Upper Extremity Evaluation and Checklist Forms
Occupational/Physical Therapist UE Functional Evaluation
A pre and post prosthetic evaluation form. It will help the OT/PT evaluate an UE limb loss/ limb deficient client as well as help the OT/PT set goals.
*Disclaimer: Otto Bock advises therapists to use this evaluation as a resource only.
This is NOT a definitive tool to approve or deny prosthetic devices.
Upper Extremity Prosthetic Functional Activity Checklist
*A comprehensive list of functional activities that a client will come across on a daily basis. It can be used as a questionnaire with the client to help set short and long term goals.
