Motor Skill Assessments: Standardised Tools an OT May Use

When a child struggles to tie their shoelaces at age eight, when an adult finds holding a coffee cup increasingly difficult after a stroke, or when an elderly person experiences frequent falls—these everyday challenges often signal underlying motor skill difficulties. For families navigating the National Disability Insurance Scheme (NDIS) or seeking support through private occupational therapy services, understanding how motor skills are formally assessed becomes crucial. The difference between receiving appropriate support and missing critical intervention windows often hinges on accurate, evidence-based assessment using standardised tools.

What Are Standardised Motor Skill Assessments and Why Do They Matter?

Standardised motor skill assessments are formally developed evaluation tools with established testing procedures, scoring methods, and normative data collected from large population samples. When occupational therapists use these instruments, they follow specific protocols that ensure consistent administration and interpretation across different clients, settings, and time points.

The importance of standardisation cannot be overstated in contemporary occupational therapy practice. These assessments provide objective measurements that support clinical decision-making, justify funding requests to the National Disability Insurance Agency (NDIA), and track intervention effectiveness over time. Unlike casual observation, standardised tools have undergone rigorous psychometric testing to establish their reliability (consistency of results) and validity (accuracy in measuring what they claim to measure).

For NDIS participants particularly, standardised assessments strengthen applications by providing empirical evidence of functional capacity and support needs. The assessments link motor deficits to participation restrictions in daily activities, education, employment, and community engagement—all critical factors in demonstrating reasonable and necessary criteria for funding.

Standardised motor assessments typically evaluate multiple domains including fine motor precision, manual dexterity, gross motor coordination, balance, strength, and bilateral coordination. The specific tools selected depend on the individual’s age, presenting concerns, functional goals, and the context in which difficulties occur.

Which Standardised Tools Do Occupational Therapists Use for Children?

Paediatric motor assessment requires age-appropriate instruments with comprehensive normative data. Three primary standardised tools dominate Australian occupational therapy practice for children and young people.

Bruininks-Oseretsky Test of Motor Proficiency (BOT-3)

The BOT-3, released in 2024, represents the most recent evolution of this widely used comprehensive motor assessment. Suitable for individuals aged 4 years 0 months through 25 years 11 months, the BOT-3 assesses both fine and gross motor proficiency through subtests evaluating fine motor precision, fine motor integration, manual dexterity, upper limb coordination, bilateral coordination, balance, strength, and dynamic movement.

The complete assessment typically requires 50–90 minutes to administer, though shorter forms are available for screening purposes. The BOT-3 provides scaled scores, standard scores, percentile ranks, and age equivalents, offering multiple ways to interpret motor performance relative to same-aged peers. Importantly, the BOT-3’s normative sample includes data from the United Kingdom, Australia, and New Zealand, enhancing its relevance for Australian occupational therapy practice.

The psychometric properties of the BOT series demonstrate excellent reliability, with inter-rater reliability ranging from 0.92 to 0.99 and test-retest reliability between 0.69 and 0.80. These strong psychometric credentials support the tool’s use in clinical decision-making and NDIS assessments.

Movement Assessment Battery for Children (MABC-3)

The MABC-3, also updated in 2023, extends assessment capability from 3 to 25 years 11 months—a significant expansion from the previous version’s upper age limit of 16 years. This extension particularly benefits occupational therapists working with NDIS participants who require assessment throughout adolescence and into young adulthood.

The MABC-3 evaluates three key motor skill domains across age bands: manual dexterity, aiming and catching (ball skills), and balance and locomotion. Administration typically takes 30–45 minutes, making it more time-efficient than the BOT-3 whilst maintaining comprehensive coverage of motor skills.

The MABC-3’s “traffic light” interpretation system provides intuitive communication of results. Scores at or below the 5th percentile (red zone) indicate significant movement difficulty, scores between the 6th and 15th percentile (amber zone) suggest at-risk status, and scores above the 16th percentile (green zone) indicate unlikely movement difficulty. This system facilitates clear communication with families and funding bodies.

With concurrent validity correlations of 0.80 with the BOT-2 and excellent test-retest reliability (ICC 0.83–0.98), the MABC-3 demonstrates strong psychometric properties. Its particular strength lies in identifying Developmental Coordination Disorder (DCD), commonly known as dyspraxia, though it proves valuable across various paediatric conditions including cerebral palsy, autism spectrum disorder, and ADHD.

Peabody Developmental Motor Scales (PDMS-3)

For infants and young children from birth through 5 years 11 months, the PDMS-3 (released May 2023) provides comprehensive assessment of early motor development. The assessment evaluates gross motor skills through Body Control, Body Transport, and Object Control subtests, alongside fine motor skills through Hand Manipulation and Eye-Hand Coordination subtests.

The PDMS-3 introduces a supplemental Physical Fitness subtest, reflecting contemporary concerns about childhood obesity and fitness levels. Administration typically requires 45–60 minutes for the complete assessment, though individual gross motor or fine motor sections can be administered separately in 20–30 minutes.

Items receive scores on a three-point scale: 0 indicates the child cannot or will not attempt the skill, 1 indicates emerging skill performance that doesn’t fully meet criteria, and 2 indicates skill mastery. This graduated scoring system provides nuanced insight into developmental progression.

The PDMS series demonstrates strong internal consistency (alpha = 0.97) and has been validated internationally, including Rasch analysis with Brazilian samples confirming unidimensionality across subscales. For NDIS participants requiring early intervention, the PDMS-3 provides both assessment data and the Peabody Motor Activities Program (P-MAP) with 104 teaching and therapy activities.

How Are Motor Skills Assessed in Adults and Older People?

Motor assessment in adults and older populations requires different tools focused on functional mobility, fall risk, and fine motor control relevant to independence in activities of daily living.

Nine-Hole Peg Test (9HPT)

The Nine-Hole Peg Test offers a quick, standardised assessment of fine motor dexterity particularly valuable for individuals with stroke, Parkinson’s disease, multiple sclerosis, or neurological conditions. Participants place nine pegs one at a time into holes on a board as quickly as possible, then remove them—all whilst being timed.

Administration requires only 1–2 minutes per hand, making the 9HPT exceptionally time-efficient. Despite its brevity, the test demonstrates excellent psychometric properties with test-retest reliability of ICC 0.95 for the right hand and ICC 0.92 for the left hand in healthy adults. The concurrent validity correlation with the Purdue Pegboard (r = -0.74 to -0.75) and BOT-2 (r = -0.87 to -0.89) confirms it measures fine motor dexterity accurately.

Normative data varies by age, with healthy adults aged 21–35 averaging approximately 18 seconds, whilst those aged 61–80 average 19.6 seconds. This age-related normative data enables interpretation of performance within appropriate reference groups.

Berg Balance Scale (BBS)

For older adults and individuals with balance disorders, the Berg Balance Scale provides comprehensive assessment of static and dynamic balance through 14 functional tasks. These tasks range from sitting to standing without hand support, through standing unsupported for two minutes, to standing on one leg and completing tandem stance positions.

Each item receives scoring from 0 (lowest function level) to 4 (highest function level), with a maximum total score of 56. The assessment typically requires 15–20 minutes to administer using minimal specialised equipment—a standard chair, footstool, ruler, and stopwatch.

The Berg Balance Scale demonstrates excellent predictive validity for fall risk, with scores below 45 indicating greater fall risk. More specifically, scores of 41–56 suggest low fall risk, 21–40 indicate medium fall risk, and 0–20 signal high fall risk. This clear interpretation supports clinical decision-making in fall prevention programmes and home modification recommendations.

Internal consistency exceeds 0.83 for stroke populations and reaches 0.97 for elderly populations. The tool’s sensitivity and specificity of 87% for fall prediction make it a cornerstone assessment in geriatric occupational therapy and aged care services.

Timed Up and Go Test (TUG)

The Timed Up and Go Test provides rapid screening of basic mobility, balance, and fall risk in elderly and clinical populations. Individuals stand from a chair, walk three metres at a comfortable pace, turn around, walk back, and sit down—all whilst being timed.

This remarkably simple assessment requires only 1–2 minutes yet demonstrates excellent test-retest reliability (ICC 0.95–0.98) and strong concurrent validity with the 6-Minute Walk Test (r = -0.96). Healthy adults aged 60–80 typically complete the test in under 10 seconds, whilst times exceeding 13.5 seconds suggest increased fall risk in community-dwelling older adults.

Times exceeding 30 seconds indicate the individual requires assistance for safe mobility, providing clear guidance for support planning. The TUG’s practicality, safety, and strong psychometric properties explain its widespread use in Australian occupational therapy practice, particularly in aged care and NDIS assessments for older participants.

What Makes a Motor Assessment Tool Reliable and Valid?

Understanding the psychometric properties of motor skill assessments helps clarify why occupational therapists select specific instruments and how results inform clinical decisions. Reliability and validity represent fundamental quality indicators for any standardised assessment tool.

Reliability refers to consistency of measurement. Test-retest reliability examines whether the same individual achieves similar scores when tested on different occasions under similar conditions. Inter-rater reliability assesses whether different therapists obtain similar results when testing the same individual. Intra-rater reliability measures whether the same therapist achieves consistent results across multiple administrations.

High reliability coefficients (typically expressed as intraclass correlation coefficients or ICCs) indicate the assessment produces consistent results. For clinical use, reliability coefficients above 0.80 generally indicate good reliability, whilst values above 0.90 suggest excellent reliability. The BOT-3’s inter-rater reliability of 0.92–0.99 and the MABC-3’s test-retest reliability of 0.83–0.98 exemplify the strong reliability expected of standardised motor assessments.

Validity addresses whether the assessment accurately measures what it claims to measure. Content validity ensures the assessment covers relevant motor domains. Construct validity examines whether assessment results align with theoretical understanding of motor development and function. Criterion validity evaluates how well the assessment correlates with other established measures of similar constructs.

Concurrent validity, a type of criterion validity, compares assessment results with other tools administered simultaneously. The MABC-3’s concurrent validity correlation of 0.80 with the BOT-2 demonstrates both assessments measure similar motor constructs, supporting their use interchangeably depending on clinical needs.

Sensitivity and specificity represent additional critical properties, particularly for screening tools. Sensitivity refers to the assessment’s ability to correctly identify individuals with motor difficulties (true positives), whilst specificity indicates its ability to correctly identify those without difficulties (true negatives). The Berg Balance Scale’s 87% sensitivity and specificity for fall prediction exemplify strong discriminative ability.

Minimal detectable change (MDC) and minimal clinically important difference (MCID) help interpret whether changes in scores represent real improvement versus measurement error. The MABC’s MDC of 1.83 points and MCID of 1.39 points provide clear benchmarks for determining meaningful progress—essential for NDIS progress reporting.

Recent advances in psychometric analysis, including Rasch analysis of tools like the PDMS-2, provide deeper insights into item difficulty, construct validity, and measurement properties across diverse populations. Such analyses support the international applicability of assessments and confidence in cross-cultural use.

How Do Motor Skill Assessments Support NDIS Participants?

Motor skill assessments serve multiple critical functions within the NDIS framework, from initial access requests through ongoing support coordination and progress monitoring.

Determining Functional Capacity and Support Needs

Standardised motor assessments provide objective data about an individual’s current functional capacity across motor domains. This evidence forms the foundation for determining what supports are reasonable and necessary to enable participation in daily activities, education, employment, and community life.

Occupational therapists link assessment findings to specific functional impacts. For example, a child scoring in the 2nd percentile on manual dexterity subtests of the MABC-3 may demonstrate difficulties with classroom activities requiring pencil control, self-care tasks involving buttons and zippers, and play activities involving construction toys. These functional impacts, grounded in standardised assessment data, support funding requests for occupational therapy intervention, assistive technology, or support worker assistance.

Establishing Eligibility and Reasonable and Necessary Criteria

The NDIS Act requires supports to be reasonable and necessary, representing value for money, effective and beneficial, and taking account of what is reasonable to expect families and communities to provide. Standardised motor assessments strengthen applications by providing empirical evidence of functional impairment beyond what informal observation can offer.

Assessment results compared to normative populations demonstrate the extent of motor difficulties relative to same-aged peers. A BOT-3 standard score of 70 (two standard deviations below the mean, approximately 2nd percentile) provides clear evidence of significant motor impairment requiring intervention—far more compelling than subjective descriptions of “clumsy” or “slow.”

Guiding Intervention Planning

Beyond establishing eligibility, motor skill assessments guide intervention planning by identifying specific strengths and areas of need. Subtest profiles reveal whether difficulties affect fine motor precision, bilateral coordination, balance, or multiple domains. This specificity enables occupational therapists to develop targeted intervention strategies and select appropriate therapy approaches.

The PDMS-3’s item-level scoring across Body Control, Body Transport, Object Control, Hand Manipulation, and Eye-Hand Coordination domains enables therapists to design developmentally appropriate activities addressing specific emerging skills. The accompanying P-MAP activity guide facilitates translation of assessment findings into practical therapy activities.

Measuring Progress and Intervention Effectiveness

Regular reassessment using standardised tools provides objective progress data essential for NDIS plan reviews and ongoing support justification. Comparing standard scores, percentile ranks, or age equivalents across assessment periods demonstrates whether interventions effectively improve motor function or maintain skills in degenerative conditions.

Understanding MDC and MCID values helps determine whether observed changes represent meaningful improvement versus measurement error. A MABC-3 score improvement exceeding the MDC of 1.83 points provides confidence that real progress occurred rather than random variation.

Supporting Equipment and Modification Requests

Motor assessment findings support requests for assistive technology, home modifications, and vehicle modifications within NDIS plans. A Berg Balance Scale score indicating high fall risk, combined with functional mobility assessment, provides evidence for bathroom modifications, mobility aids, or support worker assistance. Fine motor assessment revealing severe dexterity limitations justifies requests for adaptive equipment for eating, dressing, and writing tasks.

What Should You Expect During a Motor Skill Assessment?

Understanding the assessment process helps individuals and families prepare appropriately and participate effectively in motor skill evaluations.

Initial Consultation and Information Gathering

Assessment typically begins with gathering background information about developmental history, medical conditions, previous therapies, current functional concerns, and goals. Occupational therapists explore how motor difficulties impact daily activities across home, school, work, and community settings. This contextual information guides tool selection and interpretation.

For NDIS participants, occupational therapists discuss plan goals, approved funding, and how assessment findings will inform support planning. Clear communication about assessment purposes, expected duration, and outcomes ensures shared understanding between therapists, participants, and families.

Assessment Environment and Materials

Most standardised motor assessments require adequate space for movement activities and a table for fine motor tasks. Whilst some assessments require specific equipment (the 9HPT needs its standardised pegboard, the Berg Balance Scale requires a footstool), most use readily available materials.

Mobile occupational therapy services like those offered throughout Queensland, Victoria, New South Wales, and Tasmania can conduct many assessments in clients’ homes, though some tools benefit from clinic environments with greater space and fewer distractions. Telehealth options may incorporate parent-administered screening tools and observational assessment, though standardised tool administration typically requires in-person evaluation.

Assessment Administration

Standardised assessments follow specific protocols for instructions, demonstrations, practice trials, and scoring. Occupational therapists balance adherence to standardised procedures with creating comfortable, supportive environments that elicit optimal performance.

Assessment duration varies considerably. The 9HPT requires only 1–2 minutes per hand, whilst the complete BOT-3 may extend 50–90 minutes. Longer assessments might be split across multiple sessions, particularly for young children or individuals with attention or fatigue concerns. The PDMS-3 permits splitting across sessions within a five-day period, maintaining standardisation whilst accommodating practical limitations.

Most assessments include practice trials enabling participants to understand task requirements before timed or scored attempts begin. Clear, standardised instructions ensure all individuals receive equivalent testing conditions.

Scoring and Interpretation

Following assessment completion, occupational therapists score responses, calculate composite scores, and compare results to normative data. Standard scores, percentile ranks, and age equivalents provide different perspectives on performance. Standard scores (typically with mean of 100 and standard deviation of 15) enable comparison to population averages. Percentile ranks indicate what percentage of the normative sample scored lower. Age equivalents show the age at which the achieved score represents typical performance.

Descriptive categories translate numerical scores into interpretive language. The MABC-3’s traffic light system (red/amber/green) and the BOT-3’s descriptive categories (well below average, below average, average, above average, well above average) facilitate communication with individuals and families.

Assessment Reporting

Comprehensive assessment reports document assessment tools used, performance across subtests and composite scores, comparison to normative data, observed strengths and difficulties, functional implications, and recommendations. For NDIS participants, reports explicitly link motor findings to participation restrictions and reasonable and necessary support needs.

Reports translate technical assessment data into meaningful information about daily function. Rather than simply stating a BOT-3 manual dexterity standard score of 75, effective reports explain this score falls approximately 1.7 standard deviations below average (approximately 6th percentile), indicating significant difficulty with tasks requiring precise finger and hand movements such as fastening buttons, using cutlery, and manipulating classroom materials.

Comparing Key Motor Assessment Tools

The following table summarises essential characteristics of primary standardised motor skill assessments used by occupational therapists in Australian practice:

Assessment Tool	Age Range	Primary Domains	Administration Time	Key Clinical Application
BOT-3	4:0–25:11 years	Fine motor precision, integration, dexterity; Gross motor coordination, balance, strength	50–90 minutes (complete); 25–45 minutes (domain-specific)	Comprehensive motor proficiency assessment; NDIS functional capacity evaluation
PDMS-3	Birth–5:11 years	Body control, transport, object control; Hand manipulation, eye-hand coordination, physical fitness	45–60 minutes (complete); 20–30 minutes (domain-specific)	Early childhood motor development; early intervention planning
MABC-3	3–25:11 years	Manual dexterity; Aiming and catching; Balance and locomotion	30–45 minutes	Developmental coordination disorder identification; motor difficulty screening
9HPT	4+ years	Fine motor dexterity; Finger coordination	1–2 minutes per hand	Quick fine motor screening; neurological condition monitoring
Berg Balance Scale	Primarily 60+ years	Static and dynamic balance; Functional mobility	15–20 minutes	Fall risk assessment; aged care evaluation
Timed Up and Go	Primarily 60+ years	Basic mobility; Balance during transitions	1–2 minutes	Rapid fall risk and mobility screening

Moving Forward with Motor Assessment

Motor skill assessments represent far more than clinical formalities—they provide the evidence base for understanding functional capacity, planning effective interventions, and securing appropriate supports. The evolution of assessment tools, with recent releases of the BOT-3, MABC-3, and PDMS-3 incorporating extended age ranges and updated normative data including Australian samples, strengthens the relevance and applicability of these instruments in contemporary practice.

For individuals navigating motor difficulties, whether developmental coordination challenges in childhood, neurological conditions in adulthood, or mobility decline in later years, standardised assessment provides the objective foundation for moving forward. These tools enable occupational therapists to identify specific motor strengths and limitations, translate those findings into functional implications, and develop evidence-based intervention plans.

Within the NDIS framework, motor skill assessments serve the dual purposes of establishing eligibility and guiding support planning. The reasonable and necessary criteria require objective evidence of functional impact—precisely what standardised motor assessments provide. Combined with observational assessment in natural environments and client-centred goal-setting, standardised tools complete a comprehensive picture of motor function and support needs.

The integration of psychometric rigour with practical clinical utility characterises effective motor assessment tools. Strong reliability ensures consistent measurement across therapists, sessions, and settings. Established validity confirms assessments accurately capture motor function. Normative data enables meaningful interpretation relative to typical development and function. Together, these properties support confident clinical decision-making and robust evidence for funding applications.

As assessment tools continue evolving, incorporating contemporary research, extended age ranges, and internationally representative norms, occupational therapists across Queensland, Victoria, New South Wales, and Tasmania gain increasingly sophisticated instruments for measuring motor function. Whether delivered through mobile services visiting homes throughout Brisbane, North Lakes, Sydney, Melbourne, the Gold Coast, and Sunshine Coast regions, or via telehealth across these states, standardised motor skill assessments remain fundamental to occupational therapy practice.