75
................... ) ................... )
( (
................... )
(
76
(
-
77
(
...... ........... ...................
( (
....................
(
78
-
1. General appearance
2. Motor Function
2.1 Gross Motor
-
2
-
3
2.2 Crossing the Midline
2.3 Laterality
2.4 Bilateral integration
2.5 Motor control
Mobility
Tremor
Chorea
Athetosis
Fluctuate
Ataxic Gait
Finger to Nose Test Dysmetria
Diadochokinesia
2.6 Praxis * *
-
-
2.7 Fine coordination
79
eye contact
eye following
Reach Out
Grasp
1. Power grasp
Hook
Spherical grasp
Cylindrical grasp
2. Precise grasp
Carry hold
Release
eye-hand coordination
Lip Closure
Tongue
Jaw control
Sucking
Swallowing
- Chewing
1. Tongue thrust
2. Tooth Grinding
3. Drooling
4.
5.
6.
80
1. Reflex
2. Rage of Motion
AROM
PROM
3. Muscle tone
Fluctuating tone [ ] UE [ ] LE
Hypo tone [ ] UE [ ] LE
Hyper tone [ ] UE [ ] LE
Spasticity Rigidity : Flexor : Mild Moderate Sever
Moderate Sever
: Extensor : Mild
0 -5
CP CP 0 -5
Balance
Muscle Strength
[
[
Endurance
Postural control
Postural alignment
Soft tissue integration
81
1.
2. Sensation N=Normal I=Impaired L=Loss
- Tactile
-
- Light touch :
-
- Pressure :
Temperature :
Pain :
Vibration :
Proprioceptive :
Vestibular :
Visual :
Auditory :
Gustatory :
3.
Stereognosis
Kinesthesis
Pain Respone
Body Scheme
- Right-Left Discrimination
Form constancy
Position in space
Visual-Closure
Figure Ground
Depth Perception
Spatial Relation
82
Sensory Processing Checklist
/
-: -
41 4 --
52110
A Always
O Often
S Sometime
R Rair
N None
83
Auditory System AO S RN
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
/ Gustatory/Olfactory System AO S RN
1.
2.
3. Proprioceptive System AO S RN
4.
5.
1.
2.
3. /
4.
5.
6.
7.
8.
9.
10.
11.
12.
84
Tactile System AO S RN
1.
2.
3.
4. /
5.
6.
7.
8.
9.
10. /
11. /
12.
13.
14.
15. /
16.
17.
18.
19.
20.
21.
Vestibular System AO S RN
1. -
2. / /
3.
4.
5. /
6.
7.
8.
9.
10.
11.
12.
13.
/
14.
85
Visual System A O S RN
1. + x
2. /
3.
4.
5.
6.
7.
8. /
9.
10. ***
***
//
86
poor integration good integration
Hyperactive *
Distractivity
Tactile Defensiveness
Gravitational Insecurity
Visual Defensiveness
Auditory
Defensiveness
*
1. :
2.
3.
4.
5.
6.
7.
8.
87
1.
2.
3.
4.
5.
-
-
-
-
-
-
-
-
-
-
-
6.
7.
8.
9.
10.
.
-
-
-
-
-
88
1.
2.
3.
4.
5.
6.
7.
8.
. (Delay
Development)
- (Gross motor skill)
- (Fine motor skill)
- (Language)
- (Emotional)
- (Social skill)
.
(Sensory integration disorder)
.
89
.
.
.
.
.
.
.
.
. Activity of Daily Living Training)
.
- 9
-
Short attention span &
distractivity
Poor Cognition
90
91
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106
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