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For Students with Visual Impairments

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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.

Comments: _________________________________________________________________
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Accessing the Computer

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.

Software synthesizer
_____ Kids Time Deluxe
_____ Write Outloud
_____ Flextalk
_____ TrueVoice
_____ Dectalk Access 32
_____ Eloquence

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

__ sticky keys __ repeat keys __ slow keys __ toggle keys __ mouse keys _____

_____ 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: ________________________________________________
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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

_____ CloseView _____ Enlarge _____ ZoomText Extra Level 1 / Level 2
_____ Other: __________________________________________________________

_____ Student should use a talking word processing - Specify ___________________________
_____ Student should use a speech synthesizer/sound card and screen reading software-

Specify ________________________________________________________________

_____ 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: ____________________________________________
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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

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