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203

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204 -

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

205

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.

206

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

/ 207
-
Sensory Processing Checklist

-

A Always
O Often
S Sometime
R Rair
N None

208

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.

209

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.

210

Visual System A O S RN
1. + x
2. /

3.
4.
5.
6.
7.

8. /

9.

10. ***
***

//