Fine Motor Goals:

Cutting:

1. _____________ will snip with scissors in 4 out of 5 trials with ________ assist and _____% verbal cues to promote separation of sides of hands and hand eye coordination for optimal participation/ success in school setting.
2. _____________ will cut across a piece of paper in 4 out of 5 trials with ________ assist and _____% verbal cues to promote separation of sides of hands and hand eye coordination for optimal participation/ success in school setting.
3. _____________ will cut out a circle in 4 out of 5 trials with ________ assist and _____% verbal cues to promote separation of sides of hands and hand eye coordination for optimal participation/ success in school setting.
4. _____________ will cut out simple shapes with smooth edges in 4 out of 5 trials with ________ assist and _____% verbal cues to promote separation of sides of hands and hand eye coordination for optimal participation/ success in school setting.
5. _____________ will cut simple shapes within a ½” of the line in 4 out of 5 trials with ________ assist and _____% verbal cues to promote separation of sides of hands and hand eye coordination for optimal participation/ success in school setting.

Blocks:

1. _____________will stack _______ blocks in 4 out of 5 trials with ________ assist and _____% verbal cues for increased precision and accuracy of distal finger skills for optimal participation/ success in school setting.
2. _____________will copy block designs with visual and verbal cues with _______ blocks in 4 out of 5 trials with ________ assist and _____% verbal cues for increased precision and accuracy of distal finger skills for optimal participation/ success in school setting.

Puzzles:

1. ______________ will complete a variety of insert puzzles independently in 4 out of 5 trials with ________ assist and _____% verbal cues for increased visuomotor and spatial relationship skills.
2. ______________ will complete simple puzzles independently in 4 out of 5 trials with ________ assist and _____% verbal cues for increased visuomotor and spatial relationship skills.
3. ______________ will place shapes into form board in 4 out of 5 trials with ________ assist and _____% verbal cues for increased visuomotor and spatial relationship skills.
4. ______________ will insert circular, square, and triangular shapes in 4 out of 5 trials with ________ assist and _____% verbal cues for increased visuomotor and spatial relationship skills.
5. ______________ will complete interlocking puzzles in 4 out of 5 trials with ________ assist and _____% verbal cues for increased visuomotor and spatial relationship skills.

Drawing:

1. _______________will imitate vertical and horizontal strokes in 4 out of 5 trials with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a tripod grasp without thumb wrap and with an open web space.
2. _______________ will copy a ___________(circle, triangle, square, cross) in 4 out of 5 trials with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining an open web space.
3. _______________ will copy closed circle ________ times with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a tripod grasp.
4. _______________ will imitate vertical and horizontal strokes in 4 out of 5 trials with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a lack of thumb wrap.
5. _______________will imitate vertical and horizontal strokes in 4 out of 5 trials with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a dominant writing hand.

Writing:

1. _____________ will draw straight line capital letters ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a tripod grasp.
2. _____________ will write upper case letters with good formation ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a lack of thumb wrap.
3. _____________ will write lower case letters using Handwriting Without Tears method ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining an open web space.
4. _____________ will write two consecutive words without a model ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills and success in school setting.
5. _____________ will write sentences using appropriate size and spacing ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a tripod grasp.
6. _____________ will write first and last name with upper and lower case letters without model ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills while maintaining a lack of thumb wrap.
7. _____________ will hold a pencil with a tripod grasp for ___ minutes to improve hand strength and writing endurance for increased graphomotor skills and success in school setting.
8. _____________ will write upper and lower case letter with decreased pressure on paper with adequate spacing for increased graphomotor skills and success in school setting.
9. _____________ write letters of the alphabet with 90%+ accuracy for correct letter formation ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills and success in school setting.
10. _____________ write letters of the alphabet with 90%+ accuracy for correct line placement ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills and success in school setting.
11. _____________ write letters of the alphabet with 90%+ accuracy for correct size ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased graphomotor skills and success in school setting.

Grasp and Release

1. _____________ will pick up small objects using an inferior pincer grasp with thumb and fingers using her ___ hand ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased grasp and release accuracy.
2. _____________ will open ___ hand to grasp a variety of size objects ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased grasp and release accuracy.
3. _____________ will pick up small objects using an inferior pincer grasp and place them into a container with thumb and fingers using her ___ hand ________ times in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased grasp and release accuracy.
4. ______________ will release toys with _____ hand volitionally in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased grasp and release accuracy.
5. ______________ will grasp a toy using BUE at midline in 4 out of 5 treatment sessions with ________ assist and _____% verbal cues for increased grasp and release accuracy.
6. _____________ will use open hands to crawl up an incline for increased grasp and release accuracy.

Beads:

1. ______________ will string and unstring large beads onto firm string/ lace ________ with assist and _____% verbal cues for increased precision handling.
2. ______________ will string and unstring small beads onto flaccid string with ________ assist and _____% verbal cues for increased precision handling.

Dressing:

1. ______________ will complete UB dressing with _________ assist and _____% verbal cues for increased functional independence in daily life.
2. ______________ will complete LB dressing with _________ assist and _____% verbal cues for increased functional independence in daily life.
3. ______________ will complete UB bathing with _________ assist and _____% verbal cues for increased functional independence in daily life.
4. ______________ will complete LB bathing with _________ assist and _____% verbal cues for increased functional independence in daily life.
5. ______________ will complete toileting with _________ assist and _____% verbal cues for increased functional independence in daily life.
6. ______________ will complete sit to stand transfer with _________ assist and _____% verbal cues for increased functional independence in daily life.
7. ______________ will complete grooming tasks with _________ assist and _____% verbal cues for increased functional independence in daily life.
8. ______________ will complete stand pivot transfer with _________ assist and _____% verbal cues for increased functional independence in daily life.
9. ______________ will complete self-feeding with _________ assist and _____% verbal cues for ________% of meal for increased functional independence in daily life.

Sensory with Self Care Tasks:

1. ______________ will tolerate washing hair for ______% of task without a tantrum in 5 out of 7 days for increased participation and functional independence in daily life.
2. ______________ will tolerate oral hygiene for ______% of task without a tantrum in 5 out of 7 days for increased participation and functional independence in daily life.
3. ______________ will go to sleep after 30 minutes of self preparation routine without difficulty (i.e. tantrums or other similar behaviors) in 5 out of 7 days for increased participation and functional independence in daily life.
4. ______________ will demonstrate an appropriate level of arousal for _____ minutes in 4 out of 5 treatment sessions for increased participation and functional independence in daily life.
5. ______________ will wearing UB and LB clothing for _______ minutes without a tantrum in 5 out of 7 days for increased participation and functional independence in daily life.

Behavioral:

1. ________________’s family will understand his sensory needs and be able to follow through on home and school activities that will assist him in maintaining an appropriate level of arousal as measured through verbal recall of information with _______% accuracy.
2. ________________ will attain and maintain an appropriate level of arousal for activities ____ hours out of the day with ___________ rest breaks as measured by teacher and family report.
3. Using sensory strategies, ___________________ will demonstrate appropriate sensory modulation skills in order to sit and participate in circle time at school without aggression towards peers in 4 out of 5 days of the week as measured by teacher report.
4. _______________ will demonstrate ability to tolerate sitting close to peers in classroom without physically striking another student in 4 out of 5 days of the week as measured by teacher report.
5. ______________ will demonstrate knowledge of sensory diet with ___% accuracy as measured by verbal and visual recall.
6. ______________ will demonstrate ability to implement sensory diet with ____% accuracy as measured by skill demonstration per teacher report in 4 out of 5 school days.
7. ______________ will tolerate standing in line without tantrums or other poor behaviors in 4 out of 5 school days as measured by teacher report.