will cooperate and assist with dressing procedures at ____ level with ____ percent frequency as measured by ________.
1 Cooperate, by not resisting, being dressed.
2 Indicate need for change of dirty clothing.
3 Assist with dressing by holding out arm, lifting leg, etc.
4 Assist with putting on/taking off: coat, hat. gloves, shoes.
5 Pull up/push down pants.
6 Manipulate clothing fasteners successfully: buttons, snaps, zippers, shoelaces, Velcro.
7 Put clothes on with intended orientation (right side out, on correct hand/foot, front on front of body).
8 Change clothing when soiled.
9 Consider weather, activity and social group in clothing choice.
will put on and remove own clothing with/without assistance _____ out of ____ opportunities as measured by ___________.
1 Cooperate and assist with dressing procedures.
2 Put on/remove socks.
3 Put on/remove shoes.
4 Tie and untie shoe laces, bows and aprons.
5 Engage and unzip the zipper.
6 Button and unbutton clothing.
7 Put on/remove pants.
8 Put on/remove tee-shin or pullover.
9 Put on/remove front buttoning shirt or cardigan sweater
10 Put on/remove coat or jacket.
11 Put on/remove dress or skirt.
12 Put on/remove underwear.
13 Put on/remove bra.
14 Put on/remove belt.
15 Put on/take off hat, gloves, etc.
16 Manage clothing fasteners.
will put on and remove socks with/without assistance _____ out of ____ opportunities as measured by ___________.
1 Remove socks by pulling off with hand.
2 Hold sock open.
3 Get toes into sock.
4 Pull sock up over heal and leg.
5 Adjust socks so heel is correct.
will put on and remove shoes with/without assistance _____ out of _____ opportunities as measured by ___________.
1 Untie shoes.
2 Unfasten Velcro.
3 Loosen shoestrings, Velcro strap.
4 Pull off shoes.
5 Position shoe in hand(s) to put on foot.
6 Put foot in shoe.
7 Put shoes on correct feet.
8 Tighten shoestrings, straps.
9 Fasten Velcro.
10 Lace/tie shoestrings correctly.
will put on and remove pants appropriately with/without assistance _____ out of ___ opportunities as measured by __________.
1 Push down pants.
2 Pull cuffs or bottoms down over feet.
3 Remove pants completely.
4 Hold pants by waist with proper alignment (front, back).
5 Put foot into correct hole.
6 Pull pants up so foot is out at bottom.
7 Put second foot in.
8 Pull ail the way up to the waist.
9 Fasten closed.
put on and remove tee-shirt or pullover appropriately with/without assistance ____ out of ____ opportunities as measured by __________________.
1 Identify front and back.
2 Lay out so back side is up.
3 Grasp bottom sides of shirt.
4 Pull over head.
5 Put arms through sleeves.
6 Pull arms out of sleeves.
7 Pull shirt off over head.
will put on and remove front buttoning shirt, cardigan sweater, coat, or jacket appropriately with/without assistance ____ out of ____ opportunities as measured by ________.
1 Grasp cuff of sleeve.
2 Flex second arm back and down.
3 Finish removing first arm from sleeve.
4 Grasp the cuff and pull on remaining sleeve to remove item.
5 Place hand on opening near neckline.
6 Put opposite arm into sleeve.
7 Pull item up to shoulder.
8 Reach second arm around in back.
9 Insert second arm and shove arm through sleeve.
10 Pull clothing up onto both shoulders.
11 Pull or fold cuffs up over hands.
will put on and remove dress with/without assistance _____ out of _____ opportunities as measured by _____________.
1 Undo fasteners in front.
2 Reach behind and undo fasteners.
3 Request assistance if fasteners in back cannot be reached.
4 Slip off straps/sleeves.
5 Push down dress.
6 Step out of dress.
7 Open fasteners.
8 Step into dress.
9 Pull up dress.
10 Slip on straps/sleeves.
11 Do up fasteners in front.
12 Reach behind and do up fasteners.
will put on and remove skirt with/without assistance ____ out of ____ opportunities as measured by __________.
1 Turn skirt around so fastener is reachable.
2 Request assistance if skirt cannot be turned to reach fastener.
3 Undo button hook/zipper.
4 Push skirt down.
5 Step out of skirt.
6 Open button hook/ zipper.
7 Step into skirt.
8 Pull up skirt.
9 Do up button/hook zipper.
10 Turn skirt around so the fastener is in the appropriate spot.
will put on and remove underwear appropriately with/without assistance _____ out of _____ opportunities as measured by _____________.
1 Pull underwear down.
2 Pull feet out of leg holes of underwear.
3 Identify front/back of underwear.
4 Grasp sides of underwear, positioned correctly.
5 Put first foot through correct hole.
6 Put second foot through remaining hole.
7 Pull underwear up to waist.
will put on and remove belt with/without assistance _____ out of _____ opportunities as measured by ____________.
1 Find correct loop to begin.
2 Pull belt through loops, one at a time.
3 Put belt through buckle.
4 Insert buckle pin into hole in belt.
5 Put end of belt through loop(s).
will manage (fasten/unfasten) clothing fasteners with/without assistance _____ out of ____ opportunities as measured by _______________.
1 Fasten/unfasten buttons.
2 Fasten/ unfasten snaps.
3 Position snaps correctly.
4 Position button and hole correctly.
5 Fasten/unfasten Velcro fasteners.
6 Fasten/unfasten hooks and eyes.
7 Zip zippers.
8 Tie and untie shoe laces, bows and aprons.
will tie and untie shoe laces, bows and aprons using double know method with/without assistance for _______ opportunities as measured by __________.
1 Pull up and tighten laces.
2 Pick up first lace and cross lace to opposite side.
3 Pick up second lace and cross over first creating an X.
4 Pick up first and second lace in separate hands.
5 Pull each lace in opposite directions.
6 Form loops with both laces.
7 Cross loops to form an X.
8 Push right loop under X and pull it out.
9 Pull each loop in opposite directions until tight.
will tie and untie shoelaces, bows and aprons using single loop method with/without assistance for ____ opportunities as measured by ______.
1 Pull up and tighten laces.
2 Complete first knot in tying.
3 Make a loop and hold with one hand.
4 Wrap other shoelace around loop once.
5 Poke wrapped shoe lace through and grasp with other hand.
6 Pull shoelaces tight.
will put on and remove bra appropriately with/without assistance _____ out of ____ opportunities as measured by ____________.
1 Slip off straps.
2 Turn bra around so fasteners are in front.
3 Undo fasteners.
4 Wrap bra around body with right side out.
5 Wrap bra around body so fasteners are in front.
6 Do up fasteners.
7 Turn bra around so fasteners are in back.
8 Pull bra up over breasts.
9 Pull straps over shoulders.
will engage and zip the zipper appropriately with/without assistance for ______number of trials as measured by _________.
1 Grasp tab with thumb.
2 Push tab down until it locks at bottom of zipper.
3 Hold tab down.
4 Grasp bottom edge with other fingers.
5 Insert prong into tab until it locks.
6 Maintain hold on bottom lock near tab.
7 Pull tab up and fasten at top.
will button and unbutton clothing appropriately with/without assistance for ____ number of opportunities as measured by _________.
1 Button/unbutton large barrel shaped buttons.
2 Button/unbutton large flat buttons.
3 Button/unbutton small buttons.
4 Select button and locale corresponding hole.
5 Grasp button between thumb and first finger of hand.
6 Grasp other side of shirt with thumb and first finger of second hand.
7 Push open button hole and push one side of button through hole.
8 Grasp button as it comes through hole.
9 Pull button through hole.
will plan an appropriate wardrobe with/without assistance in _____ out of _____ opportunities as measured by ____________.
1 Select clothes based on personal tastes.
2 Select clothes that are clean and mended.
3 Select clothes of the proper size.
4 Select clothes that match/coordinate in color or design.
5 Select clothes that are appropriate for the occasion or activity.
6 Select clothes for weather conditions.
7 Select age appropriate clothes.