Student Name __________________________ Date of assessment _______ School/System ______________________
Additional Vision Background Information Please complete with input from vision teacher Vision Teacher ____________________________ Phone _____________________________
Date of most recent eye exam _________________
Visual status: Right/OD - _____________ Left/OS - ____________________________ Field loss (Please describe in detail) __________________________________________ Optimal placement of stimuli _______________________________________________ Age/Date of onset ______________________________________________________ Cause of visual impairment (Etiology) ________________________________________ Is visual condition stable? _________________________________________________ Describe any deficiencies in color vision ______________________________________
Date of most recent Low Vision Exam _______________________
Was Low Vision Aid prescribed? Specify _____________________________________
Date of most recent Learning Media Assessment _______________
Results _________________________________________________________________ ________________________________________________________________________ Does student experience visual fatigue? (Describe conditions under which fatigue occurs) ________________________________________________________________________
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 .
Accessing Print Regular Print When accessing printed information, the _____ Student was able to read print materials without adaptations. _____ Student was able to read print materials with adaptations.
_____ acetate overlays for "dittos". Specify color(s) ____________________________ _____ materials produced with felt tip pen on bold line paper _____ materials enlarged on photocopying machine - Specify (i.e. 130%, 3 times) _____
_____ Student was not able to read print materials with or without adaptations. (If checked, skip to Braille section.)
Large Print When accessing large print the student was 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.
Optical Aids When accessing printed materials through the use of an optical aid, the student was able to use
_____ glasses _____ contact lens _____ hand held/stand magnifier, power _____ _____ telescope, power ________ _____ a CCTV (Closed Circuit TeleVision). _____ inch text on a _____ inch monitor viewing distance _____ inches polarity preference; _____ dark on light _____ light on dark
Use of CCTV controls. The student was able to:
_____ adjust size of image. _____ focus image. _____ adjust vertical brake on X/Y table. _____ independently use X/Y table for viewing materials. _____ adjust left/right margin stops.
Use of the VisAbility program with an optical scanner connected to a computer
preferred magnification ___________ viewing distance _____ inches polarity preference; _____ dark on light _____ light on dark
Use of VisAbility features. The student was able to:
_____ select menu items and tools from the toolbar with the mouse. _____ navigate around the magnified image with the mouse. _____ read text in the panning/review mode with speed setting of _____.
Braille and Tactile When accessing information through Braille and tactile graphics, the
_____ Student was able to use simple tactile graphics. _____ Student was able to read materials in Braille. Briefly describe student's Braille skills. ________________________________________________________________________ ________________________________________________________________________
_____ Student was able to read Braille on an electronic Braille display.
Auditory When accessing printed information auditorally, the
_____ Student was able to comprehend a passage when it is read to him/her (relate details/answer.) _____ Student was able to paraphrase information presented orally (sentence or story.) _____ Student was able to write, type, or Braille what he/she heard (sentence dictation) without having it repeated more than twice. _____ Student was able to understand and comprehend "fast" speech.. _____ Student was able to put tape in and remove tape from player/recorder. _____ Student was able to activate play, pause, stop, fast forward and rewind functions (please circle). _____ Student was able to utilize variable speed and pitch controls.
Reading Rates(This is an optional section used when needed to convince student of the benefits of using adaptations when reading.) When reading printed information, the
Student was able to read _____ wpm orally when provided with 12 point materials. Student was able to read _____ wpm orally when provided with materials in optimum size for viewing at 8-10 inches (_____ point print). Student was able to read _____ wpm orally when using a CCTV. Student was able to read _____ wpm orally when using VisAbility. Student was able to read _____ wpm orally when provided with materials in Braille. Student was able to read _____ wpm orally when provided with recorded materials.
Other When using a large print calculator, the
_____ Student was able to see _____ numbers displayed on a large print calculator. _____ Student was able to accurately manipulate keys on a large print calculator. _____ Student was able to perform basic functions with prompts.
When using a talking calculator, the
_____ Student was able to understand speech produced by a talking calculator. _____ Student was able to accurately manipulate keys on a talking calculator. _____ Student was able to perform basic functions with prompts.
When using a talking dictionary, the
_____ Student was able to understand speech produced by a talking dictionary. _____ Student was able to accurately manipulate keys on a talking dictionary. _____ Student was able to perform basic functions with prompts.
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 ________________________________________________
Producing Written Communication When using standard writing tools, the
_____ Student's manuscript writing was legible _____ Student's cursive writing was legible _____ Student's spacing was intact _____ Student's writing was labored and difficult _____ Student was able to write _____ words/minute
When writing with the following adaptation the student's _____ manuscript, _____ cursive writing was legible.
_____ a screen board _____ bold line paper _____ raised line paper _____ a felt tip pen _____ a white board and erasable marker _____ Other modifications _________________________________________
When using an electronic writing device, the
_____ Student was able to write characters, words and sentences. _____ Student was able to understand synthesized speech. _____ Student was able to perform basic functions with prompts.
When using a Braille writing device, the
_____ Student was able to use a manual Braille writer to emboss characters, words and sentences. _____ Student was able to use the slate & stylus to emboss characters, words and sentences. _____ Student was able to use the Mountbatten Brailler to emboss characters, words and sentences. _____ Student was able to use the Braille 'n Speak to write characters, words and sentences. _____ Student was able to understand synthesized speech of Type 'n Speak. _____ Student was able to perform basic functions with prompts.
When using standard or adaptive writing tools, the
_____ Student was able to read his/her own handwriting. _____ Student was able to copy accurately from textbook or worksheet. _____ Student was able to sign his/her name legibly in cursive.
Visually: When accessing computer based information, the
_____ Student was able to read 12 point print on the standard computer monitor at approximately _____ inches. _____ Student was able to read bold _____ point print displayed on the computer monitor at approximately 13 inches. _____ Student was able to see information on the standard computer monitor with adaptations.
_____ screen enlarging hardware - Specify ____________________________________ _____ flexible arm monitor stand (viewing distance, 2-4 inches) _____ screen enlarging software with _____ magnification
When accessing the computer through the use of screen enlarging software, the
_____ Student was 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 was able to select menu items and tools from the toolbar with the mouse. _____ Student was able to navigate around the magnified image with the mouse. _____ Student was able to read text in the panning/review mode with speed setting of _____.
_____ Student was unable to access the computer visually.
Auditorally: When accessing computer based information auditorily, the
_____ Student was able to understand synthesized speech.
Hardware synthesizer _____ Braille/Type 'n Speak _____ Double Talk _____ Accent SA _____ Dectalk
Tactually: When accessing computer based information tactually, the
_____ Student was able to use an electronic refreshable Braille display
Keyboard use:
_____ Student was able to use a standard keyboard without adaptation.
_____ Student was able to identify alphanumeric keys. _____ Student was able to identify function keys. _____ Student was able to activate two keys simultaneously. _____ Student does not have miss-hits or key repeats. _____ Student used good mechanics when typing. _____ Student utilized _____ fingers of right hand _____ fingers of left hand.
_____ Student demonstrated keyboard awareness (has a general knowledge of the key locations). _____ Student was able to touch type while looking at his/her hands. _____ Student was able to touch type while not looking at his/her hands.
_____ Student was able to utilize standard computer keyboard with adaptations.
_____ zoom caps _____ keyguard _____ finger guard/pointer _____ keylatch _____ wrist/arm support _____ head pointer _____ moisture guard _____ tactile locator dots _____ mouthstick _____ other Specify _____________________________________________________
Student was able to utilize the following keyboard utilities
_____ Student was not able to utilize standard keyboard with or without adaptations. (If checked, please complete the Computer Access Evaluation protocol.) Mouse control:
_____ Student was able to navigate the desktop with the standard mouse/trackball. _____ Student was able to maintain the mouse position while clicking/double-clicking. _____ Student was able to maintain eye contact with the screen while navigating the desktop. _____ Student was able to access pull-down menus with the standard mouse. _____ Student was not able to use a standard mouse: (If checked, please complete the Computer Access Evaluation protocol.) Additional Assessment Information: ________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Recommendations Based on the results of this assessment, the following recommendations are made regarding assistive technology to support this student's educational objectives. See Attachments for additional information on numbered items.
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.)
_____ Student should use regular print materials for
_____ short reading assignments. _____ most reading assignments.
_____ Student should use materials written with felt tip pen on bold line paper. _____ Student should use regular print materials with optical aids.
_____ glasses/contact lenses _____ hand held magnifier _____ stand magnifier
_____ 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 computer assisted reading system
_____ Kurzweil 1000 _____ Open Book _____ VERA _____ Other: ____________________________________________________________
_____Student should use a large print calculator with at least 1/2" numeral display. _____ Student should use a 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 an electronic dictionary.
_____ Talking Dictionary
_____ Student should use crayons and a screen board to develop basic tactile skills using tactile graphics. Comments: ____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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.)
_____ 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 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 slate & stylus. _____ Student should use an electronic Braille writer. Specify: __________________________ _____ Student should use portable word processor (Braille 'n Speak/Type 'n Speak, etc.) Comments: ____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Accessing the Computer Input Mode
_____ Student should use a standard keyboard. _____ Student should develop/improve keyboarding skills. _____ Student should use a standard keyboard with adaptations - Specify _________________ _____ Student should use an alternative keyboard - Specify ____________________________ _____ Student should use a standard mouse or other pointing device.
Output Mode
_____ Student should use a standard computer monitor - Optimal size: ___________________ _____ Student should use a standard computer monitor with hardware adaptations
_____ adjustable monitor arm _____ Compu Lens
_____ Student should use screen enlarging software
_____ Student should use a talking word processing - Specify ___________________________ _____ Student should use a speech synthesizer/sound card and screen reading software-
_____ Student should use a Braille Display - Specify __________________________________
Additional Hardware & Software Student should be provided with access to the following hardware & software;
_____ Macintosh computer system with
_____ Mb memory _____ hard drive _____ CD drive _____ modem
_____ IBM compatible computer system with
_____ Mb memory _____ hard drive _____ CD drive _____ modem
_____ Optical Scanner _____ Printer _____ Word processor used in student's school _____ CD Encyclopedia _____ Dictionary _____ Atlas _____ Internet access _____ Other: _____________________________________________________________ ________________________________________________________________________
Equipment needed to produce materials for student in appropriate format.
_____ Mac or IBM compatible computer system _____ Optical scanner _____ OCR software _____ Word processing software _____ Braille translating software _____ Inkjet or laser printer _____ Braille embosser/printer Additional comments/recommendations: ____________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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. At such time, a consultation, and maybe a re-evaluation will be prudent. Please do not hesitate to contact GPAT at that time. Please contact me when you have made a decision about what equipment you will be purchasing so that we can be certain we have exactly what is needed. I will be happy to help in any way that I can. If you have any questions or concerns, please do not hesitate to contact me at GPAT (404)362-2024.
Assessment Completed by _____________________________________ Position____________________________________
_____________________________ Date Assessment Report Completed
Thanks to Ike Presley from GPAT for sharing this information.