S: Caretaker reported that she does not know how client does if left alone to dress, as in the

past she has stayed with him while he dresses. She does not know what the family does when
she is not there.

O:
GM Client participated in a GM obstacle course
X2. Climbed 3 stairs and across platform with
wall support and descended stairs with HH A.
Client IND ambulated over rings while looking
down at his feet.

Fine Motor- prewriting maze. Client traced prewriting shapes (line down,
line across, cross, circle) with HOH for finger
tracing and use of a marker. Client IND traced
line down, line across x4 and cross x2.

Fine motor- coloring Client required HOH A to color within the lines
of a 2’’x2’’ section x2. Client utilized a weak
grasp.

Dressing A reward chart was utilized for doffing. Doffed

shoes IND. Doffed and donned shirt with MIN
A for bunching up shirt in back and located
arm holes. IND doffed pants and donned
pants with min A to pull pants up in back.
Client donned shoes with mod A. Client
required min VP throughout dressing task.

A: Client continues to make improvements in GM movement and would benefit from continued
activities which require ambulation on uneven surfaces to increase confidence in his own
abilities. Utilizing objects for him to retrieve or other forms of motivation may help to increase
desire to participate in GM tasks independently. Continued practice of prewriting shapes,
including producing, copying, tracing, are necessary to reach the client’s writing goal. Activities
which focus on grip strength may be necessary to improve grasp. The client does better with
dressing at the beginning of therapy compared to the end, perhaps because there are activities
he is looking forward to during therapy such as the swing and gross motor play. While the client
may have the abilities necessary to dress independently, lack of motivation and the presence of
individuals that he knows can help him may be barriers. Use of a reward at the end of therapy,
as well as leaving him alone to dress may be helpful strategies to promote independence.

P:
-leave room during dressing, give reward after dressing to leave therapy (food, special activity)
-GM obstacle course
-grip strengthening- craft with glue or playdough
-buttoning (pizza board)