This document contains a physiotherapy assessment form for measuring a child for a standing frame and sitting chair. It includes sections to record the child's personal details, medical history, and measurements for various body parts and positions. The measurements will be used to customize the standing frame and sitting chair sizes and additional supports needed, like belts, harnesses, and orthotics. The assessor records all relevant dimensions to ensure proper fit and function of the equipment.

1. Karuna Vihar EIC
Physiotherapy Assessment Form
Standing frame cum sitting chair – Assessment Form
Date: _____/_____/ 20__
Name of Child- ............................................. ........
Age/Gender- .........................................................
Weight (Kgs) …………………………………………...............
Height (inches) ……………………………………….................
Contact Details ………………………………………................
Assessor ………………………………………………..........
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Brief description of Neurological Impairment and associated secondary issues:
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2. Measurement for Sitting Chair:
Note: Assessment for sitting is done with child sitting on the low level stool with back unsupported.
Measurement for Standing Frame:
TYPE OF STANDING FRAME
Prone stander/Supine stander
With inclination/w/o inclination
Measurements with standard inch tape In Inches
Heel to Occiput
Heel to Acromian Process
Heel to Inferior angle of scapula
Heel to PSIS level
Heel to knee
Pelvic width
Standing Frame Measurement In Inches
1. Height of Standing Frame
2. Width of Standing Frame

3. Table/Desk Measurement
Length and width -
Depth of the circumference –
C size (Right to left midaxillary line with centre at xiphisternum) -
Longitudinal depth (Perpendicular line intersecting between midaxillary line and xiphisternum)-
Table Height:
Sitting chair (From buttocks to Olecranon process of elbow, when child is in sitting on a stool and elbow flexed
to 90 degree)-
Standing frame (from bottom of heel to Olecranon process of elbow with elbow flexed to 90 degree)-
Additional supports:- In Inches
Belts=
At the level of T2-T8(Chest belt)
At the level of Pelvis
Chest Harness
Velcro=
At the level of 2 ‘’ above Knee
2 At the level of 2 ‘’ below Knee
At the level of 2 ‘’ above medial malleolus
Mid foot level
AFO/Knee Gaiters/Arch Support/any other orthotic
Note: Assessment for standing frame has to be done in supine lying position.
Please describe any functional limitations not mentioned above, giving dimensions where appropriate:-
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Physiotherapist
Signature and Name of Physiotherapist