PHED430 Adapted Physical Education
Motor Screening Form
Spring 2005
(Skill Level – 1 = Beginner, 2 = Moderate Skill, and 3 = Mastered Skill)
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Category-Psychomotor (Locomotor Movements) |
Skill Level |
Comments |
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Pushes own wheelchair
forward a distance of 15 feet |
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Walks with assistance 15 feet |
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Walks without assistance |
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Walks backward |
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Stands on one foot for 5
seconds |
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Grapevine (leading with
left) |
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Grapevine (leading with
right) |
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Gallop (leading with left) |
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Gallop (leading with right) |
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Skipping |
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Sliding (leading with left) |
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Sliding (leading with
right) |
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Running (mature fashion) |
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Category-Psychomotor (Object Control Skills) |
Skill Level |
Comments |
|
Kicks a stationary ball |
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Bounces and catches a playground ball to self |
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Rolls a ball 15 feet |
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Throws a softball size ball 15 feet using mature pattern |
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Throws a softball size ball, hitting a 3 ft target from 15 ft away |
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Catches an 8.5 inch ball using mature pattern tossed from 15 feet |
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Able to strike object
tossed from 15 feet away |
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Dribble basketball |
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Demonstrates a dominant
hand |
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Category- Fitness |
Skill Level |
Comments |
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Performs 5 mature pushups |
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Performs 5 crunches |
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Performs 10 jumping jacks |
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Category- Aquatics |
Skill Level |
Comments |
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Comfortable in water |
|
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Tread water |
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Demonstrates ability to float |
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Swim lap across pool-dog paddle |
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Swim lap across
pool-(freestyle) |
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Swim lap across pool-(back
stroke) |
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Swim lap across pool-(breast) |
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Jump in from side |
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Category-Cognitive |
Skill Level |
Comments |
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Can follow directions |
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Exhibits appropriate on task behaviors |
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Category- Affective |
Yes/No |
Comments |
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Has short attention span |
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Distracts others |
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Prefers to play solo |
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Has low frustration tolerance, cries easily |
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