Scribd
Upload
28 views10 pages

Occupational Therapy Assessment Guide

The document outlines an occupational therapy assessment form for children, detailing demographic data, chief complaints, and various historical aspects including prenatal, perinatal, postnatal, family, medical, and educational histories. It includes sections for developmental history, examination of gross and fine motor skills, cognitive perceptual skills, social-emotional skills, communication and language skills, types of play, and activities of daily living. The form concludes with sections for problem identification, tools used, treatment implementation, and therapist signature.

Uploaded by

Sinoy Kurian Puthiyaparambil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
28 views10 pages

Occupational Therapy Assessment Guide

The document outlines an occupational therapy assessment form for children, detailing demographic data, chief complaints, and various historical aspects including prenatal, perinatal, postnatal, family, medical, and educational histories. It includes sections for developmental history, examination of gross and fine motor skills, cognitive perceptual skills, social-emotional skills, communication and language skills, types of play, and activities of daily living. The form concludes with sections for problem identification, tools used, treatment implementation, and therapist signature.

Uploaded by

Sinoy Kurian Puthiyaparambil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

ITHAL

CENTER FOR SPECIAL CARE

OCCUPATIONAL THERAPY ASSESSMENT

 DEMOGRAPHIC DATA
Name
Age/Gender
Date of birth
Referral
Informant
School
Location
Date of evaluation
 CHIEF COMPLAINTS

 ON OBSERVATION
 HISTORY

Conception Normal/ IVF


Mother Age
Father age
Any complication to the mother
during pregnancy

Any stressful situation in the


family
PRENATAL
HISTORY:
History of any chronic diseases:
Diabetes, Jaundice,
Hypertension, Thyroid/Others

History of fall
Any complications during
pregnancy

Abortion/ Miscarriages YES/ NO

PERINATAL Type of delivery  Normal


HISTORY:  C Section
 Forceps
 Breech presentation
Full-term/ preterm

Birth cry
 Cry immediately after
birth-
 Did not cry immediately
after birth-

Birth weight
Fever/Aspiration/ Convulsions/
jaundice/ trauma

POSTNATAL
HISTORY:

Yes/No
Is the baby sucking effectively
during breastfeeding?

History of seizures?

Consanguineous/
Non consanguineous marriage

Total number of children 1/ 2/ 3/ 4


Family tree –

FAMILY
HISTORY:

Occupation of father

Occupation of mother
Any similar illness in the family

MEDICAL Any medical reason for


HISTORY: hospitalization after delivery
Mention if child goes to school

EDUCATIONAL Type of school (special/ regular/


HISTORY: integrated)

Class the child is in

Any complaints from teachers

Attained in which age/month


 Head control (3 months)
 Roll over (4-5 months)
 Unsupported sitting
(7months)
 Crawling (7 months)
DEVELOPMENTAL  Standing (10 months)
HISTORY:  Walking (12 months)
 Social Smile (3 months)
 Cooing (3 months )
 Babbling (6-8 months)
 Uttering words (12
months)

ON EXAMINATION
Age In Specify if
Gross Motor Skills Appropriate Appropriate inappropriate
Walking
Running

Jumping
 Floor level
 From height

Stair Climbing

Obstacle Crossing

Climbing Play
Equipment

Forward and backward


jumping
Unilateral Standing
Balance Beam Walking
Hopping
Tandem Walking
Cycling

FINE MOTOR SKILLS

 Hand Dominance : Right/Left/Mixed


 In-hand manipulation :
 Stringing beads :
 Building tower of blocks :
 Buttoning :
 Scissor Skills :
 Picking up Object with tweezer :
 Paper folding :
Handwriting skills
Pre-writing
 Scribbling [10-12 months] :
 Basic figures [Imitating horizontal, vertical, circular [ 2 years] :
Pencil grasp
 Palmar supinate grasp [12-15 months] :
 Digital pronate grasp [2-3 years] :
 Static Tripod grasp [3-4 years] :
 Dynamic Tripod [5-6 years] :

Writing
 Alphabets -
 Numbers -

COGNITIVE PERCEPTUAL SKILLS

 Attention & Memory


 Anticipates parts of rhymes or song
 Points to the hand in which toy in hidden
 Says or sings at least 2 nursery rhymes or song
 Identification from 4 or more pictures
 Remembers & names which of 3 objects has been hidden
 Recalls event in the past / story
 Orientation towards time/place/person

Concepts: ( General )
 Sorts object by colour, form ,name
 Follows direction – in , out : up/ down
 Identification of at least 3 colours & 2 shapes
 Understands, hard/soft
 Understands backward / forward
 Names examples within a category
(animals, objects in kitchen, clothes )
 Identification of 3 – 6 body parts
Size & Numbers
 Understands big/small
 Gives/selects two & three
 Understands more / loss
 Gives one more
 Counts 10 objects in a row
 Gives correct numbers of objects when asked
 Tells the correct age
 Answers addition question involving + 2 to 10
Visual perception: ( Block design & puzzles )
 Imitates block train & block patterns
 Copies horizontal block patterns
 Places rounds , square & triangle forms on form board
 Puts together 2 piece puzzles
 Completes 4 to 5-piece puzzles
 Matches letters & numbers on board
SOCIAL-EMOTIONAL SKILLS:
 Eye contact (seconds)
 Recognizes parents/strangers
 Stranger fear / no fear
 Responds to others emotions
 Greets familiar adults
 Responds appropriately in social situations
 Separates from parents in a familiar surrounding
 Tries to make peer relationship
 Expresses needs through appropriate words
 Shares things & belonging
 Takes turns & waits for his / her turn
COMMUNICATION & LANGUAGE SKILLS
 Expressive
 Names common object
 Names 2-6 pictures in picture book
 Use monosyllables, bisyllables, 2 or 3 words sentences
 Gestures, points
Receptive
 Understands single or 2 step commands
 Understands gestures
 Responds to Yes / No
 Responds to ‘who ‘‘where’ questions

TYPE OF PLAY - Unoccupied play


Solitary play
On-looker play
Parallel play
Associative play
Cooperative play

ACTIVITIES OF DAILY LIVING


ADL skills No-helper Helper-modified Helper-complete
dependence dependence
Dressing:
Upper body
Lower body
Bathing
Toileting
Eating
Grooming
Bladder
management
Bowel
management

PROBLEM IDENTIFICATION :

TOOLS USED :

TREATMENT IMPLEMENTATION :

DATE : THERAPIST NAME & SIGNATURE

You might also like