GallopNYC Rider Evaluation
Rider: __________________________________
Eval Date:_______________________________
Time of Eval (circle): Fall ‘12, Fall/Winter ‘12,
Reporter: _______________________________
Winter/Spring ‘13, Summer ‘13
Instructor: _______________________________
Note Special Concerns Here – for example specific behaviors we wish to discourage, fears, etc :
Choose 1 - 3 GOALS and complete level assessment for Each Goal Chosen.
Record behaviors seen at the time of the eval over the course of the lesson.
Balance, Coordination and Muscle Tone
Goal
Level at Time
of Evaluation
1
1
Unable to
remain
balanced for 5
minutes or does
not regain
balance when
off
2
Remains
balanced for 5
minutes at
most,
sometimes
regains balance
when off
3
Remains
balanced for 15
minutes;
sometimes
regains balance
when off
4
Balances for
half of lesson;
Regains
balance when
off
5
Balances for
most of lesson,
regains balance
when off
1
Needs two
handed
physical
assistance for
all tasks
2
Needs two
handed
physical for
some but not all
tasks
3
Needs one
hand physical
assistance or
support for all
tasks
4
Needs one
hand physical
assistance or
support for
some but not all
tasks
5
Handles tasks
without hands
on assistance
1
“Floppy” cannot hold up
self or head
2
Can maintain
upright posture
(unaided) for 5
minutes
3
Can maintain
upright posture
for 10 minutes
4
Can maintain
upright posture
as needed but
slumps when
not requested
to sit up
5
Can maintain
upright posture
for duration of
lesson, minor
slumping only
Improve Balance
2
Improve Coordination
3
Improve Loose Muscle
Tone
GallopNYC Rider Evaluation
1
Can only sit
horse for 5 - 10
minutes
2
Rider can only
sit horse for
more than 10
mins but not
full lesson
3
Rider can sit
horse for most
of lesson but
must be repositioned
every 5 – 8
minutes
4
Rider can sit
horse for full
lesson but must
be re-positioned
once or twice
5
Rider can sit on
horse for full
lesson without
need to reposition
5
Ambulation
1
Needs constant
physical or
human aide to
walk (walker,
aide holding
arm)
2
Needs regular
but not constant
assistance –
cane, or
personal aide
offering help as
needed
3
Walks unaided
but limps, is not
balanced or is
uncoordinated
4
Walks
smoothly ,
balanced and/or
coordinated
5
Walks
athletically, runs
6
1
Needs three or
more verbal or
physical
prompts 75% or
more of time
2
Needs one to
two verbal
prompts or one
physical prompt
75% or more of
time
3
Does not need
physical prompt
but needs
verbal
prompt(s) for
each task 75%
or more of time
4
Needs verbal
prompts for half
of tasks (or
fewer than half)
5
Only needs
verbal prompts
once or twice
per lesson
4
Improve Stiff or tight
muscle tone
Improve Motor Planning
GallopNYC Rider Evaluation
Reduce Negative Behaviors
Goals
Level at Time
of Evaluation
7
1
2
3
4
5
Reduce Anxiety or fear
Shows
sustained fear
or anxiety cries or refuses
to approach
horse
Needs coaxing
to approach
horse or
participate in
lesson
Calm 80% of
time but
becomes
anxious under
novel situations
(new people,
tasks, changes
in routine)
Relaxed 90% of
time - goes with
flow even in
new lesson
situations
Seeks or
embraces
challenges does not show
anxiety
inappropriately
8
1
2
3
4
5
Reduce self-stimulatory
or perseverative
behavior (“stimming”)
Stimming to
point of
interfering with
lesson
Stimming 50%
or more of time
in lesson
without any
apparent
stimulus
Stimming less
than 50% of
time of lesson
and/or only
when
stimulated
Stimming 25%
of lesson or
less
Stimming less
than 10% of
lesson or calms
quickly once
riding
9
1
2
3
4
5
Reduce
Angry/Aggressive/
Disruptive/ Destructive
Behavior (“acts out”)
Angry, repeated
acts of
aggression to
self or others
that interfere
with lesson
Three to five
episodes of
acting out in a
lesson
Acts out at least
once or twice in
a lesson
Generally calm
but will act out
when frustrated
may not act out
in every lesson
Does not act
out in lessons
GallopNYC Rider Evaluation
Self Confidence
Goals
Level at Time
of Evaluation
10
1
2
3
4
5
Reduce apathy
Apathetic,
exhibits flat
affect and/or
boredom or
disinterest.
May show
fleeting interest
in some aspect
of lesson (e.g.,
asks a question
about lesson,
horse, etc.)
Engaged in
lesson about
half the time –
asks questions,
aware of activity
Engaged
throughout
lesson – aware
of sequence of
activities
Demonstrates
anticipation of
activity to come;
offers input and
suggestions
11
Encourage rider to try
new task or riding skill- such as new horse, trot,
leading
1
Strongly resists
new
experiences or
situations
2
Reluctant to try
new
experiences
3
Will try
something new
but needs
verbal coaxing
4
Readily accepts
new
experiences
12
Provide Enjoyment
(laugh and smile)
1
Exhibits flat
affect and/or
boredom or
disinterest.
2
Will show
contentment low level smile
a few times
each lesson
3
Shows overall
contentment signs of positive
affect such as
low level smiles
for half of
lesson
4
Exhibits smiles,
positive tone of
voice and some
enthusiasm for
the activities of
the lesson
about 75% of
lesson time.
13
Develop Sense of
Achievement
1
Does not
respond when
praised - does
not recognize
accomplishments
2
Will show pride
response (i.e.,
smile, chest
raised) if
praised about
half the time
3
Shows pride
response (i.e.,
smile, chest
raised) when
praised 80% of
the time
4
Recognizes
own efforts (“I
can’t believe I
did it!”) without
prompting
14
Encourage
Perseverance
1
Gives up at first
attempt and
refuses to try
again
2
Will try again
after
considerable
coaxing
3
Will try again
with some
prompting
4
Tries multiple
times without
prompting
5
Requests/seeks
out new
experiences
5
Displays overt
and enthusiastic
expressions of
enjoyment of
the activities for
virtually all of
lesson
5
Looks for
opportunities to
demo
accomplishments - shows
off skills
5
Will not give up
or reluctantly
gives up
GallopNYC Rider Evaluation
Responsibility
Goals
15
Follows instructions
Level at Time
of Evaluation
1
Does not
comply with
requests 80% of
the time
2
Complies only
after more than
three verbal
requests
3
Complies after
moderate verbal
coaxing (1 -3
requests)
4
Complies with
one or two step
instructions w/o
coaxing or
reminders
16
Takes Initiative
1
Consistently
passive - relies
totally on
instructor
2
Needs direction
from instructor
only when
“stuck”
3
Anticipates next
activities or
request direction
when needed
4
Gives input into
lesson activities
5
Takes charge of
lesson (sets
goals - directs
course of
lesson)
17
Helps Others—other
riders, instructor or
volunteers
1
Does not
respond to
request for help
2
Responds to
request for help
about half the
time
3
Will help if
prompted by
instructor or
volunteer
4
Offers help if
needed w/o
prompting
5
Looks
for/requests
opportunities to
help
18
Goal-Directedness
1
Does not exhibit
interest in or
seem to
understand
goals of lesson
2
Understands
goals of lessons
but makes
minimal effort to
achieve them
3
Accepts goals
and makes
repeated efforts
to achieved
them
4
Helps set goals
for lesson
and/or session
and recognizes
when they are
attained
5
Self establishes
progressively
harder goals
and
acknowledges
effort and
success in
meeting them
5
Follows three or
more step
routines w/o
coaxing or
reminders
GallopNYC Rider Evaluation
Social Interaction
Goals
19
Develop approp. level
of Social Interaction
Level at time of
Eval
1
Ignores others
2
Interacts with
others only
when and to
extent prompted
by Instructor
3
Interacts with
others without
prompts but
only to complete
tasks
4
Shows interest
and/or pleasure
in interacting
with others smiles, talks
appropriately,
makes requests
5
Highly sociable,
makes bids for
play and/or
conversation
20
1
2
3
4
5
Encourage effort to
Communicate
Does not exhibit
any intent to
communicate
Will
communicate
when asked, for
ex may respond
to a question,
50% of time
Will initiate
communication
to satisfy need
or desire at
least once per
lesson
Will initiate
communication
for social
interaction,
comment on
other people or
things at least
once per lesson
Will initiate
communication
and expect or
insist on
response
21
1
2
3
4
5
Build Spirit of Cooperation
Avoids
others/uncooper
ative in groups
Is cooperative in
groups when
prompted
Will participate
in group
activities w/o
prompting
Enjoys/Requests Games
or group
activities
Positively
contributes to
group activities
22
Develop Empathy –
concern for horse,
affection (hug, etc),
awareness of horse or
instructors’ needs
1
None oblivious/lacks
awareness of
horse and
instructor
2
Responds to
horse or
instructor when
prompted - w/o
seeming to
convey feeling
3
Shows affection
for horse or
awareness of
others’ (horse or
instructor’s)
perspectives or
feelings at least
once during
lesson
4
Shows affection
for horse or
awareness or
consideration
for horse or
others 1 -3
times during
lesson
5
Shows insight
into
horses’/others’
behaviors,
attitudes etc.
during lesson at
least once
GallopNYC Rider Evaluation
Attention and Focus
Goals
Level at Time of
Evaluation
23
1
2
3
4
5
Level of Attn’n /Focus
Is not focused, even
on simple tasks, may
distract others,
throughout lesson
May focus on simple
tasks, but can be
easily distracted
throughout lesson
Focuses mainly when
motivated
by/interested in
activity, focus for less
than 10 minutes of
lesson
Sustains focus and
attention for 10 or
more minutes
Can s
focus
lesson
Communication
Goals
Level at Time
of Evaluation
24
1
2
Level of
Verbal
Ability
Non-Verbal
Intentional
Vocalizing or
indicating w/o
words
3
Uses one word
Phrases if
prompted
4
5
Uses one word
unprompted or two three word phrases
prompted
Uses three or
more words
unprompted