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SCHEDA

di osservazione

PSICOMOTRICITA’

Cognome: ___________________________________________________________

Nome: ___________________________________________________________

Indirizzo: ___________________________________________________________

Data di nascita: ___________________________________________________________

Classe: ___________________________________________________________

Familiari: ___________________________________________________________

Diagnosi medica: ___________________________________________________________

Diagnosi psicologica: ___________________________________________________________

Altre notizie: ___________________________________________________________

Motivo della richiesta di

esame e modalità di arrivo ___________________________________________________________

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L’ESAME PSICOMOTORIO

1. ASPETTI GENERALI

Morfologia: ___________________________________________________________

Mimica: ___________________________________________________________

Sguardo: ___________________________________________________________

Emotività: ___________________________________________________________

Reazioni di prestance: ___________________________________________________________

Comportamento: ___________________________________________________________

Vissuto del disturbo: ___________________________________________________________

Elementi particolari: ___________________________________________________________

2. ATTIVITA’ SPONTANEA

Materiale utilizzato: ___________________________________________________________

Aspetti psicomotori: ___________________________________________________________

Immagine mentale: ___________________________________________________________

3. MOTRICITA’

3.1. COORDINAZIONE GENERALE

• Cammino:

_____________________________________________________

_____________________________________________________

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• Corsa

Libera: ___________________________________________________________

Sul posto: ___________________________________________________________

• Salto

o A piedi uniti

Sul posto: ___________________________________________________________

Nello spostamento: ___________________________________________________________

con ostacolo: ___________________________________________________________

o Su un sol piede

Sul posto: ___________________________________________________________

Nello spostamento: ___________________________________________________________

con ostacolo: ___________________________________________________________

• Salti alternati

_____________________________________________________

_____________________________________________________

3.2. IN INIBIZIONE/CONTROLLO DEL MOVIMENTO

Su comando: ___________________________________________________________

con adattamento esterno: ___________________________________________________________

3.3. MOTRICITA’ FACCIALE

_____________________________________________________

_____________________________________________________

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3.4. COORDINAZIONE OCULO-MANUALE

Organizzazione: ___________________________________________________________

armonia: ___________________________________________________________

velocità: ___________________________________________________________

economia: ___________________________________________________________

precisione/adattamento: ___________________________________________________________

3.5. MOTRICITA’ FINE

Tipo di prensione: ___________________________________________________________

Tipo dell’attività: ___________________________________________________________

4. TONO

4.1. Mobilitazione passiva: _____________________________________________________

4.2. Rilassamento spontaneo: _____________________________________________________

4.3. Estensibilità

Braccia: ___________________________________________________________

Gambe: ___________________________________________________________

Testa: ___________________________________________________________

4.4. Oscillazione: ___________________________________________________________

4.5. Paratonia: ___________________________________________________________

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4.6. Rilasciamento volontario

• Spontaneo

Assiale: ___________________________________________________________

Distale: ___________________________________________________________

• Su comando:

Assiale: ___________________________________________________________

Distale: ___________________________________________________________

4.7. Emozionale

Diadococinesie: ___________________________________________________________

4.8. Sincinesie:

Diffusione tecnica: ___________________________________________________________

Diffusione tonico-cinetica: ___________________________________________________________

5. DISSOCIAZIONE

Arti superiori: ___________________________________________________________

Arti superiori/inferiori: ___________________________________________________________

6. POSTURA

Tipologia Occhi aperti Occhi chiusi

Supino: _____________________ ______________________

Prono: _____________________ ______________________

Seduto: _____________________ ______________________

Ginocchio: _____________________ ______________________

Eretta: _____________________ ______________________

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7. EQUILIBRIO

7.1. Statico

Occhi aperti Occhi chiusi

Su due piedi _____________________ ______________________

Su uno solo _____________________ ______________________

Un piede avanti l’altro _____________________ ______________________

In punta _____________________ ______________________

7.2. Dinamico

Nel passaggio da una postura all’altra: ________________________________________________

Nelle varie attività: ________________________________________________

7.3. Spinta

_____________________________________________________

_____________________________________________________

8. CONTROLLO EMOZIONALE

8.1. Occhi chiusi:

Davanti: ___________________________________________________________

Dietro: ___________________________________________________________

9. RITMO

9.1. Spontaneo

_____________________________________________________

_____________________________________________________

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9.2. Adattamento:

Con le mani (lento/medio/veloce): ____________________________________________________

Cammino (lento/medio/veloce): ____________________________________________________

9.3. Riproduzione di strutture ritmiche (M.Stambak)

_____________________________________________________

_____________________________________________________

10. LATERALITA’

10.1. Assiale

Rotazione: ___________________________________________________________

Occhio: ___________________________________________________________

Orecchio: ___________________________________________________________

10.2. Periferica

Neurologica Gestuale Simbolica D’uso

Mano: ___________________________________________________________

Piede: ___________________________________________________________

11. SPAZIO

11.1. Percezione

_____________________________________________________

_____________________________________________________

11.2. Adattamento

_____________________________________________________

_____________________________________________________

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11.3. Orientamento

Su di se: ___________________________________________________________

Nello spazio: ___________________________________________________________

Sugli altri: ___________________________________________________________

11.4. Strutturazione

_____________________________________________________

_____________________________________________________

12. TEMPO

Conoscenza dei concetti: ___________________________________________________________

Orientamento: ___________________________________________________________

Adattamento: ___________________________________________________________

Vissuto: ___________________________________________________________

13. SCHEMA CORPOREO

Indicazione: ___________________________________________________________

Denominazione: ___________________________________________________________

Strutturazione: ___________________________________________________________

Imitazione: ___________________________________________________________

Disegno: ___________________________________________________________

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14. PRASSIE

Relative all’autonomia: ___________________________________________________________

Qualità del gesto: ___________________________________________________________

Capacità di acquisizione di

nuove prassie: ___________________________________________________________

15. GRAFO MOTRICITA’

Postura: ___________________________________________________________

Braccio: ___________________________________________________________

Prensione: ___________________________________________________________

Qualità del tratto grafico: ___________________________________________________________

Disposizione spaziale: ___________________________________________________________

Contenuti: ___________________________________________________________

Scrittura: ___________________________________________________________

16. OGGETTI

Conoscenza: ___________________________________________________________

Manipolazione: ___________________________________________________________

Uso funzionale: ___________________________________________________________

Vissuto: ___________________________________________________________

17. CONTROLLO VISIVO

_____________________________________________________

_____________________________________________________

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18. CONTRO UDITIVO

_____________________________________________________

_____________________________________________________

19. SENSO MUSCOLARE

_____________________________________________________

_____________________________________________________

20. MEMORIA

Visiva: ___________________________________________________________

Uditiva: ___________________________________________________________

Verbale: ___________________________________________________________

21. VIGILANZA

_____________________________________________________

_____________________________________________________

22. CAPACITA’ ATTENTIVA GENERALE

_____________________________________________________

_____________________________________________________

23. LINGUAGGIO

Comprensione: ___________________________________________________________

Espressione: ___________________________________________________________

Concordanza tra pensiero,

parola e azione: ___________________________________________________________

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24. REAZIONI COMPORTAMENTALI

Inibizione: ___________________________________________________________

Impulsività: ___________________________________________________________

Partecipazione: ___________________________________________________________

Altro: ___________________________________________________________

25. COLLOQUIO

___________________________________________________________ Vissuto dell‘esaminatore:

___________________________________________________________

26. SINTESI

_____________________________________________________

_____________________________________________________

27. IPOTESI DIAGONISTICA E PROGETTO DI INTERVENTO

_____________________________________________________

_____________________________________________________