Standing frame cum sitting Assessment form for Special needs

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Often the tools in the developing countries are not supported. Here I have framed an assessment tool for the sitting chair and standing frame for the children with special needs. Comments and suggestions are welcome at physionalin1@indiatimes.com

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Standing frame cum sitting Assessment form for Special needs

  1. 1. Karuna Vihar EIC Physiotherapy Assessment Form Standing frame cum sitting chair – Assessment FormDate: _____/_____/ 20__Name of Child- ............................................. ........Age/Gender- .........................................................Weight (Kgs) …………………………………………...............Height (inches) ……………………………………….................Contact Details ………………………………………................Assessor ……………………………………………….......... ……………………………………………….........Brief description of Neurological Impairment and associated secondary issues:………………………………………………………………………………………………………………………................................………………………………………………………………………………………………………………………...........................................…………………………………………………………………………………………………………………......................................……………........……………………………………………………………………………………………..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
  2. 2. Measurement for Sitting Chair:Note: Assessment for sitting is done with child sitting on the low level stool with back unsupported. Measurement for Standing Frame:TYPE OF STANDING FRAMEProne stander/Supine standerWith inclination/w/o inclination Measurements with standard inch tape In Inches Heel to Occiput Heel to Acromian Process Heel to Inferior angle of scapula Heel to PSIS level Heel to knee Pelvic width Standing Frame Measurement In Inches 1. Height of Standing Frame 2. Width of Standing Frame
  3. 3. Table/Desk MeasurementLength and width -Depth of the circumference –C size (Right to left midaxillary line with centre at xiphisternum) - Longitudinal depth (Perpendicular line intersecting between midaxillary line and xiphisternum)-Table Height:Sitting chair (From buttocks to Olecranon process of elbow, when child is in sitting on a stool and elbow flexedto 90 degree)-Standing frame (from bottom of heel to Olecranon process of elbow with elbow flexed to 90 degree)- Additional supports:- In InchesBelts=At the level of T2-T8(Chest belt)At the level of PelvisChest HarnessVelcro=At the level of 2 ‘’ above Knee2 At the level of 2 ‘’ below KneeAt the level of 2 ‘’ above medial malleolusMid foot levelAFO/Knee Gaiters/Arch Support/any other orthoticNote: Assessment for standing frame has to be done in supine lying position.Please describe any functional limitations not mentioned above, giving dimensions where appropriate:-___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ PhysiotherapistSignature and Name of Physiotherapist

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