Progress Monitoring Forms - Fine Motor · 2021. 3. 28. · Progress Monitoring Forms Purpose: The...

Progress Monitoring Forms

Fine Motor Skills

Your Therapy Source Inc

Your Therapy Source, Inc.43 South Main StreetSchaghticoke, NY 12154

Copyright © 2011 by Your Therapy Source, Inc. All rights reserved.

Visit www.YourTherapySource.com

for other school based therapy and special needs resources.

Publisher’s Note: The publisher and author has made every attempt to make sure that the information in this book is correct and up to date. All physical activities require approval from a child’s pediatrician. The author or the publisher will not be liable for any impairment, damage, accident or loss that may occur from any of the suggested activities in this book.

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Purpose: The Progress Monitoring Forms allow therapists or other personnel to track an individual’s motor skills over time. By monitoring the skills over the course of the year(s), the therapist can get a visual picture of improvement, decline or maintenance of different skills. This can assist the therapist to make clinical decisions regarding Response to Intervention programs, regular treatment sessions and discharge planning.

How to Use the Forms: Step 1: Determine which form is suitable for the individual’s goal. You may need more than one form for each individual. Each form is meant to be a guide. The therapist will need to establish a goal for each skill which may not necessarily be the top of the scale on the graph.

Step 2: For each therapy session or consultation indicate the intervention and the date.

Step 3: When an assessment is completed, indicate the individual’s abilities in the graph. For example, if the therapist observes that the child held the scissors correctly when cutting 2 out of 4 trials in November mark it on the graph.

Step 4: Continue to graph the dates of assessment and results throughout the year.

Step 5: Analyze the graph to answer the following questions:Are the interventions successful?Do different interventions yield better results?Is there a pattern over vacations (i.e skills decline over a break)?Are no gains being made at all?

Step 6: Plan ahead. Does the individual need an increase or decrease in therapy services? If no progress has been made following several different interventions do you need to discontinue therapy services? If following a Response to Intervention model, does the individual need more intensive services or not?

Here is an example of a completed form.

Progress Monitoring FormsGrasp

Name:

School Year:

Therapist:

Dates of Interventions

Postural control activities:

Other:

Practicing the skill:

Fine motor skill practice:

© Your Therapy Source Inc www.YourTherapySource.com

Comments:

Consultation with staff or parents:

Hand strengthening activities:

Dates of Assessment

Out of 4 trials, how often does the child use palmar grasp (ie picking up block)?

Dates of Assessment

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

1

2

3

1

2

3

4

4

Out of 4 trials, how often does the child use a pincer grasp (ie picking up smaller objects)?

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

Upper extremity strengthening:

Does the child use the correct grasp for different sized objects?

Progress Monitoring FormsGrasp and Release

Name:

School Year:

Therapist:


Postural control activities:


Other:




Comments:



Out of 10 trials, how many objects can the child grasp and release with wrist extended?(ie picking up small objects and releasing into container)

# o

f o

bje

cts

gra

sp

ed

an

d r

ele

as

ed

Dates of Assessment

1

2

3

4

5

6

7

8

9

10

Progress Monitoring FormsOpening Containers

Name:

School Year:

Therapist:


Visual perceptual activities:

Coordination activities:

Other:




Comments:


Muscle strengthening activities:

Dates of Assessment

Out of 4 trials, how many times can the child open/unscrew a container with a large lid or top?

Dates of Assessment

# o

f ti

me

s o

pe

ns

larg

e lid

/to

p

1

2

3

1

2

3

4

4

# o

f ti

me

s o

pe

ns

sm

all lid

/to

p

Out of 4 trials, how many times can the child open/unscrewa container with a small lid or top?

Progress Monitoring FormsClosing Containers

Name:

School Year:

Therapist:




Other:




Comments:



Dates of Assessment

Out of 4 trials, how many times can the child close a container with a large lid or top?

Dates of Assessment

# o

f ti

me

s c

los

es

larg

e lid

/to

p

1

2

3

1

2

3

4

4

# o

f ti

me

s c

los

es

sm

all lid

/to

p

Out of 4 trials, how many times can the child closea container with a small lid or top?

Progress Monitoring FormsToys

Name:

School Year:

Therapist:




Other:




Comments:



Dates of Assessment

Out of 4 trials, how many times can the child manipulate toys with large pieces independently?

Dates of Assessment

To

ys

wit

h

larg

e p

iec

es

1

2

3

1

2

3

4

4

Out of 4 trials, how many times can the child manipulate toys with small pieces independently?

To

ys

wit

h

sm

all p

iec

es

Progress Monitoring FormsStringing Large Beads

Name:

School Year:

Therapist:




Other:




Comments:



Dates of Assessment

How many large beads can the child string?

# o

f b

ea

ds

on

str

ing

1

2

3

4

5

6

7

8

9

10

Progress Monitoring FormsStringing Small Beads

Name:

School Year:

Therapist:




Other:




Comments:



Dates of Assessment

How many small beads can the child string?

# o

f b

ea

ds

on

str

ing

1

2

3

4

5

6

7

8

9

10

Progress Monitoring FormsTower of Blocks

Name:

School Year:

Therapist:




Other:




Comments:



How many small blocks out of 10 can the child stack to build a tower?

Size of blocks:

# o

f B

loc

ks

Sta

ck

ed

to

Bu

ild

a T

ow

er

Dates of Assessment

1

2

3

4

5

6

7

8

9

10

Progress Monitoring FormsImitating Simple Block Building

Name:

School Year:

Therapist:




Other:




Comments:



Out of four trials, how many times can the child copy a simple block design?

Block design: Size of blocks:

# o

f T

ime

s S

imp

le B

loc

k D

es

ign

Co

pie

d

Dates of Assessment

1

2

3

4

Progress Monitoring FormsImitating Complex Block Building

Name:

School Year:

Therapist:




Other:




Comments:



Out of four trials, how many times can the child copy a complex block design?

Block Design: Size of blocks:

# o

f T

ime

s C

om

ple

x B

loc

k D

es

ign

Co

pie

d

Dates of Assessment

1

2

3

4

Progress Monitoring FormsSimple Puzzles

Name:

School Year:

Therapist:




Other:




Comments:



Out of four trials, how many times can the child complete a simple wooden puzzle (i.e. putting one wooden piece with knobs or without into a matching hole)?

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

Dates of Assessment

1

2

3

4

Progress Monitoring FormsPuzzles

Name:

School Year:

Therapist:




Other:




Comments:



What size jigsaw puzzle can a child complete?Circle small or large puzzle pieces.

SMALL PIECES LARGE PIECES

# o

f p

uzzle

pie

ce

s c

hild

ca

n c

om

ple

te

Dates of Assessment

5

10

15

20

25

30

35

40

45

50

Progress Monitoring FormsBook Use

Name:

School Year:

Therapist:



Other:




Comments:



How many times, out of 3 trials, can the child open and close a book?

Dates of Assessment

Op

en

/Clo

se

Bo

ok

1

2

3

Dates of Assessment

Tu

rn P

ag

es

of

Bo

ard

Bo

ok

1

2

3

Dates of Assessment

Ty

pic

al b

oo

k

1

2

3

How many times, out of 3 trials, can the child turn individual pages of a board book?

How many times, out of 3 trials, can the child turn individual pages of a typical book?

Progress Monitoring FormsUnbutton, Unzip and Unsnap

Name:

School Year:

Therapist:



Other:




Comments:



How many times out of 3 trials can the child unbutton?

Dates of Assessment

Un

bu

tto

n

1

2

3

Dates of Assessment

Un

zip

1

2

3

Dates of Assessment

Un

sn

ap

1

2

3

How many times out of 3 trials can the child unzip?

How many times out of 3 trials can the child unsnap?

Progress Monitoring FormsButton, Zip and Snap

Name:

School Year:

Therapist:



Other:




Comments:



How many times, out of 3 trials, can the child button?

Dates of Assessment

Bu

tto

n

1

2

3

Dates of Assessment

Zip

1

2

3

Dates of Assessment

Sn

ap

1

2

3

How many times, out of 3 trials, can the child zip?

How many times, out of 3 trials, can the child snap?

Progress Monitoring FormsHolding Scissors

Name:

School Year:

Therapist:




Other:




Comments:



Type of scissors used: Circle: Right handed or left handed scissors

Dates of Assessment

Out of 4 trials, how often does the child hold the scissors correctly?

Dates of Assessment

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

1

2

3

1

2

3

4

4

Out of 4 trials, how often does the child hold and move the piece of paper he/she is cutting correctly?

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

Progress Monitoring FormsScissor Skills - Snip and Straight Lines

Name:

School Year:

Therapist:




Other:




Comments:



Dates of Assessment

Out of 4 trials, how often does the child snip with scissors?

Dates of Assessment

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

1

2

3

1

2

3

4

4

Out of 4 trials, how often does the child cut accurately on a straight line?

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

Type of scissors used:

Progress Monitoring FormsScissor Skills - Curved and Crooked Lines

Name:

School Year:

Therapist:




Other:




Comments:



Dates of Assessment

Out of 4 trials, how often does the child cut accurately on a curved line?

Dates of Assessment

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

1

2

3

1

2

3

4

4

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls


Out of 4 trials, how often does the child cut accurately on a crooked line?

Progress Monitoring FormsScissor Skills - Simple and Complex Shapes

Name:

School Year:

Therapist:




Other:




Comments:



Dates of Assessment

Out of 4 trials, how often can the child cut out simple shapes (i.e. circle, square, triangle)?

Dates of Assessment

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

1

2

3

1

2

3

4

4

Out of 4 trials, how often can the child cut out complex shapes (i.e. magazine pictures)?

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls


Progress Monitoring FormsGlue Use

Name:

School Year:

Therapist:




Other:




Comments:



Dates of Assessment

Out of 4 trials, how often does the child use the proper amount of glue?

Dates of Assessment

Pro

pe

r u

se

of

glu

e

1

2

3

1

2

3

4

4

Out of 4 trials, how often is the child able to glue two objects together?

Glu

e t

og

eth

er

Progress Monitoring FormsStaple, Tape and Clip

Name:

School Year:

Therapist:



Other:




Comments:



Out of 3 trials, how often does the child use a stapler ?independently

Dates of Assessment

Sta

ple

s

ind

ep

en

de

ntl

y

1

2

3

Dates of Assessment

Us

es

Ta

pe

in

de

pe

nd

en

tly

1

2

3

Dates of Assessment

Us

es

Pa

pe

r C

lip

in

de

pe

nd

en

tly

1

2

3

Out of 3 trials, how often does the child use tape ?independently

Out of 3 trials, how often does the child use paper clips independently?

Progress Monitoring FormsPaperwork

Name:

School Year:

Therapist:



Other:




Comments:




Dates of Assessment

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

1

2

3

4

Out of 4 trials, how many times can the child successfully fold and crease paper?

Dates of Assessment

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

1

2

3

4

Out of 4 trials, how many times can the child successfully place a sheet of paper in a folder?

Progress Monitoring FormsCoins

Name:

School Year:

Therapist:



Other:




Comments:



Out of 3 trials, how often can the child pick up one coin off of desk?

Dates of Assessment

# o

f ti

me

co

mp

lete

d

ou

t o

f 3

tri

als

1

2

3

Dates of Assessment

1

2

3

Dates of Assessment

1

2

3

Out of 3 trials, how often can the child pick up 3 coins and keep all 3 in the hand?

Out of 3 trials, how often can the child pick coin up and put it a piggy bank?

# o

f ti

me

co

mp

lete

d

ou

t o

f 3

tri

als

# o

f ti

me

co

mp

lete

d

ou

t o

f 3

tri

als

Progress Monitoring FormsTying Shoes

Name:

School Year:

Therapist:



Other:




Comments:




Dates of Assessment

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

1

2

3

4

Out of 4 trials, how many times can the child successfully untie shoes?

Dates of Assessment

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

1

2

3

4

Out of 4 trials, how many times can the child successfully tie shoes?

Progress Monitoring FormsHand Dominance

Name:

School Year:

Therapist:


Body awareness activities:


Other:


Crossing midline activities:


Comments:



Out of four trials, how often does the child use his/her dominant hand for fine motor and visual motor skills?

Circle dominant hand.

RIGHT HAND DOMINANT LEFT HAND DOMINANT

# o

f ti

me

s c

om

ple

ted

o

ut

of

4 t

ria

ls

Dates of Assessment

1

2

3

4

Progress Monitoring FormsColoring in the Lines

Name:

School Year:

Therapist:




Other:




Comments:



When coloring a picture, how many times does the child color outside the lines?

# o

f T

ime

s C

olo

red

Ou

tsid

e t

he

Lin

es

Dates of Assessment

0

8

7

6

5

4

3

2

1

10

9

Progress Monitoring FormsColoring

Name:

School Year:

Therapist:


Other:



Comments:



When coloring, what percentage of the picture is the child able to color?

% o

f p

ictu

red

co

lore

d in

Dates of Assessment

25

50

75

100




Progress Monitoring FormsDot to Dot Puzzles

Name:

School Year:

Therapist:



Muscle strengthening:

Other:




Comments:



How many dots can the child connect to complete a simple drawing?

# o

f d

ots

co

nn

ec

ted

Dates of Assessment

2

4

6

8

10

12

14

16

18

20

Progress Monitoring FormsDrawing a Person

Name:

School Year:

Therapist:




Other:




Comments:


Body awareness Activities:

How many body parts are included when the child draws a person?

# o

f b

od

y p

art

s d

raw

n

Dates of Assessment

1

2

3

4

5

6

7

8

9

10

Progress Monitoring FormsPre-Writing Skills #1

Name:

School Year:

Therapist:



Other:




Comments:



Out of 3 trials, how often can the child copy a horizontal line?

Dates of Assessment

# o

f ti

me

co

mp

lete

d

ou

t o

f 3

tri

als

1

2

3

Dates of Assessment

1

2

3

Dates of Assessment

1

2

3

Out of 3 trials, how often can the child copy a vertical line?

Out of 3 trials, how often can the child copy a diagonal line?

# o

f ti

me

co

mp

lete

d

ou

t o

f 3

tri

als

# o

f ti

me

co

mp

lete

d

ou

t o

f 3

tri

als

Progress Monitoring FormsPre-Writing Skills #2

Name:

School Year:

Therapist:



Other:




Comments:



Out of 3 trials, how often can the child copy a circle?

Dates of Assessment

# o

f ti

me

co

mp

lete

d

ou

t o

f 3

tri

als

1

2

3

Dates of Assessment

1

2

3

Dates of Assessment

1

2

3

Out of 3 trials, how often can the child copy a square?

Out of 3 trials, how often can the child copy a triangle?

# o

f ti

me

co

mp

lete

d

ou

t o

f 3

tri

als

# o

f ti

me

co

mp

lete

d

ou

t o

f 3

tri

als

Progress Monitoring FormsErasing and Sharpening Pencils

Name:

School Year:

Therapist:




Other:




Comments:



Dates of Assessment

Out of 4 trials, how many times does the child erase pencilmarks without tearing the paper?

Dates of Assessment

# o

f ti

me

s e

ras

es

in

de

pe

nd

en

tly

1

2

3

1

2

3

4

4

# o

f ti

me

s s

ha

rpe

ns

pe

nc

il in

de

pe

nd

en

tly

Out of 4 trials, how many times does the child sharpen a pencil independently?

Pencil Grasp Used: Pencil Grip Used (if any):

Progress Monitoring FormsPencil Grasp

Name:

School Year:

Therapist:




Other:




Comments:



How many minutes can the child write with an effective and/or appropriate pencil grasp?

Min

ute

s

Dates of Assessment

1

2

3

4

5

6

7

8

9

10

Progress Monitoring FormsLetter Formation

Name:

School Year:

Therapist:




Other:




Comments:


Multisensory activities:

How many letters out of 26 can the child form correctly?

Le

tte

rs F

orm

ed

Co

rre

ctl

y

Dates of Assessment

2

24

22

20

18

16

14

12

10

8

6

4

KEY: CAPITAL letters lowercase letters

Progress Monitoring FormsWriting on the Lines

Name:

School Year:

Therapist:



Muscle strengthening activties:

Other:




Comments:



How many letters out of 10 can the child correctly write on the line?

Le

tte

rs w

ritt

en

on

th

e lin

e

Dates of Assessment

1

2

3

4

5

6

7

8

9

10

Progress Monitoring FormsSizing of the Letters

Name:

School Year:

Therapist:




Other:




Comments:



How many letters out of 26 are the proper size?

# o

f L

ett

ers

th

at

are

Pro

pe

r S

ize

Dates of Assessment

2

26

24

22

20

18

16

14

12

10

8

6

4

KEY: CAPITAL letters lowercase letters

Progress Monitoring FormsSpacing

Name:

School Year:

Therapist:




Other:




Comments:



How many words out of 10 are properly spaced?

Dates of Assessment

2

4

6

8

10

Wo

rds

Sp

ac

ed

Co

rre

ctl

y

How many letters out of 10 are properly spaced?

Dates of Assessment

2

4

6

8

10

Le

tte

rs S

pa

ce

d C

orr

ec

tly

Progress Monitoring FormsCopying

Name:

School Year:

Therapist:




Other:




Comments:



How many words are correctly copied out of 10?

Wo

rds

Co

pie

d C

orr

ec

tly

Ou

t o

f 1

0

Dates of Assessment

1

2

3

4

5

6

7

8

9

10

Progress Monitoring FormsHandwriting Speed

Name:

School Year:

Therapist:




Other:




Comments:



How many letters can the child write in one minute?

Le

tte

rs W

ritt

en

in

On

e M

inu

te

Dates of Assessment

10

20

30

40

50

60

70

80

90

100

Progress Monitoring FormsNumbers

Name:

School Year:

Therapist:




Other:




Comments:



How many numbers out of 10 are written correctly?

Nu

mb

ers

Wri

tte

n C

orr

ec

tly

Ou

t o

f 1

0

Dates of Assessment

1

2

3

4

5

6

7

8

9

10

Progress Monitoring FormsPeabody Developmental Motor Scales

Name:

School Year:

Therapist:



Fine motor skill activities:

Other:




Comments:


Motor skills practice:

Mo

nth

s

Dates of Assessment

10

20

30

40

50

60

70

80

90

Age Equivalent on Peabody Developmental Motor Scales

Ceiling Age 83 months

Key: Gross Motor Scale Fine Motor Scale Total Motor

ndFewell RR, Folio MR. Peabody Developmental Motor Scales. 2 ed; Austin: Pro-Ed; 2000

Progress Monitoring FormsBruininks-Oseretsky Test of Motor Proficiency 2nd Edition

Name:

School Year:

Therapist:



Fine motor activities:

Other:




Comments:


Motor skills practice:

Ye

ars

Dates of Assessment

Age Equivalent on Bruininks-Oseretsky Test of Motor ProficiencyBruininks, R., & Bruininks, B. (2005). Bruininks-Oseretsky Test of Motor Proficiency-2nd edition. Minneapolis, MN: NCS Pearson.

Key: Fine Motor Manual Coordination Total Motor Composite Body Coordination Strength and Agility

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

Progress Monitoring FormsBeery VMI

Name:

School Year:

Therapist:




Other:




Comments:



Percentile Scores on the Beery-Buktenica Developmental Test of Visual Motor IntegrationKeith E. Beery, PhD, Norman A. Buktenica, and Natasha A. Beery

Beery-Buktenica Developmental Test of Visual Motor Integration Minneapolis, MN NCS

. (2010).

The Pearson.

Pe

rce

nti

le S

co

re

Dates of Assessment

10

20

30

40

50

60

70

80

90

100

KEY: Beery VMI Motor Coordination Visual Perception


Name:

School Year:

Therapist:



Fine motor activities:

Other:




Comments:


Motor skill practice:

Dates of Assessment

skill

References:

N. Pollock, J. Lockhart, B. Blowes, K. Semple, M. Webster, L. Farhat, J. Jacobson, J. Bradley & S. Brunetti. The McMaster Handwriting Assessment Protocol – 2nd edition. School of Rehabilitation Science. McMaster University. 2009.

Pratt, P, Allen, A. (1989) Occupational Therapy for Children. St Louise, MO. CV Mosby Company.

Your Therapy Source Inc (2006) Modifications and Interventions for School - Reporting Forms. Schaghticoke, NY Your Therapy Source Inc.

Your Therapy Source Inc.

www.YourTherapySource.com

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Progress Monitoring Forms - Fine Motor · 2021. 3. 28. · Progress Monitoring Forms Purpose: The...

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