Challenge Module Score Form Note that three trials were not always done even when a child did not score a 4 the first or second time. If assessor decided not to test a second or third time though, this is explained in the notes column. Child s Preferred Hand: Right Left # Trial # 1. 10 x star jumps Score (0, 1, 2, 3, 4 or NT) Child s Preferred Leg: Right Left Time (sec) Trial 1 3 8.91 3 9:06 3 8.65 2. 4 x catch/toss a basketball (alternate sides) Trial 1 3 16.96 4 15.00 1 N/A Notes (Incl. Modifications) If Not Tested, Indicate Why Trial 1: Does more than 10 be sure to stop the timer at 10 even if child keeps going :Style remains good but no faster :She is trying to speed up but we can be confident she has reached her best Trial 1:1 Double bounce on 4th return throw and some double bounces prevented by assessor stepping forward to catch ball. This ONE step forward by assessor is allowed and should be done when the ball is just short as far as dsitance. Assessor could improve accuracy of her throws : Youth instructed to throw ball back harder so just one bounce. Ball generally thrown well by assessor. Make sure to get to left and right side each time! Do not start again though if your throws are not quite perfect throws. :All assessor s throws were really good this time. Catches ball 3x, misses ball 1x on what was a good left side throw by assessor Challenge Score Form, August 2014 Page 1 of 6
3. 10 x bounce a basketball with alternate hands standing stationary Trial 1 1 2.94 1 1.78 1 2.03 4. Throw tennis ball to target on wall (score from first 3 tries ONLY) Trial 1 2 2 2 Trial 1:3 bounces :In this item, trial ends as soon as ball is caught by child for the first time (see guidelines in manual) :For this last trial, maybe should have told her to move when bouncing (could still score a 2 if she manages 10 bounces). Looks like too hard otherwise. Did 2 bounces and then lost control Trial 1:All throws underhand. First one is within 3x3 foot square :On the inner border of the the 3x3 square :In 3 x 3 foot 5a. 5 x single hand bounce/catch tennis ball RIGHT hand Trial 1 3 7.37 2 N/A 2 N/A 5b. 5 x single hand bounce/catch tennis ball LEFT hand Trial 1 4 6.34 6. Running kick of soccer ball Trial 1 1 N/A 2 2.75 3 2.10 Trial 1:Remember she is allowed to move for this one :Dropped first, then did 4. Always stop the trial when they have had 5 attempts at catching! : Only 4 successful catches. Misses 4th catch and had to catch on the rebound does not count as a catch Trial 1: Easy! Trial 1: Cannot see how far ball went but it was not to 10m : Ball goes > 10m but hits wall first can only estimate time as not possible to see end of track Challenge Score Form, August 2014 Page 2 of 6
: Ball goes > 10m but hits wall first - can only estimate time as not possible to see end of track 7. 3m crossovers on straight line, stops and returns Trial 1 3 17.30 4 8.65 8. 3 x step over and back over raised stick Trial 1 0 N/A 3 16.05 4 13.49 9. 10m forward to backward walk Trial 1 1 15.01 2 11.88 2 12.95 10. 10m run and complete stop Trial 1 3 3.52 3 3.61 4 3.47 11. 10m run, pick up bowling pin and return Trial 1 0 7.72 2 8.46 0 8.78 Trial 1: Really careful the first time. To finish, should have stepped with both feet past end of track : Great speed, better ending Trial 1: Only 1 full cycle completed. Time is not relevant for this trial and can be noted as N/A : Problem solves well how to do at a good speed : Time taken, depending on sensitivity of stop watch will provide a score of 3 or 4 must score to the exact number! Do not round up or down Trial 1: 5 steps backwards before stepping out of path twice : Just manages to hold her balance on the backward portion great concentration : Very difficult skill for her. Great effort Trial 1: Solid finish position. Just needs to speed up : : Fun to try to go even faster this time! Trial 1: Steps out of path while picking up pin : Steps out on return run : Steps out of path while picking up pin Challenge Score Form, August 2014 Page 3 of 6
12. Run through 6 pylon pathway Trial 1 2 7.44 3 5.87 3 5.75 13. 3m backwards walk on line Trial 1 0 5.31 2 13.91 1 4.72 Trial 1; Very nice style Trial 1: Does not stay on line consistently and does not seem to be >1m distance on line at any time : Any foot angle is acceptable as long as part of the foot is on the line : Off several times but distance on line before step off was > 1m 14. Standing broad jump Trial 1 15. Skip forward down a pathway 16. 10 x Skip jump rope Trial 1 2 4.65 2 4.72 2 3.28 Trial 1 1 9.96 1 9.53 3 8.25 Held end position OK cannot score distance from the video. Would have been a good idea for assessor to ask child to stay in position while she marked the distance Trial 1: Looks very natural and easy, just not really fast : : Manages to speed up, but steps on right line at about the 7 m mark so still scores a 2 even though fast enough for a 4. Always watch carefully for this! Trial 1: 2 step overs, 3 jumps : 2 step overs, 8 jumps : All jumps with double bounce 17. Lunch tray pick up and carry 10m Start timing as soon as participant has picked tray up from bench (just as tray lifts off), not before!!! Trial 1 3 13.37 4 9.96 Challenge Score Form, August 2014 Page 4 of 6
# Description Score (0, 1, 2, 3, 4 or NT) 18. Bounce basketball along 10m pathway Time Trial 1 1 N/A 1 N/A 1 N/A 19a. 20 second RIGHT leg stand Trial 1 1 7.16 1 9.75 1 8.88 19b. 20 second LEFT leg stand Trial 1 3 >20.0 Notes (Incl. Modifications) If Not Tested, Indicate Why Trial 1: Max 3 consecutive bounces before a catch. Multiple steps out of path at the beginning in particular. : Max 4 consecutive bounces, then catches to control the ball and start the bounces again. Loses control of ball at about the 7 metre mark and trial ends. : Max 4 consecutive bounces for two rounds then loses control of ball at 5 m and trial ends Trial 1: ignore the first partial attempt (film error). Keep timer going util her L foot touches the ground (swinging it in the air still counts as one leg stand) : Touches toes down to floor may be difficult to see : Touches toes down to floor Trial 1: Arms for stability so even though she looks very stable have to score down to a 3. Decided not to do extra trials as expected that child would have to use arms. Might have been good to still try this arms free approach to be sure 20. 20 second tandem stand on line Trial 1 3 >20 Trial 1: She was likely helped into that position by the PT. Left leg behind was child s choice. Arms used for stability so cannot score more than 3 even though stable. Decided not to do extra trials as expected that child would have to use arms. Might have been good to still try this arms free approach to be sure Challenge Score Form, August 2014 Page 5 of 6
# Description Score (0, 1, 2, 3, 4 or NT) 21. Dribble soccer ball with feet along 10 m pathway Time Trial 1 2 N/A 3 15.36 2 10.07 22a. 5 x cycles step ups RIGHT leg leads Trial 1 2 12.07 2 9.00 22b. 5 x cycles step ups LEFT leg leads Trial 1 2 12.43 2 9.50 3 7.10 23. Sideways two-footed hop over 5m long line Trial 1 0 N/A 2 7.03 3 6.31 24. 5 cycles of in and out stepping pattern across two lines Trial 1 2 8.75 2 9.19 3 7.28 Notes (Incl. Modifications) If Not Tested, Indicate Why Trial 1: Makes it to 9 m before it goes out though. Good to stay close to child due to small risk of fall if having trouble with the skill : Almost out of path after 5m but shadow of the ball still over the path line so OK : She loses control of the ball at the end so cannot score that she did the full 10m Trial 1: : Slight trip but does not count against her as she keeps going and does not lose the pattern. Third trial not filmed Trial 1: : : Trial 1: Less than 5 hops IN TOTAL (for this item do not have to be consecutive to count) : Touches line after 5m mark but one touch is allowed for a 2 : Great Verbal cuing by assessor allowed. Difficult to see taped lines. The camera is also not at the best angle for viewing line touches. The PT is an a perfect position to see. Has been scored as if she did not step on line in any trial. Challenge Score Form, August 2014 Page 6 of 6
25. Balance beam walk, controlled stop. Trial 1 3 6.36 4 4.15 Trial 1: Make sure to stop the timer as soon as child s foot stops on the red mark at end of beam : Well done. No penalty on this item for use of arms for balance Challenge Score Form, August 2014 Page 7 of 6
Overal impression of the participant s ability to participate in the Challenge. Generally, were they able to stay focused throughout the entire test without losing focus/interest in the test? Lost Interest Stayed Focused Additional Assessment Comments Challenge Module (e.g. Discuss motivation, effort, and/or fatigue observed in participant, general adaptations to module.) Additional Comments Feedback from participant (e.g. Discuss participant s comments about ease/difficulty of items, favourite/least favourite items and why). YOU RE DONE! Challenge Score Form, August 2014 Page 8 of 6