Questionaire

Children Aged 2 to <4 Years

My child…

Has difficulty controlling head and trunk posture in most positions and uses specially adapted seating to sit comfortably and has to be lifted by another person to move about

Can sit on own when placed on the floor and can move within a room and uses hands for support to maintain sitting balance and usually uses adaptive equipment for sitting and standing and moves by rolling, creeping on stomach or crawling

Can sit on own and walk short distances with a walking aid (such as a walker, rollator, crutches, canes, etc.) and may need help from an adult for steering and turning when walking with an aid and usually sits on floor in a “W-sitting” position and may need help from an adult to get into sitting and may pull to stand and cruise short distances and prefers to move by creeping and crawling

Can sit on own and usually moves by walking with a walking aid and may have difficulty with sitting balance when using both hands to play and can get in and out of sitting positions on own and can pull to stand and cruise holding onto furniture and can crawl, but prefers to move by walking

Can sit on own and moves by walking without a walking aid and is able to balance in sitting when using both hands to play and can move in and out of sitting and standing positions without help from an adult and prefers to move by walking

Children Aged 4 to <6 Years

My child…

Has difficulty sitting on their own and controlling their head and body posture in most positions and has difficulty achieving any voluntary control of movement and needs a specially-adapted supportive chair to sit comfortably and has to be lifted or hoisted by another person to move

Can sit on their own but does not stand or walk without significant support and adult supervision and may need extra body / trunk support to improve arm and hand function and usually needs adult assistance to get in and out of a chair and may achieve self-mobility using a powered wheelchair or is transported in the community

Can walk on their own using a walking aid (such as a walker, rollator, crutches, canes, etc.) and can usually get in and out of a chair without adult assistance and may use a wheelchair when travelling long distances or outside and finds it difficult to climb stairs or walk on an uneven surface without considerable help

Can walk on their own without using a walking aid, but has difficulty walking long distances or on uneven surfaces and can sit in a normal adult chair and use both hands freely and can move from the floor to standing without adult assistance and needs to hold the handrail when going up or down stairs and is not yet able to run and jump

Can walk on their own without using a walking aid, including fairly long distances, outdoors and on uneven surfaces and can move from the floor or a chair to standing without using their hands for support and can go up and down stairs without needing to hold the handrail and is beginning to run and jump

Children Aged 6 to <12 Years

My child…

Has difficulty sitting on their own and controlling their head and body posture in most positions and has difficulty achieving any voluntary control of movement and needs a specially supportive chair to sit comfortably and has to be lifted or hoisted by another person to move

Can sit on their own but does not stand or walk without significant support and therefore relies mostly on wheelchair at home, school and in the community and often needs extra body / trunk support to improve arm and hand function and may achieve self-mobility using a powered wheelchair

Can stand on their own and only walks using a walking aid (such as a walker, rollator, crutches, canes, etc.) and finds it difficult to climb stairs, or walk on uneven surfaces and may use a wheelchair when travelling for long distances or in crowds

Can walk on their own without using walking aids, but needs to hold the handrail when going up or down stairs and often finds it difficult to walk on uneven surfaces, slopes or in crowds

Can walk on their own without using walking aids, and can go up or down stairs without needing to hold the handrail and walks wherever they want to go (including uneven surfaces, slopes or in crowds) and can run and jump although their speed, balance, and coordination may be slightly limited

Young People Aged 12 - 18 Years

My child…

Has difficulty sitting on their own and controlling their head and body posture in most positions and has difficulty achieving any voluntary control of movement and needs a specially adapted chair to sit comfortably and be transported anywhere and has to be lifted or hoisted by another person or special equipment to move

Can sit with some pelvic and trunk support but does not stand or walk without significant support and therefore always relies on wheelchair when outdoors and can achieve self-mobility using a powered wheelchair and can crawl or roll to a limited extent to move around indoors

Can stand on their own and only walks using a walking aid (such as a walker, rollator, crutches, canes, etc.) and finds it difficult to climb stairs, or walk on uneven surfaces without support and uses a variety of means to move around depending on the circumstances and prefers to use a wheelchair to travel quickly or over longer distances

Can walk on their own without using walking aids, but needs to hold the handrail when going up or down stairs and therefore walks in most settings and often finds it difficult to walk on uneven surfaces, slopes or in crowds and may occasionally prefer to use a walking aid (such as a cane or crutch) or a wheelchair to travel quickly or over longer distances

Child Mobility Assessment Questionnaire

Children Aged 2 to <4 Years

Children Aged 4 to <6 Years

Children Aged 6 to <12 Years

Young People Aged 12 - 18 Years