Developmental Practitioners Association

Your identifier

Date of First Assessment

Age on entry (whole years only)

Brief comments on main issues at start of therapy

Brief comments on outcomes at end of therapy

You can either type in the boxes or use the up/down arrows in each box

Impairment 1 - Uninhibited Primitive Reflex scores

Impairment 1

Activity/Independence

Social Participation

Wellbeing

Carer Wellbeing

Impairment 2 scores

Impairment 2

Diagnosis or general description of impairment

Impairment 2 category - choose best fit from this list if there is no diagnosis yet and give more detail in the box below

Communicating and interacting

Cognition and learning

Social, emotional and health difficulties

Sensory and/or physical needs

Diagnosed Special Education Need

Diagnosed medical condition

Length of intervention in weeks

Impairment 1 - Uninhibited Primitive Reflex scores

Impairment 1 post

Activity/Independence post

Social Participation post

Wellbeing post

Carer Wellbeing post

Impairment 2 post intervention scores

Impairment 2 post

Impairment 1 - uninhibited primitive reflexes

Impairment 1 change

Impairment 2 change

Activity/Independence change

Social Participation change

Wellbeing change

Carer Wellbeing change

I consent to have the DPA store my submitted information in the Developmental Practitioners Association TOMs research project