FUNCTIONAL VISION and LEARNING MEDIA ASSESSMENTS

FUNCTIONAL VISION and LEARNING MEDIA ASSESSMENTS

Students with Cortical Vision Impairments

By Christine Roman Lansky

SECTION 1 – GENERAL STUDENT INFORMATION

1.  Student Name:

2.  Date of Birth:

3.  Report Date:

4.  Examiner:

5.  Assessment Instrument:

6.  Assessment Dates:

7.  Reason for Assessment:

SECTION 2 – Background Information

1.  Setting for Assessment/Program:

2.  Previous and Current Vision Services:

3.  Other Medical History:

4.  Visual History (explain the eye condition including acuity):

5.  Appearance of the Eyes:

SECTION 3 – Interviews – Various Perspectives

1.  Teacher Summary and Date:

2.  Parent/Guardian Summary and Date:

SECTION 4 – Observations – Areas of Strength and Need

1.  Classroom:

2.  Recess:

3.  Lunch:

4.  Orientation and Mobility Observation/Screening/Evaluation:

5.  Other:

SECTION 5 – Cortical Vision Scale

1.  Color Preference: Most children who have CVI respond more quickly to objects of a particular color.

2.  Need for Movement: Many children with CVI respond best visually.

3.  Visual Latency: The characteristic of visual latency is one in which there is a delayed response between the time a target is presented and the time the individual first notices it.

4.  Visual Field Preferences: Many children with CVI have strong visual field preferences.

5.  Difficulties with Visual Complexity: Difficulties with visual complexity can mean difficulty with complexity of the surface of an object, of the viewing array, or of the sensory environment.

6.  Light-gazing and Nonpurposeful Gaze: Some children with CVI spend prolonged periods of time gazing at primary source of light.

7.  Difficulty with Distance Viewing: Some students with CVI have difficulty with distance viewing as though they were highly nearsighted.

8.  Atypical Visual Reflexes: there are two responses whose lack is often associated with CVI. The blink reflex is one in which the individual blinks simultaneously to a touch at the bridge of the nose. The second reflex occurs when an individual blinks as a target (usually an open hand) moves quickly toward the face at midline.

9.  Difficulty with Visual Novelty: Many children with CVI tend to visually attend to objects or targets seen previously, but may ignore visually novel or new things.

10.  Absence in Visually Guided Reach: Some children with CVI do not display the ability to look at and touch an object at the same time as the actions are performed separately.

SECTION 6 – Learning Media Assessment

1.  Indicators of Readiness:

2.  Initial Selection of Learning Media:

3.  General Learning Media Current Print Functioning (indicates how printed materials are accessed):

4.  Computer Monitor Access (indicates access to computer monitor):

SECTION 7 – Summary

Based on the CVI Range Assessment, STUDENTS NAME scored in the RANGE SCORE.

This means

SECTION 8 – Recommendations

Recommendations

FVA-LMA for Students with CVI.docx Page 2 of 2