Vision Aids Evaluation

Student Name:  _________________________________________________________	
School System: ________________________________	Date:  _________________	

During this evaluation, informal measures were used to evaluate the student’s ability to access print, produce written materials, access the computer and use various assistive technologies.  Some of the information requested may have been obtained from the Learning Media Assessment, Clinical Low Vision Evaluation or Functional Low Vision Evaluation.
(Whenever a “/” appears between items, all items that apply should be circled)
Accessing Print
Regular Print	
When accessing printed information, the student was able to read regular print materials…
 without adaptations at a distance of ______ inches
 with adaptations at a distance of ______ inches using…
       prescribed glasses/contacts.
       materials enlarged on a photocopying machine to a ______ point font size. 	
The student experienced visual/physical fatigue after reading…
  without adaptations for ______ minutes.
  with adaptations for ______ minutes.	
Large Print	
When accessing large print materials, the student was able to read…
 12 point print at approximately…
     _____ inches without using a prescribed optical device.
     _____ inches with a prescribed optical device.
 14 point print at approximately…
     _____ inches without using a prescribed optical device.
     _____ inches with a prescribed optical device.
 18 point print at approximately…
     _____ inches without using a prescribed optical device.
     _____ inches with a prescribed optical device.
 24 point print at approximately…
     _____ inches without using a prescribed optical device.
     _____ inches with a prescribed optical device.
 30 point print at approximately…
     _____ inches without using a prescribed optical device.
     _____ inches with a prescribed optical device.
 36 point print at approximately…
     _____ inches without using a prescribed optical device.
     _____ inches with a prescribed optical device.
 _____ point print at approximately…
     _____ inches without using a prescribed optical device.
     _____ inches with a prescribed optical device.
The prescribed optical device used by the student was…
 none   glasses/contacts   magnifier (describe) _________________________________	
The student’s preferred font family was…
 APHont   Arial   Verdana   Other	
The student’s preferred point size when not using a prescribed optical device was…
 12    14    18    18    24    30    36    ______  	

Video Magnifier	
When viewing a video magnifer at a normal distance of 13 – 16 inches, the student was able to accurately identify…
 line drawings as small as ______ inch(es) and
 text as small as ______ inch(es)
on a ______ inch monitor.	
When viewing text using a video magnifier, the student preferred…
 black text on a white background.   white text on a black background.
  a custom color combination of __________ text  __________ background.	
When using a video magnifier, the student was able to…
 adjust the size of the image.
 focus image.
 smoothly navigate using the XY table with adjustments made by the examiner.
 independently adjust the XY table brake and stops.
 write name and a short sentence using regular line paper.
 write name and a short sentence using bold line paper.
 move from line to line while reading at _____ words per minute.
When reading using a video magnifer, the student preferred an…
 In-line monitor.    Off-line monitor.
When writing using a video magnifer, the student preferred an…
 In-line monitor.    Off-line monitor.
Notes:  _______________________________________________________________________	
Non-optical devices	
When accessing printed materials, the student…
preferred…
 incandescent    fluorescent    window lighting.
 less lighting    more lighting than is currently available.
 materials on a copy stand    materials on the desk.
 using __________ colored overlays.
expressed having problems with glare from the…
 incandescent    fluorescent    window lighting.
Notes:  _______________________________________________________________________	
Braille and Tactile	
When accessing materials tactually, the student was able to…
 identify simple tactile graphics.
 read braille at a rate of _____ words per minute.
 read braille on a refreshable braille display at a rate of _____ words per minute.
Notes:  _______________________________________________________________________	
Auditory	
When accessing printed information from a recording, the student was able to…
 answer simple questions and relate details from a recording.
 paraphrase information presented from a recording.
 write/type/braille a sentence presented from a recording with no more than two repetitions.
 insert and remove tape/disc from a cassette/digital playback device.
 activate play/pause/stop/fast forward/rewind/chapter navigation/ page navigation/bookmark functions.
 understand fast speech.
Notes:  _______________________________________________________________________	

Reading Rates	
This is an optional section to be completed when there is a need to determine the positive or negative effects of using certain adaptations or assistive technology for reading. If testing silent reading, please check the student’s comprehension.	
When reading printed information, the student was able to read…
_____ wpm orally/silently materials provided in a 12 point font size.
_____ wpm orally/silently _____ point font size which is the optimal size for this student to read          materials at a distance of 10-13 inches.
_____ wpm orally/silently when using a video magnifer.
_____ wpm orally/silently when using a portable electronic magnifier.
_____ wpm orally/silently when using a prescribed magnifier.
_____ wpm orally/silently when provided with materials in braille.
_____ wpm when provided with recorded materials.
Notes:  _______________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________	
Distance	
When accessing materials from the board or overhead, the …
  student able to read information without the use of an optical device at a distance of _____ feet.
  student able to read information with the use of a(n) ________________________________ optical device at a distance of _____ feet.
  materials were provided to the student from a teacher copy/peer copy/peer reader.
Notes: _______________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________	
Other	
The student was able to….
  use a regular calculator and
        accurately manipulate keys.
        perform basic functions without instruction.
  use a large print calculator and
        see _____ inch numerals on the display.
        accurately manipulate keys.
        perform basic functions without instruction.
  use a talking calculator and
        understand synthesized speech.
        accurately manipulate keys.
        perform basic functions without instruction.
  use a talking dictionary and
        understand synthesized speech.
        accurately manipulate keys.
        perform basic functions without instruction.
  other: _____________________________________________________________________
  other: _____________________________________________________________________
Notes:  _______________________________________________________________________
_____________________________________________________________________________	

Writing
Handwriting	
When using standard writing tools, the student was able to…
  write cursive legibly with/without difficulty and with/without normal spacing at a rate of _____ wpm dictation/ _____ copying sample.
    write cursive legibly with/without difficulty and with/without normal spacing at a rate of _____ wpm dictation/ _____ copying sample.
  read own handwriting.
  sign own name.
Notes:  _______________________________________________________________________	
The student needed the following adaptations when writing…
  signature guide.
  screen board.
  raised line paper.
  bold line paper.
  felt tip pen.
  white board with erasable markers.
Notes;  _______________________________________________________________________	
Braille Writing	
When using a braille writing device, the student was able to…
  use a manual braille writer to emboss characters/words/sentences.
  use a slate and stylus to emboss characters/words/sentences.
  use a(n) ____________________ electronic device to enter characters/words/sentences.
  other:  _____________________________________________________________________
Notes:  ______________________________________________________________________
_____________________________________________________________________________	
Computer Access – Output 
Visual	
When accessing information on a standard computer, the student was able to…
  read menu items and system text on a _____ inch monitor at a distance of _____ inches.
  read _____ pt. Times New Roman, _____ pt. Arial, _____ Verdana, _____ APHont, on a _____ inch LCD/CRT monitor at a distance of 13-16 inches.
  read the standard word processor font at a distance of 13-16 inches using a _____ inch LCD/CRT monitor.
  read menu items/icons using standard Window’s display enhancements…
       inverted/black on white/white on black color scheme.
       standard/large/extra large icons and system fonts.
Notes:  _______________________________________________________________________	
When accessing the computer using ____________________ screen enlargement software, the student…
 was able to read the standard word processor font using _____ X magnification at a distance of 13-16 inches.
  expressed a polarity preference of inverted/black on white/white on black.
  was able to locate and activate menu items/icons using a mouse without enhancements.
  was able to locate and activate menu items/icons using ______________________________ ___________________________________________________________mouse enhancements.
  was able to maintain orientation when navigating around magnified screen.
Computer Access – Output (Visual – screen enlargement) cont.
  was able to navigate the screen using shortcut keys with instruction.
  was able to change basic screen magnification settings using shortcut keys with instruction.
  expressed a preference for ____________________________________________________
___________________________________________________________ window viewing mode.
  other:  _____________________________________________________________________
Notes:  _______________________________________________________________________
______________________________________________________________________________	
Auditory	
When accessing the computer using ____________________________ screen reading program the student was able to…
  understand synthesized speech.
  navigate the screen using shortcut keys with instruction.
  change basic screen reading settings using shortcut keys with instruction.
  other:  _____________________________________________________________________
Notes:  _______________________________________________________________________
______________________________________________________________________________	
Tactile	
When accessing the computer using ___________________________ refreshable braille display, the student was able to…
  read braille text on the refreshable display.
  navigate the text using the keys on the braille display with instruction.
Notes:  _______________________________________________________________________	
Computer Access – Input 
Keyboard	
When using a standard computer keyboard, the student was able to…
  locate and identify alphanumeric keys using vision/touch.
  locate and identify function keys using vision/touch.
  locate and identify navigation keys using vision/touch.
  activate two keys simultaneously.
  activate keys without excessive miss-hits/key repeats.
  use good posture/wrist position.
  touch type at a rate of _____ wpm using _____ fingers of _____ hand(s).
Notes: _______________________________________________________________________	
The student needed the following utilities when accessing the computer keyboard…
  sticky keys
  toggle keys
  repeat keys
  slow keys
  mouse keys
  other: _____________________________________________________________________
Notes:  _______________________________________________________________________
_____________________________________________________________________________	
The student needed the following adaptations when accessing the computer keyboard…

The assistance of an Occupational or Physical Therapist may be necessary when completing this section. If the student has no functional keyboard access to the computer then a full computer access evaluation may be required.

  zoom caps
  key latch
  moisture guard
  key guard
  wrist/arm support
Computer Access – Input (keyboard) cont.
  pointer
  head pointer
  mouth stick
  other: _____________________________________________________________________
  other: _____________________________________________________________________
Notes:  _______________________________________________________________________
_____________________________________________________________________________	
Pointing Device	
When using a standard computer mouse, the student was able to…
  quickly navigate the desktop.
  maintain mouse position when clicking/double-clicking.
  maintain eye contact with the screen while navigating the desktop.
  access pull-down menus.
Notes:  _______________________________________________________________________	
The student was able to perform the following using keyboard shortcuts instead of a mouse…
  navigate desktop using a standard/laptop keyboard.
  navigate a word processor document using a standard/laptop keyboard.
  perform basic file operations using a standard/laptop keyboard.
  explore basic menu items using a standard/laptop keyboard.
  navigate basic web pages using a standard/laptop keyboard.
  edit a word processor document using a standard/laptop keyboard.
  use spell check using a standard/laptop keyboard.
  fill in forms using a standard/laptop keyboard.
  locate files for saving and opening using a standard/laptop keyboard.
  format documents using a standard/laptop keyboard.
Notes: _______________________________________________________________________
_____________________________________________________________________________	

Additional Evaluation Information	
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________	

Recommendations for Assistive Technology
Accessing Printed Materials	
Students with visual impairments will typically use a variety of strategies to access printed information depending on the task and the environment. Please list these in the space provided.	
The student will benefit form using…
  regular print materials for ______________________________________________________
_____________________________________________________________________________
  regular print materials with glasses/contacts/magnifier/stand magnifier for _______________
_____________________________________________________________________________
  materials enlarged on the copier for _____________________________________________
_____________________________________________________________________________
  materials printed in _____ pt. _____________ font for _______________________________
_____________________________________________________________________________
  large print books for __________________________________________________________
_____________________________________________________________________________
  a CCTV for _________________________________________________________________
_____________________________________________________________________________
  braille materials for __________________________________________________________
_____________________________________________________________________________
  auditory playback device for ___________________________________________________
_____________________________________________________________________________
  computer based auditory reading for _____________________________________________
_____________________________________________________________________________
  large print dictionary for _______________________________________________________
  computer based dictionary for __________________________________________________
  talking dictionary for __________________________________________________________
  tactile graphics other than those in textbooks for ___________________________________
_____________________________________________________________________________
  other: _____________________________________________________________________
_____________________________________________________________________________
  other:  _____________________________________________________________________
_____________________________________________________________________________	
Producing Written Materials	
Students with visual impairments will typically use a variety of strategies to produce written materials depending on the task and the environment. Please list these in the space provided.	
The student will benefit from using…
  regular paper and pencil for ____________________________________________________
_____________________________________________________________________________
  felt tip pen/bold line/raised line paper for __________________________________________
_____________________________________________________________________________
  white board with erasable markers for ____________________________________________
_____________________________________________________________________________
  regular paper and pencil for ____________________________________________________
_____________________________________________________________________________
  a computer with word processing software for _____________________________________
_____________________________________________________________________________
  a manual braille writer for _____________________________________________________
_____________________________________________________________________________
  a slate and stylus for _________________________________________________________
_____________________________________________________________________________
	
Recommendations – Written Materials cont.
  a recording device for ________________________________________________________
_____________________________________________________________________________
  other _____________________________________________________________________
_____________________________________________________________________________
  other _________________ ____________________________________________________
_____________________________________________________________________________
	
Math Aids	
The student will benefit from using…
  an abacus for _______________________________________________________________
_____________________________________________________________________________
  a basic/scientific/graphing large display calculator for ________________________________
_____________________________________________________________________________
  a basic/scientific/graphing talking calculator for _____________________________________
_____________________________________________________________________________
  a basic/scientific/graphing computer based calculator for _____________________________
_____________________________________________________________________________
  other: _____________________________________________________________________
_____________________________________________________________________________
  other: _____________________________________________________________________
_____________________________________________________________________________	
Computer Access Input	
The student will benefit from…
  using a standard keyboard.
  developing/improving keyboard skills
  developing/improving the use of keyboard shortcuts
  using a standard keyboard with modifications. 
  using an alternative keyboard.
  using a standard pointing device.
  using an alternative pointing device.
  using a copy holder.
  other: _____________________________________________________________________
_____________________________________________________________________________
  other: _____________________________________________________________________
_____________________________________________________________________________	
Computer Access Output	
The student will benefit from…
  using a standard computer monitor.
  using a 17”/19”/21” LCD/CRT computer monitor. 
  monitor display settings of _____________________________________________________
_____________________________________________________________________________
  screen magnification software with the following set as the default _____________________
_____________________________________________________________________________
  screen reading software with the following set as the default __________________________
_____________________________________________________________________________
  an electronic braille display
  other: _____________________________________________________________________
_____________________________________________________________________________
  other:  _____________________________________________________________________
_____________________________________________________________________________	
Additional Computer Requirements	
The student will require a computer with the following minimum hardware specifications….
  Hardware on the currently available computer system meets the student’s needs.
  Standard full-size keyboard.
  Monitor as specified in Computer Output section above.
  _____  MB RAM
  _____  GB Hard drive
  floppy disk drive
  cd/cd recorder/dvd/dvd recorder
  modem/network/wireless network card
  _____  MB video card
  sound card/speakers/headphone
  scanner ___________________________________________________________________
  printer _____________________________________________________________________
  other:  _____________________________________________________________________
_____________________________________________________________________________	
The student will require the following minimum software (other than assistive technology)…
  Software on the currently available computer system meets the student’s needs.
 Windows 98/NT/2000/XP home/XP professional operating system.
  MSWord/WordPad/FS Edit/HJ Pad word processor _________________________________
_____________________________________________________________________________
  Internet Explore
  Outlook/Outlook Express
  Excel/Access/PowerPoint/Front Page ____________________________________________
_____________________________________________________________________________
  other: _____________________________________________________________________
_____________________________________________________________________________	
Materials Production	
The student will require enlarged/braille/tactile materials produced using…
  Currently available materials production capabilities meet the student’s needs.
  Computer system dedicated to materials production _________________________________
_____________________________________________________________________________
  a scanner __________________________________________________________________
  OCR software ______________________________________________________________
  braille translation software _____________________________________________________
  braille embosser ____________________________________________________________
  printer ____________________________________________________________________
  tactile graphics production equipment ____________________________________________
_____________________________________________________________________________
  tactile graphics production software _____________________________________________
  other:  ____________________________________________________________________
_____________________________________________________________________________	
Recommendation Notes	
Notes:  _______________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________	

Specific Assistive Technology Services
What Device or Service is needed?
For devices - list required features and/or names of representative products	For Use in What Environments?	When will this be needed?
 “now” or a grade	Is Training Required?
List names	

				

				

				

				

				

				

				

				

___________________________________
Evaluation Completed by	______________________
Position	________________
Date	
___________________________________
Evaluation Completed by	______________________
Position	________________
Date