A Guide to Task Oriented Assessment 

Selecting the tasks to include in the assessment 

Most often 12-15 month old infants are referred for PT when they have not achieved the age appropriate milestones of sitting, crawling, pulling up to supported standing and starting to cruise. 

The information gleaned from the reason for referral, the parent interview usually provides a guide to which abilities need to be assessed. Taking time to observe the infant moving about and playing in an environment that offers a range of opportunities for playing allows the therapist to gather information about the emotional,cognitive and attention factors that contribute to, or restrain motor learning. 

Taken together this information guides the selection of tasks that need to be assessed. 

1 Object exploration, motivation, persistence and cooperative play

Infants learn through experience, and the motivation to move is often driven by the desire to reach for, and explore, new and interesting objects.  At 12-15 months typically developing infants have developed an extensive range of object handling abilities, and the range and sophistication of object play provides a window into their cognitive development. 

By a year, infants are also motivated to engage with a social partner, play cooperative games, follow instructions and mimic the actions. Taking time to play with an infant allows the therapist to get to know the infant, how best to keep him/her interested and engaged and willing to participate in therapy activities. 

2  Active independent sitting and transitions 

By 12-15 moths one can expect an infant to sit and reach in all directions, including for toys that are further than arm's reach, to shift from sitting to prone kneeing and back again easily and with good control. This is referred to as active sitting. 

Assessment of active sitting provides insight into the the infant's ability to adapt her actions to the affordances provided by the environment, her dynamic balance in sitting, range of movement, as well as persistence and willingness to take on challenges and  persist. 

It also provides information about the active range of movement of the hips and trunk.

See Assessment of Active Sitting for details and PDF checklist 

3   Transitions to prone kneeling and crawling 

By 12-15 months one can expect a child to be able to transition from prone or sitting into prone kneeling, and crawl using a reciprocal pattern. 

Many infants who have movement difficulties do not learn to get up into prone kneeling, and if they do may use a bilateral flexion rather than a reciprocal crawling pattern. 

There are several reasons why an infant my not learn to transition on into prone kneeling or adopt a reciprocal crawling pattern: these include 

• Coordination difficulties: infants born pre-term, those at risk for autism, and infants with a family history of developmental coordination disorder (DCD) may have underlying differences in how the brain learns new actions 
• Joint hypermobility: infant with a genetic predisposition to generalised joint hypermobility (GJH), as well as Down Syndrome infant, lack the naturally occurring stability of the trunk and limbs provided by the fascial system (including the myofascia) and as a result need additional muscle strength in the trunk and UEs.
• Restricted hip adduction: often associated with preterm birth and GJH.  
• Limited experience in prone: needed to develop the postural control needed for closed chain actions in prone, as well as UE arm strength.

A comprehensive assessment of the infant's abilities in prone and prone kneeling allows the therapist to start to identify the factors that contribute to the failure development  the variety of patterns of movement employed by typically developing infants, and which underpin the infant's ability to push up into prone kneeling and start to crawl. 

The assessment of prone includes adapting the environment. Often an infant who strongly protests when placed in prone, will happily lie in prone when the chest is supported on a low step. Letting the infant kneel at a step reduces the weight carried by the arms and allows the infant to maintain the prone kneeling position. 

See Guide to Assessing Prone Lying and Prone Kneeling

4 Assessment of supported standing

By 12-15 months infants are expected to pull up into standing, stand with good balance and reach in all direction in supported standing and start to cruise. 

Infants with developmental delay and coordination difficulties often require additional practice learning to balance in standing especially when reaching, flex the knees,  and intricate sequencing of weight shift needed to take a step sideways. 

Assessment of supported standing that includes reaching in all directions, bending the knees to reach down to the floor, sitting down on a step and standing up again help to identify the tasks that need training. 

See Guide to the Assessment of Supported Standing 

5 Range of movement 

Because infant of 12-15 months often object to being made to to lie down and have their limbs moved,  I tend to leave the assessment of ROM to the end of the assessment session.  If the infant does object, I try to re-engage him/her for a few minutes in a fun and non-challenging game so that the session ends on a good note. 

It is particularly important to assess movements that elongate two joint muscles and associated fascial structures such as straight leg raise with dorsiflexion, pnone knee bend with hip adduction, neck flexion with bilateral shoulder flexion/adduction.