Pediatric Evaluation Report

Student’s Name: Chase R. (pseudo-name Norms Used: Male

to ensure anonymity) Date of Assessment: 2/20/19
th
Grade: 4 grade Examiners Name(s): Adri Sigafoose,
Age: 10 years and 3 months OTS supervised by Ashely Baryo, MS,
DOB: 12/20/08 OTRL
Assessment: Bruininks-Oseretsky Test of Motor Proficiency 2 (BOT-2)
Referral
Chase was referred to school-based occupational therapy due to his parents and
teachers ongoing concerns about his poor handwriting.
Background Information
Chase is a hardworking and quiet student at O. upper elementary. He has two
older brothers and lives with his mother and father. He enjoys watching movies and
playing video games. Chase is neutral about his feelings towards school. His favorite
class in school is gym and he enjoys outside recess. Chase does not have any pertinent
medical history that impacts his ability to participate in school or occupational therapy.
This assessment was performed at O. upper elementary in the back of the school
cafeteria. The cafeteria provided seclusion and enough space to perform the BOT-2. Adri
Sigafoose, OTS, administered the assessment and was supervised by Ashley Baryo, MS,
OTRL. Chase tolerated the assessment well. His affect was flat through the assessment,
but he worked diligently on the tasks provided to him.
Results
The BOT-2 was performed with Chase to evaluate a variety of his motor skills.
The BOT-2 can be broken down into four subtests: fine motor manual control, manual
coordination, body coordination, and strength and agility. Scores are based on novel
subtest tasks which evaluate different aspects of motor development. Chase was not
evaluated on strength and agility due to the main focus of this evaluation to assess fine
motor coordination and motor planning. Chase’s BOT-2 scores are described below and
are broken down by subtests.
Fine Manual Control
Fine Manual Control is divided into two subtests: Fine Motor Precision and Fine
Motor Integration. The Fine Motor Precision subtest consist of tasks that require accurate
hand and finger movements. The goal is to draw, fold, or cut within a given boundary.
The specific tasks consist of drawing items, folding paper, cutting shapes, filling in
shapes, drawing lines through a maze, and connecting dots. Scores are given based on the
student’s ability to stay within the given boundaries. The Fine Motor Integration subtest
assesses the student’s ability to reproduce drawings of geometric shapes that range in
difficulty. For example, the first shape the student is asked to copy is a circle and the
most difficult shape is overlapping pencils. The scores are based on shape, closure, edges,
orientation, overlap, and size. Chase’s results for Fine Manual Control are listed below:
Fine Manual Total Point Score Scale Score Age Equivalence/ Performance
Control %ile Rank
Fine Motor 33 10 7.9-7.11 Below Average
Precision
Fine Motor 36 13 9.3-9.5 Average
Integration
Total Composite 23 18%ile Average
Manual Coordination
Manual Coordination is divided into two subtests: Manual Dexterity and Upper
Limb Coordination. The Manual Dexterity subtest uses goal-directed tasks that involve
reaching, grasping, and bimanual coordination. The goal of these tasks is accuracy, but
the tasks are timed to differentiate levels of dexterity. Tasks include transferring pennies
into a box, stringing wooden blocks, sorting cards by shape/color and inserting pegs into
a pegboard. The Upper Limb Coordination subtest measures eye-hand coordination, and
visual tracking with coordinated arm and hand movement. Tasks include catching and
dribbling a ball, and throwing the ball at a target. Chase’s results for Motor Coordination
are listed below:
Motor Total Point Score Scale Score Age Equivalence/ Performance
Coordination %ile Rank
Manual 29 15 9.9-9.11 Average
Dexterity
Upper Limb 32 10 8.3-8.5 Below Average
Coordination
Total Composite 25 18%ile Average

Body Coordination
Body Coordination is divided into two subtests: Bilateral Coordination and
Balance. The Bilateral Coordination subtest measures many of the necessary skills for
playing sports and other leisure games. The tasks require body control and coordination
of upper and lower extremities. Each task is demonstrated by the examiner and verbal
cues are permitted when the student is unfamiliar with the task. Some of the exercises
include jumping jacks, scissor jumps, pivoting thumbs and fingers, and synchronized
tapping of the feet and fingers on the same and opposite sides of the body. The Balance
subtest measures motor-control skills that are necessary for sustaining posture while
standing, walking or reaching. A few of the tasks associated with this subtest are
balancing on a balance beam with eyes open and closed, walking on a line, and standing
on one leg. Chase’s results for Body Coordination are listed below:
Body Total Point Score Scale Score Age Equivalence/ Performance
Coordination %ile Rank
Bilateral 23 16 10.9-10.11 Average
Coordination
Balance 30 10 6.6-6.8 Below Average
Total Composite 26 27%ile Average

Interpretation of Results
From the results of the BOT-2, Chase demonstrates average to below-average
scores of motor proficiency. Chase’s motor proficiency scores are below the average
scores for children his age, except for his score in bilateral coordination. The BOT-2
scores show that Chase demonstrates characteristics of dyspraxia. He shows a lack of
coordination while performing voluntary movements and difficulty with motor planning
novel tasks. With each of the Bilateral Coordination tasks, the student is allowed a second
trial if they do not earn the maximum score on their first try (the better trial is used for
scoring). In this category, Chase required a second trial for 3 out of the 7 tasks. For the
Balance subtest, Chase required a second trial for 3 out of the 9 tasks. For all of the tasks
that Chase struggled to perform and required a second trial, he was asked to balance with
his eyes closed. This suggests that Chase may have a proprioception deficit. A client who
has a problem with proprioception can still maintain balance by compensating with
vestibular function and vision, but the deficit is noticeable when vision is taken away.
During the Body Coordination assessment, Chase required regular verbal prompting and
visual modeling. He was able to formulate appropriate questions while learning a novel
task, but had a difficult time performing the task after the initial demonstration. Chase’s
fine motor precision and upper-limb coordination skills are below average which may be
negatively affecting his handwriting. Dyspraxia/proprioception difficulties can negatively
affect Chase’s performance in gross motor activities such as gym, organized sports, or
playing on the playground. Dyspraxia will affect Chase’s role as a student and his
engagement in the occupation of formal education.
Recommendations
Chase’s occupational therapy interventions will be planned around strengthening
fine motor, motor planning and coordination skills. The purpose behind engaging in fine
motor tasks will be to increase hand strength and precision. Chase demonstrated an
effective tripod grasp on the pencil which indicates that his poor handwriting skills may
be due to lack of endurance or poor motivation. A classroom modification that is
recommended for Chase is specialty paper that helps students position letters on the line.
Chase will benefit from paper with raised, bumpy baselines or paper that has the bottom
half of the writing space highlighted. Chase would also benefit from exercises that
address motor planning, visual motor and coordination skills. An example of an
intervention that occupational therapy provides and would address these areas is Bal-A-
Vis-X which are exercises that require passing bean-bags or balls in an organized,
rhythmic pattern. Chase would also benefit from sensory integration interventions to help
him become aware of where his body is in space (proprioception). The scores Chase
received on the BOT-2 would not qualify him for school-based occupational therapy, but
it is recommended that Chase receives occupational therapy from an outside source at
least once a week for one-hour sessions.

Adri Sigafoose, OTS Ashley Baryo, MS, OTRL

3/15/19 3/15/19

Self-Reflection
This experience was valuable to my education about pediatric practice. I learn
best when I can be physically involved in an event and perform the task. I also learn well
with immediate feedback. For example, if I described or demonstrated a task poorly, Ms.
Ashley would correct me right away and show me a better way to teach the task. Chase is
an easy-going student and was a great candidate for my first standardized assessment. I
believe that I will become more proficient with administering standardized assessments
the more I am exposed to them. I feel confident in my skills of administering and scoring
the BOT-2. I am not yet proficient in my ability to receive a referral and promptly think
of an assessment that will be helpful. I believe this skill comes with practice and am
thankful for this opportunity to practice.