Documente Academic
Documente Profesional
Documente Cultură
Student
DOB
Assessor
Power
Manual
Walker
Braces
Other
Transfer w/Asst
Crutches
Surgeries
Health Related Disorders
Reflex Actions
Contractures
PA
Task
Fitness
Fitness
Fitness
Fitness
Fitness
Fitness
Sit Backs
Fitness
Fitness
Fitness
Fitness
Shoulder Rounds
Fitness
Arm Circles
Fitness
Fitness
Fitness
Fitness
Fitness
Fitness
Fitness
Fitness
Perceptual Motor
Perceptual Motor
Perceptual Motor
Perceptual Motor
Perceptual Motor
Perceptual Motor
Mobility
Move Forward
Mobility
Move Backward
Mobility
Move Right
Mobility
Move Left
Data
w/Assist
Page 1
Task
Mobility
Push Forward
Mobility
Push Backward
Mobility
Mobility
Mobility
Mobility
Mobility
Wheelchair Slalom
Mobility
Ambulatory Slalom
Mobility
Navigate Obsticles
Transferring
Stand Independently
Transferring
Transferring
Transferring
Transferring
Transferring
Transferring
Balance
Balance
Balance
Balance
Balance
Balance
Balance
Balance
Locomotor
Walks w/Walker
Locomotor
Locomotor
Locomotor
Locomotor
Object Control
Object Control
Object Control
Object Control
Object Control
Object Control
Throw Overhand
Object Control
Throw Underhand
Object Control
Object Control
Object Control
Data
w/Assist
Page 2
Task
Object Control
Object Control
Object Control
Object Control
Object Control
Object Control
Object Control
Strike w/Hand
Object Control
Strike w/Object
Object Control
Fine Motor
Grasp Object
Fine Motor
Release Object
Fine Motor
Fine Motor
Stack Objects
Fine Motor
Fine Motor
Fine Motor
Fine Motor
Fine Motor
Fine Motor
Cognitive
Cognitive
Cognitive
Cognitive
Cognitive
Matches Colors
Cognitive
Matches Numbers
Cognitive
Data
w/Assist
Tongue
Teeth
Chin
Back
Neck
Shoulders
Waist
Stomach
Chest
Buttocks
Arm
Elbows
Page 3
w/o Assist
Unable
Page 4
Unable
Page 5
Unable
Wrist
Hand
Fingers
Hips
Leg
Thigh
Knee
Foot
Ankle
Heel
Toes
Page 6
Date
Birthdate
Physical Description
Grade
Muscle Rating
Strength
Right
Examiner
Range of Motion
+ resistance
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
Muscle Picture
Flaccid
Spastic
Rigid
Tremor
Range of Motion
Left
Comments