Clients Name: Guadalupe School

Supervising Therapist: Sarah Gray

Student Therapist: Heather Ashton and Courtney
McDonald
Precautions:

Date: 11/19/2015

Clients Goals:
1 Within 3 months, student will Improve fine motor precision to hold writing utensil with a tripod grasp
100% of the time to complete writing assignments.

2 Within 3 months, student will follow directions during classroom activities by requiring verbal prompts
3

less than 25% of the time.

Within 3 months, student will demonstrate fine motor coordination by independently and consistently
writing first name with

correct letter formation, sizing, and appropriate spacing.

4 Within 3 months, student will demonstrate fine motor precision and visual eye hand coordination by
writing upper case alphabet with appropriate sizing on 3/5 attempts.
5 Within 3 months, student will demonstrate fine motor precision and eye hand coordination to
accomplish correct line adherence within 1/4 on 3/5 letters with fewer than 3 verbal cues.
Clients Occupations to be treated include: (check all that apply)
ADLs/Self Care: (bathing, showering, toileting & hygiene, swallowing/eating, feeding, Personal device
care & managing personal belongings, personal organization ,functional mobility, personal hygiene and
grooming)
X Instrumental ADLS & Graphic Communication: (Care of others, Care of pets, child rearing,
Communication management, driving & community mobility, financial management, health
management & maintenance, home establishment & management, meal prep & cleanup,
religious/spiritual activities & expression, safety & emergency maintenance/awareness, & shopping &
Handwriting, Keyboarding, Drawing, Coloring, Art, etc).
Rest & Sleep: (Rest, sleep preparation, sleep participation)

Work: (Employment interests & pursuits, Employment seeking & acquisition, job performance,
retirement preparation and adjustment, volunteer exploration & participation).
Play & Social Participation: (Social Awareness, Building/Maintaining Relationships, Turn-taking,
imaginative play, sharing materials, exploring new play ideas/opportunities, play exploration, social
participation in community, family and with peers)
Leisure: (Leisure exploration & participation)

Client Factors & Performance Skills/Patterns addressed: (check all that apply)
Motor/Muscle/Movement
Skills
x Core
x Manipulatio
Stability
Endurance

n
Coordination

Sensory Skills
Temperatur
e
Hearing

Social Skills

x Pressure

x
x Position/Alig

x
x Motor

x Vestibular

Smell

x Concludes/Transitions/Takes turns
x Communicates (verbal/non-verbal)

x Tactile

Pain

x Looks/Turns (Makes eye-contact)

ns
Joint Mobility

x Joint Stability
x Tone &

Strength

Planning
Reaching/gr
asp
Reflexes

x Controlled

Movement

x Propriocepti
ve
x Discriminati
on

Taste

x Engages/Approaches Others

x Visual

x Emotional Expression

x Modulati
on

x Physical behavior (regulates

movement, position, touch)

Division of Occupational Therapys LIFE SKILLS CLINIC

540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu

Other

Other

Other

Processing/Cognitive/Mental functions:

Visual Perceptual/Visual Motor Skills

Attends

Oculomotor Skills

x Object Perception

Memory

Visual Attention

x
x

Sequences Tasks
Executive Functions

x
x

x
x

Visual Discrimination
Visual Motor Speed

x Eye-hand
Coordination
x Copying Shapes
x Spatial Relations

Chooses/Uses
materials
Locates/Gathers
materials
Adjusts/Accommodate
s
Initiates/Continues/Ter
minates
Tasks/Activities
Other

Experience of self &

time
Emotional
regulation
Energy & drive
Notices/responds to
cues
Pacing of activities

Visual Memory

x Form Constancy

Organizes Materials

Depth Perception

Navigates
Environment
Orientation to self,
other, time & place

x
x
x

Visual Closure
x

Figure Ground

Visual Acuity
x Sequential Memory
Visual Closure

Other

Materials:
Rolling pin, play dough, legos, Turkey page, scissors, crayons, stretch paper.

Space

Intervention Description &

Time

Approach
:
Establish/
Restore

Thera
py
room

Warm up: (5 Minutes)

Gross motor coordination, social
participation, praxis,
proprioception
Turkey Pokey (Hokey Pokey)
-Students and therapists will stand
in a circle and play Hokey Pokey
using the Turkey lyrics:

Type:
Preparatory
Activity

Activity Demands

Practice
Model:
Biomechani
cal, Social
Participatio
n
Anticipated

Goal(s)
addresse
d:
All

Outcome:

(OTPF table 7)
-Gross motor movement for
Relevance: Fun/engaging,
improved coordination
warm-up
-Proprioceptive and
Objects: None
vestibular input to organize
Social Demands: Sharing
system and increase focus
space in the room, following
-Sharing space with peers to
directions, singing together
increase social participation
You put your right wing in
Space Demands: Enough
-Praxis experience for
You put your right wing out
room for students to stand in improved motor planning
You put your right wing in
a circle and dance
And you shake it all about
Sequencing/timing:
You do the turkey pokey
Sequence of movements,
Division of Occupational Therapys LIFE SKILLS CLINIC
540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu

And you turn your self around

Thats what its all about
Additional verses:
Left wing (left arm)
Drumsticks (legs)
Stuffing (tummy)
Wattle (head)
Tail feathers (bottom)
Turkey body (whole self)
Therapy
Room

timing of song
Performance Skills:
Stabilize, position, reach,
bend, coordinate,
Body Function/Structures:
Attention, memory, energy
and drive, vision, hearing,
vestibular, proprioceptive,
touch, neuromusculoskeletal
and movement, arms, hands

Activity 1: (10 Minutes)

Lego letters
Tactile, proprioception, visual,
strength, endurance, fine motor
control, praxis, visual motor
integration, problem solving
-Students will be given a small
container of play dough
-Students will then roll out the play
dough to make a wide, flat surface
-Students will choose appropriate
Lego pieces and use them to stamp
letters X, Y, Z, A, I, and T into the
play dough

Approach
:

Activity 2: (10 Minutes)

Turkey Letter Craft
Fine motor control, eye-hand
coordination,
strength/endurance, postural
control, bilateral coordination,

Establish/
Restore

Type:
Preparatory
Activity

Practice
Model:
Sensory
processing,
biomechanica
l

Goal(s)
addresse
d:
All

Activity Demands

Anticipated Outcome:

(OTPF table 7)
Relevance: fun engaging/
letter recognition
Objects: rolling pins, Legos,
play dough
Social Demands: following
directions, respecting others
work and space, being
attentive to therapist
Space Demands: Room for
a table and six chairs
Sequencing/timing: roll out
dough before stamping
letters
Performance Skills:
stabilize, position, reach,
grip, manipulate, coordinate,
move, flow, endure, attend,
heed, choose, use, initiate,
sequence, notice/ respond,
place self
Body Function/Structures:
arms, hands, cognition,
sensory functions, joint
mobility and stability, muscle
tone and endurance, control
of voluntary movement

-Increase hand strength and

endurance to improve ability
to write
-Increase ability to form
letters in order to increase
speed in handwriting
-Increased letter recognition
through tactile learning in
order to complete school
assignments quickly
-Increased problem solving
abilities in order to complete
classroom work

Approach
:

Practice
Model:

Establish/Res
tore

Type:

Occupational
Activity

Handwriting,
Motor
Learning,
Biomechanica

Goal(s)
addresse
d:
All

Division of Occupational Therapys LIFE SKILLS CLINIC

540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu

letter formation, attention,

sequencing.
-Students will be given Turkey page.
-Students write letters X, Y, Z, A, I,
and T on turkey feathers
-Students color and cut out turkey
and feathers
-Students glue feathers on turkey

Cool Down: (5 minutes)

After Thanksgiving Dinner Stretches
Proprioception, vestibular,
strength,
endurance, postural control &
alignment, gross motor
coordination
-Tell students that after you eat a
big Thanksgiving dinner, sometimes
you need to stretch.
-Model each stretch for students
and guide their movements to
achieve correct pose when needed.

Activity Demands

Anticipated Outcome:

(OTPF table 7)
Relevance: Letter formation,
fun/engaging
Objects: Turkey page,
scissors, crayons
Space Demands: Table,
chairs, room at table
Social Demands: Following
directions, respecting others
space
Sequencing/timing: Steps to
writing letters
Performance Skills: Align,
stabilize, position, reach,
grip, manipulate, coordinate,
move, calibrate, flow,
endure, pace, attend, heed,
use, handle, initiate,
continue, sequence,
terminate, organize,
regulate, transition.
Body Function/Structures:
Attention, memory, Sensory
functions,
neuromusculoskeletal
functions, arms, hands,
trunk, brain.

- Increase performance in
correct letter formation
- Increase fine motor control
in order to hold pencil and
improve handwriting
- Improved hand/UB strength
for endurance while writing
- Increase ability to recognize
and form letters
- Improve ability to
participate in sequencing
tasks to improve handwriting
and classroom participation
- Improve ability to attend to
task to increase classroom
participation

Approach
:

Practice
Model:

Establish/rest
ore

Type:
Activity,
preparatory
task

Activity Demands

Biomechanica
l,
Sensory
Processing

Goal(s)
addresse
d:
All

Anticipated Outcome:

(OTPF table 7)
-Build core
Relevance: Fun/engaging,
strength/endurance to
improve posture
calming
-Calm student down to
Objects: Stretch paper
prepare to return to class
Space Demands: Enough
-Provide proprioceptive input
room for each child to stretch to integrate senses
Social Demands: Follow
directions, stay in designated
space
Sequencing/timing: Steps of
Division of Occupational Therapys LIFE SKILLS CLINIC
540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu

stretches
Performance Skills: Align,
stabilize, position, reach,
bend, coordinate, move,
endure, attend, heed,
initiate, continue, sequence,
adjust, transition.
Body Function/Structures: All
body structures, cognition,
balance, proprioception, and
strength

Home Program/Homework:
Students will practice making Lego letters at home.

Student Therapist Signature: Courtney McDonald and Heather

Ashton
Supervising Therapist Signature:

Date: 11/12/2015
Date:

Division of Occupational Therapys LIFE SKILLS CLINIC

540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu

Division of Occupational Therapys LIFE SKILLS CLINIC

540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu

Visual Schedule

Division of Occupational Therapys LIFE SKILLS CLINIC

540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu

Division of Occupational Therapys LIFE SKILLS CLINIC

540 Arapeen Drive Suite 200
Main Clinic Number 801-585-6837FAX 801-585-6813www.LifeSkillsClinic@utah.edu