PHYSICAL THERAPY EVALUATION
Child’s Name: Lucas Scott
Date of Birth: 9/6/20
Date of Evaluation: 12/16/20
Chronological age: 3 months, 10 days
Adjusted age: 1 month, 28 days
Examiner: Ashley Blockburger, PT, DPT
Evaluation time: 60 minutes
Therapy Dx: Gross motor delay (R62.50)
Recommended Minutes Per Week:
REASON FOR REFERRAL:
Lucas Scott was referred for a complete physical therapy evaluation to determine his need for direct
physical therapy services to address concerns of inability to turn his head, low muscle tone, and gross
motor delay. The results of this evaluation will aid in determining eligibility of enrollment in direct physical
therapy services and in program planning. A complete evaluation was obtained through standardized
testing, clinical observation, and parent/caregiver questionnaire.
BACKGROUND/ MEDICAL HISTORY INFORMATION:
Gender: Male
Length of Pregnancy: 34 weeks
Birth Weight: 5 pounds, 12 ounces
Medical Diagnosis: Acid reflux
Current Medications: Famotidine
Pertinent Medical History: Lucas was born at 34 weeks via induced labor, weighing 5 pounds and 12
ounces. His mother had a history of a previous miscarriage. During the pregnancy, his mother experienced
excessive vomiting and stated her body kept trying to go into preterm labor with her water rupturing at 34
weeks. She was placed on bed red and labor was induced to prevent infection. Lucas had jaundice after
birth. No gross motor milestones have been reported at this time. He has difficulty with choking/gagging
and excessive spit-up and vomiting during feeding activities. His mother reported he has difficulty breast
feeding and bottle feeding. His mother noted he does not have a preferred type of play at this point. He
enjoys his puppy lovie security blanket.
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Parent Concerns: low muscle tone, inability to turn head
CLINICAL/BEHAVIORAL OBSERVATIONS:
Lucas Scott was seen at Little Bitty City Enrichment Center in Hot Springs, AR on December 16th, 2020 for
a complete physical therapy evaluation.
The following test results are considered to be an accurate representation of Keegan’s current gross motor
abilities.
Gait


Keegan ambulates independently community distances over level surfaces with a wide base of
support and non-reciprocal arm swing.
He has difficulty navigating uneven or unlevel surfaces and demonstrates poor safety awareness
and loss of balance when navigating these surfaces.
Range of Motion
 Keegan demonstrated full passive range of motion in his trunk and extremities.
Muscle Tone/Strength/Posture
 Keegan demonstrated decreased tone in his trunk and extremities observed through handling of
the observer.
 Keegan demonstrated increased muscle stiffness and tightness throughout examination process
with all passive movements.
 In standing, Keegan displayed slight pronation of both feet, but longitudinal arch was present when
he pushed up onto his toes.
Range of Motion
 DH demonstrated full passive range of motion in her trunk and extremities.
Muscle Tone/Strength/Posture
 DH demonstrated decreased tone in her trunk, as evidenced by exaggerated lumbar lordosis.
 She was noted to have winging of scapula on both left and right side, indicating decreased
shoulder strength.
 Good strength was noted in her ability to maintain sitting balance, standing balance, and balance in
tall-kneel position.
 Noted slight increased tone in L bicep and L quadriceps with PROM.
 In standing, DH displayed slight pronation of both feet, but longitudinal arch was present when she
pushed up onto her toes.
PRIMITIVE REFLEXES:
Primitive reflexes are autonomic, brain stem controlled movements that emerge and should integrate within
the first year of life. Primitive reflexes are the foundational base of development with all other aspects of
development depending on their timely and appropriate integration. Their function is to aide an infant with
beginning to move in the gravity filled world outside the womb, develop hand and eye coordination, hand
use, vision, speech, and strength and motor control in the neck, trunk, shoulders, arms, hands, legs and
feet. As children develop and gain volitional (purposeful, chosen) movement, the primitive reflexes become
integrated and are overridden by conscious thought of movement. Generally, when these reflexes do not
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integrate, it can affect fluidity of movement (smoothness of movement), strength, and flexibility. Reflexes
that remain active diminish strength in the core, neck, arms/hands, legs/feet and can cause gross and fine
motor delays. There are several functional deficits associated with the primitive reflexes assessed on this
evaluation date. You can read below regarding the functional deficit observed and its relation to the severity
of the primitive reflex assessed:
Spinal Galant Reflex (SG): Children with a retained SG reflex often present in the following ways:
 Restless and hyperactive-tight clothing, belts, or just leaning against the back of a chair can
trigger the reflex and cause the child to fidget
 Clumsy and uncoordinated
 Impulsive
 Decreased attention and concentration
 Prefer loose clothing and around the waist
 Fixated lumbar spine into posterior pelvic tilt
 If SG is active on only one side, it can cause scoliosis of the spine
 In severe cases, it can cause uncontrolled urination.
Jonah displayed a severe Spinal Galant reflex with lateral flexion of the trunk to the right and left
when the therapist stroked along the spine on the right and left sides.
Tonic Labyrinthine Reflex (TLR): Children with a retained TLR reflex often present in the
following ways:
 Difficulty holding head up—may lean forward or to the side
 Weak neck muscles
 Fear of heights
 Hunched posture—rounded shoulders, posterior pelvic tilt
 Over flexible joints
 Difficulty coordination eye movements—cross eyed
 Poor balance and coordination
 Sequencing and spatial challenges
 Problems judging speed, depth, and distance
 Motion sickness
 Challenges with kicking balls—due to looking down
 Difficulty throwing balls due to head movement
 Difficulty with attention
**Difficulty to test.
Symmetrical Tonic Neck Reflex (STNR): Children with a retained STNR reflex often present in
the following ways:
 Poor posture—trouble keeping back straight
 Slumping when sitting
 Supports head with hands while doing tabletop work
 Child did not crawl or only scooted on bottom
 Difficulty sitting in Indian style
 Sits with legs in “w” position
 Vision difficulties with accommodation—adjusting eyes to and from long and short distance (for
example from their paper to the blackboard and back)
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






Posterior pelvic tilt
Poor arm strength and endurance
Difficulty doing a somersault
Poor coordination between the upper and lower body
Difficulty sitting still/poor attention
Problems reading and spelling
Difficulty crossing midline of body
Based on observation, difficult to get an accurate reading due to poor positioning during testing—
due to poor trunk strength. Jonah demonstrated frequent “w” sitting throughout observation which
is a symptom of the STNR reflex.
Asymmetrical Tonic Neck Reflex (ATNR) Children with a retained ATNR reflex often present in
the following ways:
 Difficulty crossing midline
 Difficulty coordinating limbs to ride a bicycle
 Poor spatial judgement
 Poor hand coordination; dropping things frequently
 Gripping writing utensils tightly and pressing down hard when writing
 Difficulty distinguishing between left and right and supine and prone
 Binocular vision difficulties: strabismus, phorias.
Jonah demonstrated a moderate to severe ATNR reflex with bilateral collapsing of elbows when
therapist turned head left and right while in quadruped.
Fear Paralysis Reflex (FP) Children with a retained FP reflex often present in the following ways:
 Fear of the dark
 Anxious
 Oversensitive to sounds, light, touch
 Easily disturbed
 Tense muscles in legs and back, walks on toes
 Poor endurance/stamina
 Problems asserting oneself/passive
 Fits of emotions due to fear or feeling scared
 Prefers to be/play alone
Jonah displayed a severe Fear Paralysis reflex response during evaluation. He displayed anxious
behaviors such as crying and clinging onto therapist throughout assessment and was easily upset
by transitions. He displayed frequent episodes of emotion and crying during evaluation.
Moro Reflex Children with a retained Moro reflex often present in the following ways:
 Anxious
 Oversensitive to sounds, light, touch
 Motion sickness
 Poor concentration
 Problems asserting oneself/becomes angry or aggressive easily
 Poor endurance/stamina
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

Fits of emotion due to anger or frustration
Impulsive
Jonah did not respond to loud noise during observation. He didn’t maintain proper test position for
accurate testing.
Rooting Reflex: Children with a retained Rooting reflex often present in the following ways:
 Sensitivity to textures
 Difficulty swallowing and chewing food
 Thumb sucking
 Speech and articulation problems
 Dribbling
 Drooling
 Thumb sucking
 Dexterity problems when talking
Jonah demonstrated a severe rooting reflex throughout evaluation process that interfered with several
activities. Jonah was noted to bring all toys and objects to his mouth during evaluation.
Protective and Righting Reactions: Children who have not developed appropriate protective and
righting reactions may be unable to:
 Maintain their head in midline when sitting upright or when shifted off balance
 Demonstrate appropriate postural control
 Maintain balance when their center of gravity is shift off balance
 Break a fall by using upper extremities to support oneself
 Demonstrate age appropriate gross motor tasks
Jonah demonstrated decreased protective reactions when tilted forward in a horizontal position; he
presented extended arms and hands with elbows bent but he was unable to bear weight through upper
extremities. He was able to break a fall when shifted off balance sideways by extending and supporting
himself with an open palm on the right and the left. He was unable to break a fall by extending arms
and supporting himself with his palms when shifted off balance forward, collapsing forward. He
demonstrated no righting reaction when pulled backward and was unable to extend arms and head
forward to recover balance, falling backward. He was unable to utilize his upper extremities to break a
fall when pushed backward in sitting.
TESTS ADMINISTERED:
Standardized Assessment
Alberta Infant Motor Scale:
The Alberta Infant Motor Scale (AIMS) is a criterion based assessment that evaluates the motor
development of babies from birth to eighteen months of age. It breaks down the components of infant
movements up to independent walking is achieved. Skills are evaluated on a pass/fail basis. A percentile of
less than 25 is considered to be significantly delayed.
Subscale
Subscale
Score
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Prone
Supine
Sit
Stand
Total
Score
4
4
0
0
8
Percentile: 5
Z-Score: -1.64
Peabody Developmental Motor Scales, Second Edition:
The PDMS-2 is a standardized test designed to assess motor skills in children from birth through 72
months of age. It is composed of six subtests that measure interrelated motor abilities needed to perform
gross motor and fine motor tasks. The gross motor scales include the following subtests: reflexes,
stationary, locomotion, and object manipulation. DH’s scores are as follows:
PDMS-2: Gross Motor Scale
Raw
Age
Standard
Percentile
Z-score
Score
Equivalent
Score
Reflexes
n/a
n/a
n/a
n/a
n/a
Stationary
39
21 months
5
5
-1.67
Locomotion
123
30 months
5
5
-1.67
Object
18
23 months
5
5
-1.67
Manipulation
*Note: A z-score represents how well a child is functioning above or below the mean, with a normal score range of –1.0 - +1.0.
Standard scores are based on a distribution with a mean of 10 and standard deviation of 3.
PDMS-2: Summary
Overall Scores
Sum of Standard Scores
Gross Motor Quotient
Percentile Rank
z-score
Percent Delay
Average Age Equivalent
Gross Motor
15
68
1
-2.14
***
24 months
*Note: A quotient is a standard score with a mean of 100 and standard deviation of 15; therefore a normal quotient score ranges
between 85-115; a quotient score reflecting 1.5 standard deviations below the mean equals 77 or less. A percentile ranking
indicates the percentage of all children this age that would be expected to score lower than this child does.
According to the PDMS-2, DH is functioning below normal in her age group in stationary, locomotor and
object manipulation skills, and her overall gross motor quotient score fell below the normal range, indicating
a significant delay in her gross motor skill development.
The Pediatric Evaluation of Disability Inventory (PEDI):
The PEDI is a standardized test that assesses key functional capabilities and performances in children
ages 6 months to 7.5 years. The PEDI can also be used for older children whose abilities fall below that of
a 7 year old without disability. Raw scores are converted to standard scores and a standard deviation can
be determined. A need is defined as a score that is -1.5 standard deviations or greater from the mean.
Only the Mobility domain was administered during this evaluation.
DH’s scores are as follows:
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Mobility
Domain
Raw Score
Normative
Standard
Score
Standard
Error
Scaled Score
Z-Score
43
23.9
2.7
57.4
-2.61
*Note: A z-score represents how well a child is functioning above or below the mean, with a normal score range of –
1.0 - +1.0. Standard scores are based on a distribution with a mean of 50 and standard deviation of 10.
Mullen Scales of Early Learning:
The Mullen Scales of Early Learning provides a comprehensive assessment of language, motor and
perceptual abilities for children of all ability levels, age birth to 5 years 8 months. It provides normative
scores to provide the examiner with objective means of identifying the child’s significant strengths and
weaknesses for learning to enable the examiner to interpret how the child processes information.
Gross Motor
Raw
Score
25
TScore
20
Percentile
Rank
1
Age
Equivalency
22 Months
Standard
Deviation
-3.0
%
Delay
56 %
*Note: A lower Raw Score indicates a higher level of gross motor dysfunction. The Percent Delay is the based on the average
Gross Motor Age Efficiency and the child’s current age.
According to the Mullen Scales of Early Learning, Enzo is functioning below normal in his age group in
gross motor skills and his raw score fell below the normal range, indicating a profound delay in his gross
motor skill development.
Test of Gross Motor Development 2 (TGMD-2)
The Test of Gross Motor Development 2 (TGMD-2) is a standardized test of gross motor function for
children ages 3-11 years, 9 months, which measures performance in locomotion (i.e. running, galloping,
skipping, hopping, leaping, etc.) and in object control (i.e. catching, throwing and kicking). Each skill tested
has certain criteria, which must be observed as the child performs the skill. In addition to providing
standardized scores, this test also breaks down skills into parts and allows the tester to identify particular
weaknesses in movement components within a skill. Each gross motor skill includes several performance
criteria. The child receives a score of 1 if the component is performed correctly and a zero if the component
is not performed correctly. After completing this procedure for two trials, the examiner totals the scores the
two trials to obtain a raw skill score for each item. The raw skill scores are added up toa raw subtest score.
The subtest score is then converted to a standard score and a gross motor quotient. A standard score of
less than seven is indicative of a gross motor delay. A gross motor quotient of less than 89 is also indicative
of gross motor delay. Percentiles can also be obtained for each subtest.
Hudson’s scores are as follows:
Raw Score
Locomotor
13
Object
17
Control
Sum of Standard Scores: 2
Gross Motor Quotient: 46
Overall percentile:<1
Standard Deviation:
Standard
Score
1
1
Percentile
Rank
<1
<1
Age
Equivalency
<3 years
<3 years
Percent Delay
67%
67%
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*Note: A quotient is a standard score with a mean of 100 and standard deviation of 15; therefore, a normal quotient score
ranges between 85-115. A quotient score reflecting 1.5 standard deviations below the mean equals 85 or less. A percentile
ranking indicated the percentage of all children this age that would be expected to score lower than this child does.
Hudson’s gross motor quotient score of 46 indicates that he is performing below the normal range for his
age with a standard deviation of -4.9, which indicate his gross motor skills are below what is expected for
his age.
BOT-2 Bruininks-Oseretsky Test of Motor Proficiency:
The BOT-2 is a standardized test designed to assess motor proficiency in children from 4-21 years of age.
It is composed of eight subtests including fine motor precision, fine motor integration, manual dexterity,
upper-limb coordination, bilateral coordination, balance, running speed and agility, and strength. The BOT2 covers a broad array of fine and gross motor skills providing scores in four motor areas and one
comprehensive measure of overall motor proficiency. These composites are fine manual control, manual
coordination, body coordination, strength and agility, and total motor composite. Evon’s scores are as
follows:
BOT-2: Gross Motor Proficiency
Z-score
Severity
Total
Scale
Standard Percentile
Age
Level
Subtest
Points
Score
Score
Rank
Equivalent
Bilateral
4 years,
-1.4
Below
9
8
Coordination
8months
average
5 years, 6
-1.0
Below
Balance
27
10
months
average
Body
-1.4
Below
18
38
12
Coordination
average
Running Speed
4 years, 10
-1.4
Below
17
8
and Agility
months
average
4 years, 4
-1.8
Below
Strength
9
6
months
average
Strength and
-1.6
Below
14
34
6
Agility
average
*Note: A z-score represents how well a child is functioning above or below the mean, with a normal score range of –1.0 - +1.0.
Standard scores are based on a distribution with a mean of 10 and standard deviation of 3. A z-score of -1.5 (moderate) or more
severe warrants skilled physical therapy services.
According to the BOT-2, Evon is functioning below average in his age group in bilateral coordination,
balance, running speed and agility, and strength. His body coordination and strength and agility scores fell
below the normal range, indicating a mild-moderate delay in his gross motor skill development.
Sensory Processing Measure (SPM):
The Sensory Processing Measure is an integrated system of rating scales that enables assessment of
sensory processing issues, praxis, and social participation in elementary school-aged children
(kindergarten to sixth grade). The SPM consists of three forms: Home, Main Classroom, and School
Environment that can be used to measure problems in social participation, planning and ideas (praxis), and
five sensory systems: visual, auditory, tactile, body awareness (proprioception), and balance and motion
(vestibular). It is intended to support the identification and treatment of children with sensory processing
difficulties. A higher raw score indicates a higher level of dysfunction and the percentile score represents
the percentage of children in the normative sample who scored lower than the child who is being evaluated.
The T-score has a mean of 50 and a standard deviation of 10: thus, T-score from 40-59 are within normal
function, 60-69 represents moderate dysfunction, and 70+ represents severe dysfunction.
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SPM Main Classroom Form
Scales
Raw Score
T-Score
Percentile
Interpretive Range
Standard
Deviation
-1.0
Social Participation
(SOC)
Vision (VIS)
23
60
84
Some Problems
27
80
>99
-3.0
Hearing (HEA)
21
77
>99
Touch (TOU)
Taste and Smell
Body Awareness
(BOD)
Balance and Motion
(BAL)
Planning and Ideas
(PLA)
Total Systems
Systems (TOT)
10
4
15
58
n/a
66
79
n/a
>99
Definite
Dysfunction
Definite
Dysfunction
Typical
n/a
Some Problems
29
75
>99
-2.5
36
75
>99
106
74
>99
Definite
Dysfunction
Definite
Dysfunction
Definite
Dysfunction
-2.7
-0.8
n/a
-1.6
-2.5
-2.4
According to the SPM, Evon demonstrated an overall definite dysfunction in his sensory processing abilities,
praxis, and social participation.
FUNCTIONAL STRENGTHS AND LIMITATIONS:
Strengths: DH is able to perform the following skills:
Static and Dynamic Balance skills:
 Maintain balance in kneeling positon while rotating head to track a toy
 Stand on one foot for up to 3 seconds, has trouble maintaining hands on hips
 Standing on tiptoes with arms overhead for 1-2 seconds
 Take up to 3 steps on balance beam without LOB
Locomotor skills:
 Walk up four steps with no support from wall or hand rail placing both feet on each step
 Walk backward 10 feet without heels touching toes
 Jump down from an 18” step without assistance
 Run 45 feet in 6 seconds with arms held out to side
 Jump forward 12” using 2-footed takeoff and landing
 Jump over 2” hurdle without tripping, using 2-footed takeoff and landing
Object manipulation skills with the ability to:
 Kick a stationary ball 3” without it deviating more than 20 degrees to either side
 Present extended arms directly in front, palms upward in preparation to catch ball
 Throw a tennis ball by moving upward and back with the ball traveling up to 4’ in the air
Functional mobility skills with ability to:
 Pedal a tricycle on indoor surfaces independently
 Transition from sit to stand through half kneel
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
Walk/run on level and unlevel surfaces with good balance
Limitations: DH is not yet able to perform the following age appropriate skills:
Static and Dynamic Balance:
 Standing on one foot for 5 seconds with hands on hips
 Standing on tip toes with arms held overhead without moving feet for 3 seconds
 Standing on one foot for 5 seconds with hands on hips without swaying more than 20 degrees
Locomotor skills:
 Jump up and touch above standing reach
 Walk forward on a line with hands on hips
 Walk up stairs placing one foot on each step with/without support from wall or rail
 Walk on tiptoes with hands on hips
 Jump forward >12” using 2-footed takeoff
 Run with arms moving back and forth across body, balls of feet used to push forward, toes pointed
forward, a high knee and heel lift, trunk leaning forward
 Walk down steps placing 1 foot on each step without support
 Jump forward on 1 foot
 Running and stopping
Object manipulation skills:
 Throw a tennis ball forward underhand
 Catch a ball by attempting to bend arms toward chest to secure ball
 Move arm upward and back to throw a ball overhand 7’
 Kick a ball forward using opposing arm and leg movements
 Throw a tennis ball forward arms and legs moving in opposition
 Throw a tennis ball overhand and hit a target
Functional mobility skills:
 Maintaining balance with walking over obstacles (stepping stones, obstacle course, etc.)
 Demonstrate appropriate coordination and motor planning with various peer play activities
 Participate in tasks that require attention to follow several step commands
 Mirror play activities demonstrated by therapist/peers
INTERPRETATION OF RESULTS:
Informed Clinical Opinion/Impressions
DH is an active, playful little girl who continues to demonstrate a significant delay in the development of her
gross motor skills according to the PDMS-2. ***She has made good progress over the past year, meeting 7
short term objectives and improving her skill level by 5 months. ***However, she continues to display
delayed functional mobility skills, decreased static and dynamic balance skills, poor jumping and lower
extremity motor coordination skills and trunk/extremity muscle weakness. According to the standardized
test results referenced above, DH qualifies for and will benefit from continued physical therapy services.
It is the informed clinical opinion of the examiner that DH’s functional gross motor deficits pose a risk to her
ability to safely participate in age appropriate activities with her peers. In the absence of skilled physical
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therapy intervention addressing the deficits indicated in this report, DH’s deficits in functional mobility,
muscle strength, locomotor skills, static/dynamic balance, and ball skills would increase and further inhibit
her ability to function at an age appropriate gross motor level.
It is this therapist's clinical opinion that these services are medically necessary and cannot be effectively or
appropriately administered by a caregiver. It is also this therapist's clinical opinion that provision of these
skilled services will result in meaningful and functional improvement of the deficits stated above and will
prevent worsening of the deficits and or ultimately decreased independence. Progress towards the
achievement of the individualized goals and objectives is expected within one year.
Recommendations
1) Based on the results of this evaluation, it is recommended that DH continue to receive physical
therapy services for 90 minutes of individual therapy per week as tolerated by the patient and
warranted by progress. Therapy should address strength, balance, locomotion and object
manipulation deficits outlined above. Therapy sessions should also include frequent sensory
breaks including vestibular and proprioceptive input activities, to allow for improved attention to
tasks, focus and motor planning.
2) At home, DH should continue to work on tasks that improve motor planning, coordination, balance,
and overall trunk/extremity strengthening. DH would benefit from engaging in activities that require
directing attention to tasks for extended periods of time to improve focus and concentration with
peer play.
3) DH should wear snug fitting, supportive athletic type shoes to provide good foot/ankle support.
GOALS:
1. DH will participate in preparatory activities including sensory integration, therapeutic facilitation,
motor planning/coordination, and positioning with no adverse reactions.
2. DH will demonstrate standing on one foot during activity for 5 seconds with no LOB, to improve
balance and coordination.
3. DH will participate in activity standing on tip toes for 5 seconds with good balance and control, to
improve LE strength and balance.
4. DH will demonstrate ability to take 5 steps on balance beam with good control, to improve trunk
stabilization and balance.
5. DH will walk up one flight of stairs placing 1 foot on each step using the handrail for support with
good control to improve functional mobility and strength.
6. DH will walk up one flight of stairs independently with no LOB and good control to improve
functional mobility and strength.
7. DH will jump 24” from one floor marker to another with 2-footed takeoff and landing to improve
motor planning and coordination.
8. DH will participate in a game of chase, demonstrating proper running form with arms moving back
and forth across body to improve coordination and functional mobility.
9. DH will demonstrate ability to throw ball underhand 5’ with no cues for direction to improve UE
coordination and motor planning.
10. DH will kick a stationary ball 6’ with opposing arm and leg movements and good control to improve
LE strength and coordination.
11. DH will participate in a multi-step obstacle course with challenged balance and challenged gait
activities with demo only to promote engagement and attention to activities.
12. DH will perform yoga positions of “dog” “tree” “flying bird” with 5 second hold in each position to
improve coordination, motor planning, trunk stability and orientation to tasks.
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13. DH will choose two activities from activity cards and maintain attention for 5 minutes with therapist
at play to promote engagement for gross motor play with peers.
If there are any questions regarding this evaluation report, recommendations or plan of care, please feel
free to contact Little Bitty City Enrichment Center at (501) 525-4855.
__________________________________
Ashley Blockburger, PT, DPT
__________________________
Date
cc: PCP; Parent
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