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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.
Terms of Use: The electronic books from Your Therapy Source Inc can only be purchased from this site. They are copyrighted by Your Therapy Source Inc. This book can only be used by the original purchaser. The files may not be reproduced or transferred to others in print or electronically. All rights reserved.
www.yourtherapysource.com
Progress Monitoring Forms
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:
Dates of Interventions
Postural control activities:
Upper extremity strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Hand strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Upper extremity strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Hand strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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
Type of scissors used:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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
Type of scissors used:
Progress Monitoring FormsGlue Use
Name:
School Year:
Therapist:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
Visual perceptual activities:
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:
Dates of Interventions
Visual perceptual activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
Visual perceptual activities:
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:
Dates of Interventions
Body awareness activities:
Coordination activities:
Other:
Practicing the skill:
Crossing midline activities:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Upper extremity strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Hand strengthening activities:
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:
Dates of Interventions
Other:
Practicing the skill:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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
Coordination activities:
Fine motor skill practice:
Visual perceptual activities:
Progress Monitoring FormsDot to Dot Puzzles
Name:
School Year:
Therapist:
Dates of Interventions
Visual perceptual activities:
Muscle strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Coordination activities:
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:
Dates of Interventions
Visual perceptual activities:
Upper extremity strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
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:
Dates of Interventions
Visual perceptual activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Coordination activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Muscle strengthening activities:
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:
Dates of Interventions
Coordination activities:
Upper extremity strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Hand strengthening activities:
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:
Dates of Interventions
Visual perceptual activities:
Muscle strengthening activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
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:
Dates of Interventions
Visual perceptual activities:
Muscle strengthening activties:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Multisensory activities:
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:
Dates of Interventions
Visual perceptual activities:
Muscle strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Multisensory activities:
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:
Dates of Interventions
Visual perceptual activities:
Muscle strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Multisensory activities:
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:
Dates of Interventions
Coordination activities:
Muscle strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Visual perceptual activities:
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:
Dates of Interventions
Coordination activities:
Muscle strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Visual perceptual activities:
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:
Dates of Interventions
Visual perceptual activities:
Muscle strengthening:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Multisensory activities:
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:
Dates of Interventions
Muscle strengthening activities:
Fine motor skill activities:
Other:
Visual perceptual activities:
Coordination activities:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
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:
Dates of Interventions
Muscle strengthening activities:
Fine motor activities:
Other:
Visual perceptual activities:
Coordination activities:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
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:
Dates of Interventions
Visual perceptual activities:
Muscle strengthening activities:
Other:
Practicing the skill:
Fine motor skill practice:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
Multisensory activities:
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
Progress Monitoring Forms
Name:
School Year:
Therapist:
Dates of Interventions
Muscle strengthening activities:
Fine motor activities:
Other:
Visual perceptual activities:
Coordination activities:
© Your Therapy Source Inc www.YourTherapySource.com
Comments:
Consultation with staff or parents:
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.
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