Student Name _______________________ Date of assessment _____________
Person Completing Checklist _______________________ Position ______________________
During this assessment, informal measures were utilized to evaluate the student's ability to access print, produce written communication, access the computer and use various assistive technologies. Some of the information requested may be obtained from the Learning Media Assessment, the Clinical Low Vision Evaluation or the Functional Low Vision Evaluation.
Accessing Print
Regular Print
When accessing printed information, the
_____ Student is able to read regular print materials at _____ inches without adaptations.
_____ Student is able to read regular print materials with adaptations.
_____ using prescribed glasses or contacts
_____ materials enlarged on photocopying machine - Specify (i.e. 130%, 3 times) __________ Student is able to read regular print materials with or without adaptations for _____ min before experiencing either visual or physical fatigue.
Large Print
When accessing large print with prescribed optical aid (if appropriate) the student is able to read
72 point print at approximately _____ inches. 60 point print at approximately _____ inches. 48 point print at approximately _____ inches. 36 point print at approximately _____ inches. 30 point print at approximately _____ inches. 24 point print at approximately _____ inches. 18 point print at approximately _____ inches. 14 point print at approximately _____ inches. 12 point print at approximately _____ inches.
_____ student prefers less lighting than currently available.
_____ student prefers to have materials placed on a reading stand or copy holder.
Braille and Tactile
When accessing information through braille and tactile graphics, the
_____ student is able to use simple tactile graphics.
_____ student is able to read materials in braille. Attach results of formal/informal Braille Assessments conducted by TVI.
_____ student's oral braille reading rate is _____ wpm
_____ student is able to read braille on an electronic/refreshable braille display.
Auditory
When accessing printed information auditorally, the
_____ student is able to demonstrate comprehension by answering simple questions & relating details about a passage when it is read to him/her.
_____ student is able to paraphrase information presented orally (sentence or story.)
_____ student is able to write, type, or braille what he/she heard (sentence dictation) without having it repeated more than twice.
_____ student is able to put tape in and remove tape from player/recorder.
_____ student is able to activate play, pause, stop, fast forward and rewind functions (please underline those demonstrated.)
_____ student is able to understand and comprehend compressed or "fast" speech.
_____ student is able to manipulate variable speed and pitch controls.
Reading Rates
(This is an optional section used when needed to demonstrate to the student, parents, teachers or administrators the benefits of using adaptations when reading.)
When reading printed information, the
student is able to read _____ wpm orally when provided with 12 point materials.
student is able to read _____ wpm orally when provided with materials in the optimum size for viewing at 10 -13 inches (_____ point print.)
student is able to read _____ wpm orally when using a CCTV.
student is able to read _____ wpm orally when using VisAbility.
student is able to read _____ wpm orally when provided with materials in braille.
student is able to read _____ wpm orally when provided with recorded materials.
Other
When using a large print calculator, the
_____ student is able to see _____ inch numerals displayed on a large print calculator.
_____ student is able to accurately manipulate keys on a large print calculator.
student is able to perform basic functions ___ with, ___ without instruction.
When using a talking calculator, the
_____ student is able to understand synthesized speech produced by a talking calculator.
_____ student is able to accurately manipulate keys on a talking calculator.
student is able to perform basic functions ___ with, ___ without instruction.
When using a talking dictionary, the
_____ student is able to understand synthesized speech produced by a talking dictionary.
_____ student is able to accurately manipulate keys on a talking dictionary.
student is able to perform basic functions ___ with, ___ without instruction.
When accessing information presented on black board or overhead projector, the student reported that he/she
_____ sits close enough to read board. _____ gets a copy from the teacher _____ gets a copy from other students. _____ uses a hand held or spectacle mounted telescope _____ has information read aloud to student and _____ writes information on paper _____ types information into computer or portable note taker. _____ brailles on braille writer _____ records on tape recorder. _____ Other, please specify ________________________________________________
Are these options working adequately? ___ yes ___ no Explain briefly: ______________
_____ student's manuscript writing is legible. _____ student's cursive writing is legible. _____ student's spacing is intact. _____ student's writing is labored and difficult. _____ student is able to write _____ wpm from ___ dictation, ___ copy. _____ student is able to read his/her own writing. _____ student is able to sign his/her name legibly in cursive ___ with, ___ without a signature guide.
When writing with the following adaptation the student's _____ manuscript, _____ cursive writing is legible.
_____ a screen board _____ bold line paper _____ raised line paper _____ a felt tip pen _____ a white board and erasable marker _____ Other modifications _________________________________________
When using a braille writing device, the
_____ student is able to use a manual braille writer to emboss characters, words and sentences at ___ wpm from ___ dictation, ___ copy.
_____ student is able to use the slate & stylus to emboss characters, words and sentences at ___ wpm from ___ dictation, ___ copy.
_____ student is able to use the MountBatten brailler to emboss characters, words and sentences at ___ wpm from ___ dictation, ___ copy.
_____ student is able to use a portable note taking device such as the Braille 'n Speak to enter characters, words and sentences at ___ wpm from ___ dictation, ___ copy.
When using an electronic writing device, (computer, portable note taker) the
_____ student is able to write characters, words and sentences.
_____ student is able to perform basic functions ___ with, ___ without instruction from the examiner.
When accessing electronic information on a stand alone computer or in the computer lab, the
_____ student is able to read menus and other system text items on a _____ inch monitor at approximately _____ inches.
student was able to read bold _____ point print in an ___ Arial, ___ Antique Olive, ___ Tahoma, ___ Verdana font displayed on a _____ inch monitor at approximately 13 inches.
student is able to see information on the standard computer monitor with
_____ screen magnification hardware (Compu-Lenz) at approximately ____ inches. _____ flexible arm monitor stand at approximately _____ inches. _____ screen enhancements provided with computer operating system _____ WIN 95/98 High Contrast _____ WIN 95/98 Large _____ WIN 95/98 Extra Large _____ screen magnification software with _____ magnification
When accessing the computer through the use of screen magnification software, the
_____ student is able to read 12 point print enlarged to _____x magnification at a viewing distance of approximately 13 inches.
_____ student expressed a polarity preference for; _____ dark on light, _____ light on dark.
_____ student is able to locate and select menu items, buttons and icons with the mouse/pointing device.
_____ student is able to navigate around the magnified image with the mouse/pointing device.
student ___ is, ___ is not able to maintain orientation when navigating around the screen.
_____ student is able to read text in the panning/review mode with a speed setting of _____.
_____ student expressed a viewing mode preference. Specify ___________________________
_____ Student is unable to access the computer visually.
Auditory
When accessing computer based information auditorally, the
_____ student is able to understand synthesized speech produced by
Software synthesizer
_____ Kids Time Deluxe _____ Write Outloud _____ Other
_____ Flextalk _____ TrueVoice
_____ Dectalk Access 32 _____ Eloquence
Hardware synthesizer
_____ Braille/Type 'n Speak _____ Double Talk _____ Other
_____ Accent SA _____ Dectalk
_____ student is able to execute navigation commands with instruction.
Tactile
When accessing computer based information tactually, the
_____ student is able to read braille text displayed on an electronic refreshable braille display.
_____ student is able to execute navigation commands with instruction.
_____ student is able to enter text through the braille keyboard.
Input Devices
Keyboard Use
_____ The student is able to use a standard keyboard without adaptation. _____ The student is able to locate and identify alphanumeric keys. _____ The student is able to locate and identify function keys. _____ The student is able to activate two keys simultaneously. _____ The student does not demonstrate excessive miss-hits or key repeats. _____ The student uses good mechanics when typing. (Posture, wrist elevation, etc.) _____ The student types with ___ fingers of right hand and ___ fingers of left hand. _____ The student demonstrates keyboard awareness (has a general knowledge of the key locations). _____ The student is able to touch type while looking at his/her hands. _____ The student is able to touch type without looking at his/her hands. _____ The student is able to utilize a standard computer keyboard with adaptations. (Seek assistance from occupational and physical therapist as needed.)
_____ other Specify _____________________________________________________
The student is able to utilize a standard computer keyboard with the following keyboard utilities. (Seek assistance from general technology specialist, OT or PT to complete this section.)
_____ The student is not able to utilize a standard keyboard with or without adaptations. (If checked, refer student for a Computer Access Evaluation.)
Use of a Pointing Device
_____ The student is able to navigate the desktop with the standard mouse/trackball.
_____ The student is able to maintain the mouse position while clicking/double-clicking.
_____ The student is able to maintain eye contact with the screen while navigating the desktop.
_____ The student is able to access pull-down menus with the standard mouse.
_____ The student is not able to use a standard mouse. (If checked, please request a Computer Access Evaluation.)
Based on the results of this assessment, the following recommendations are made regarding assistive technology to support this student's educational objectives.
Accessing Printed Materials (Students with visual impairments will use a combination of strategies to access printed information. Some will be appropriate for short reading assignments and others will be necessary for longer passages.)
Check all that apply
_____ Student should use regular print materials for _____ short reading assignments. _____ most reading assignments.
_____ Student should use regular print materials with optical aids. _____ glasses/contact lenses _____ hand held magnifier _____ stand magnifier
_____ Student should use materials written with felt tip pen on bold line paper.
_____ Student should use regular print materials enlarged on a photocopying machine.
_____ Student should use large print books.
_____ Student should use regular print materials scanned into a computer, edited and printed out in ______ point print.
_____ Student should use regular print materials with CCTV (Closed Circuit TeleVision).
_____ Student should use regular print materials with the VisAbility program.
_____ Student should use materials in braille.
_____ Student should use recorded materials.
_____ Student should use a computer assisted reading system such as Kurzweil 1000, Open Book, etc.
_____ Student should use a ___ basic, ___ scientific calculator with at least 1/2" numeral display.
_____ Student should use a ___ basic, ___ scientific talking calculator.
_____ Student should use calculator program on computer.
_____ Student should use a large print dictionary with at least 18 point print.
_____ Student should use dictionary/thesaurus program on computer.
_____ Student should use a talking dictionary
_____ Student should use crayons and a screen board to develop basic tactile skills using tactile graphics.
_____ Student should use tactile graphics to access maps, charts, diagrams, etc.
Producing Written Communication (Students with visual impairments will use a combination of strategies to produce written communication. Some will be appropriate for short writing assignments and others will be necessary for longer assignments.)
Check all that apply
_____ Student should use pen/pencil and paper
_____ for short writing assignments.
_____ for most writing assignments.
_____ Student should use felt tip pen and bold line paper.
_____ Student should use bold line graph paper for math.
_____ Student should use crayons and a screen board for beginning handwriting.
_____ Student should use a white board with erasable markers.
_____ Student should use a computer with the word processing software most commonly used in the student's school.
_____ Student should use computer with form filling software such as VisAbility.
_____ Student should use manual braille writer.
_____ Student should use manual braille writer with extended keys.
_____ Student should use a unimanual braille writer.
_____ Student should use slate & stylus.
_____ Student should use an electronic braille writer. Specify: __________________________
_____ Student should use portable word processor (Braille 'n Speak/Type 'n Speak, etc.)
The recommendations made above do not all have to be implemented immediately. The suggestions are designed for a 2 - 3 year plan in which the student masters certain skills and is provided access to additional technologies that can facilitate his/her educational program. During that time, new technologies will become available that will enhance his/her ability to maximize his/her educational potential. The specific devices recommended may no longer be the most appropriate, but the assistance that they provide will continue to be a need for this student.
_____________________________________ ____________________________________ Assessment Completed by (Signature) Position
This document was developed by Ike Presley, American Foundation for the Blind, (100 Peachtree Street, Suite 620, Atlanta, GA 30303) Permission to photocopy is granted for non-commercial purposes if this credit is retained.