Professional Documents
Culture Documents
Ihc RT Assessment
Ihc RT Assessment
Latency Age
~alne:
--------------------------------~-Age:
__ D.O.B:
-----
Admit Date:
Evaluation Date: ----
Admit Diagnosis:
Medications/Allergies:
1. Educational History:
a. What grade are you in school?
----------------~----------~---b. Do you like school? ----------------------------------------c. Vvhat do you want to be when you grow up?
a. Right
Left
Needs Assistance ----2. Balance on each foot for 5 seconds (eyes closed) :
a. Right
Left
Needs Assistance
_
J.
"
4. Tln'ow a ball:
a.
b.
c.
d.
5. Catches a ball:
a. Used two hands
b. U sed one hand
Examiners observations:
Able
Able
Unable
Unable
..
II
2. Look at the picture on the left. Check (x) three objects from those shown on the
light that you see in the picture on the left
Draw a Person
Co~.mitiye
Puzzles/word games
Reading
Cooking
Videogames
Computer games
EmotionaUCreative Expression
Dance
Art
Music
Poetry
Spiritual
Church Activities
Meditation
Yoga
Social
Visiting F1iends
Shopping
Pets
Other
__
Staying on task
__
Following Directions
___
Improving Sportsmanship
___
Having fun
__
___
___
__
Controlling temper/anger
appropriatel y
__
Speaking up for myself/being
asseliive
. __ . _ Letting adults take care of me
Improving fitness
. Leaming to cope with stress
Being able to express myself
Leaming cooperation/teamwork
Other:
2. Eye Contact
__ good, appropriate
__ looked away occasionally
__ looked away frequently
__ little to no eye contact
3. Attention Span
__ attended to therapist during entire assessment
__ occasionally needed to be cued to pay attention
4. Frustration/Agitation Level
__ participated without
frustration/agitation
__ occasiol1ally fru.strated
__ often frustrated/agitated
__ frustrated/unable to pari.
__
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6. Apparent Comprehension
__ good comprehension
__ basic comprehension
__ poor comprehension
7. Response Time
__ answered most questions innnediately
needed some thought to come up with answers
_ needed a lot of time to respond
__ did not respond
8. Body Posture
erect
rounded shoulders
slouched, head down
__ limp, unable/unwilling
to pariicipate
Strengths:
\Veaknesses:
Treatment RecOlIDnendation/Approaches:
Provide structured, age recreation therapy, phvsical education, art education, play therapy
and cOlIDnunity settings for patient to work on above stated goals as behavior allows.
Provide encouragement and feedback aspatient makes progress in sociaL emotional,
cognitive, spiritual, and physical domains of development. Encourage patient to express
feelings during recreation therapy activities and in the milieu.
Specific Recommendations: