In every section, mark the 1 response that most closely describes the child's best performance in 3 attempts:
1. Sitting to standing-
"Hold arms up & stand up"
- Able to stand without using hands & stabilize independently
- Able to stand independently using hands
- Able to stand using hands after several tries
- Needs minimal assist to stand or stabilize
- Needs moderate or maximal assist to stand
2. Standing to sitting-
"Sit down slowly without using your hands"
- Sits safely with minimal use of hands
- Controls descent by using hands
- Uses back of legs against chair uncontrol descent
- Sits independently, but has uncontrolled descent
- Needs assistance to sit
3. Transfers-
"Child transfers 1-way to a seat with armrest & 1-way to a seat without armrests"
- Able to transfer safely with minor use of hands
- Able to transfer safely; definite need of hands
- Able to transfer with verbal cueing &/or supervision
- Needs 1 person to assist
- Needs 2 people to assist or supervise (close guard) to be safe
4. Standing unsupported-
"Stand 30 seconds without holding on or moving his/her feet"
- Able to stand safely 30 seconds
- Able to stand 30 seconds w/supervision
- Able to stand 15 seconds unsupported
- Needs several tries to stand 10 seconds unsupported
- Unable to stand 10 seconds unassisted
5. Sitting with back unsupported & feet on floor-
"Sit with arms folded on chest for 30 seconds"
- Able to sit safely & securely 30 seconds
- Able to sit 30 seconds under supervision or may require use of arms to maintain sitting position
- Able to sit 15 seconds
- Able to sit 10 seconds
- Unable to sit 10 seconds without support
6. Standing unsupported with eyes closed-
"Stand still, close eyes, & keep them closed"
- Able to stand 10 seconds safely
- Able to stand 10 seconds with supervision
- Able to stand 3 seconds
- Unable to keep eyes closed 3 seconds but stays steady
- Needs help to keep from falling
7. Standing unsupported with feet together-
"Place feet together & stand still without holding on"
- Able to place feet together infependently & stand 30 seconds safely
- Able to place feet together independently & stand for 30 seconds with supervision
- Able to place feet together independently but unable to hold for 30 seconds
- Needs help to attain position but able to stand 30 seconds with feet together
- Needs help to attain position &/or unable to hold for 30 seconds
8. Standing unsupported 1 foot in front-
"Stand with 1 foot in front of the other (heel to toe)"
- Able to place feet tandem independently & hold for 30 seconds
- Able to place foot ahead of other independently & hold 30 seconds
- Able to take small step independently & hold 30 seconds or requires assistance to place foot in front but can stand for 30 seconds
- Needs help to step but can hold 15 seconds
- Loses balance while stepping or standing
9. Standing on 1 leg-
"Stand on 1 leg as long as able without holding on"
- Able to lift leg independently & hold 10 seconds
- Able to lift leg independently & hold 5-9 seconds
- Able to lift leg independently & hold 3-4 seconds
- Tries to lift leg; unable to hold 3 seconds but remains standing
- Unable to try or needs assist to prevent fall
10. Turn 360 degrees-
"Make a full circle, STOP, & make a full circle in the other direction"
- Able to turn 360° safely in
4 seconds each way - Able to turn 360° safely in 4 seconds in 1 direction but other direction requires > 4 seconds
- Able to turn 360° safely but slowly
- Needs close supervision or constant verbal cueing
- Needs assistance while turning
11. Turning to look behind left & right shoulder while standing still-
"Stand with feet still & follow object as it is moved to each side"
- Looks over each shoulder, wt shifts include trunk rotation
- Looks over 1 shoulder w/ trunk rotation, wt shift in opposite direction is to level of shoulder; no trunk rotation
- Turns head to look to level of shoulder; no trunk rotation
- Needs supervision when turning; chin moves greater than ½ distance to shoulder
- Needs assist to keep from losing balance/falling; mov't of chin is less than ½ distance to shoulder
12. Pick up object from floor from a standing position-
"Pick up object placed in front of dominant foot"
- Able to pick up object safely & easily
- Able to pick up object but needs supervision
- Unable to pick up object but reaches 1-2 inches from object & keeps balance independently
- Unable to pick up object; needs supervision while attempting
- Unable to try; needs assistance to keep from losing balance or falling; mov't of chin is less than ½ distance to shoulder
13. Placing alternate foot on step stool standing unsupported-
"Place each foot alternately on the step stool & continue until eachfoot touched the stool 4 times"
- Stands independently & safely & completes 8 steps in 20 seconds
- Able to stand independently & completes 8 steps > 20 seconds
- Able to complete 4 steps w/o assistance but requires close supervision
- Able to complete 2 steps; needs minimal assistance
- Needs assistance to maintain balance or keep from falling
14. Reaching forward with outstretched arm while standing-
"Stretch out your fingers, make a fist & reach forward as far as able w/o moving feet"
- Can reach forward confidently > 10 inches
- Can reach forward > 5 inches, safely
- Can reach forward > 2 inches, safely
- Reaches forward but needs supervision
- Loses balance while trying, requiring external support
Score:
Scoring: The items are scored in descending order with the top statement = 4 & the bottom statement = 0.
Maximum score = 56
Source: Franjoine MR, Gunther JS & Taylor MJ (2003).