches Numbers

Cognitive

Identifies Body Parts
Head
Eyes
Eyelid
Nose
Cheek
Ear
Forehead
Eyebrow
Eyelashes
Mouth
Lips

Data

w/Assist

Tongue
Teeth
Chin
Back
Neck
Shoulders
Waist
Stomach
Chest
Buttocks
Arm
Elbows

Los Angeles Unified School District

Page 3

Adapted Physical Education Skills Tests
Eligibility

w/o Assist

Los Angeles Unified School District

Unable

Page 4

Adapted Physical Education Skills Tests
w/o Assist

Los Angeles Unified School District

Unable

Page 5

Adapted Physical Education Skills Tests
w/o Assist

Unable

Wrist
Hand
Fingers
Hips
Leg
Thigh
Knee
Foot
Ankle
Heel
Toes

Los Angeles Unified School District

Page 6

Adapted Physical Education Evaluation

Muscular Strength and Range of Motion
Name

Date

Birthdate
Physical Description

Grade

Muscle Rating

WNL: Within Normal Limits
LOM: Limitation of motion

Strength
Right

Examiner

Range of Motion

+ resistance
ü w/o resistance
0 unable

Comments

Track

Left

Anatomical Movement
Finger Flexion
Finger Extension
Wrist Flexion
Wrist Extension
Supination
Pronation
Elbow Flexion
Elbow Extension
Shoulder Flexion
Shoulder Extension
Shoulder Abduction
Shoulder
ShoulderAdduction
Internal
Rotation
Shoulder External
Rotation
Spinal Flexion
Spinal Extension
Hip Flexion
Hip Extension
Hip Abduction
Hip Adduction
Knee Flexion
Knee Extension
Plantar Flexion
Dorsi Flexion

90 
45
80 
70 
90 
90 
150 
0
180
45
180
45 
135
45
85 
30
120 
30
45 
20 
135
0
50 
20 

Range of Mot
Right

apted Physical Education Evaluation

ar Strength and Range of Motion

Muscle Picture
Flaccid
Spastic
Rigid
Tremor

Range of Motion
Left

Comments