Learning Media Assessment Report

LEARNING MEDIA ASSESSMENT REPORT

Based on the APH Sensory Learning Kit (SLK)

By Millie Smith

SECTION 1 – General Student Information

1.  Student Name:

2.  Date of Birth:

3.  School District/School:

4.  Dates of Assessment:

5.  Assessment Team:

6.  Date of Report:

SECTION 2 – Background Information

The Learning Media Assessment (LMA) is a required assessment for students with visual impairments, including those with additional disabilities. The data from the LMA is used to determine the most appropriate learning/literacy media (learning materials) for the student. Aside from determining if Braille is an appropriate learning or literacy medium for the student, it addresses, for students with additional disabilities, all sensory channels, to identify which channels and associated materials are accessible to the student and can be used for learning. The following data were collected during the SLK assessment and recorded on the Sensory Response Record.

SLK Form 1: Sensory Learning Summary (important sensory or medical information used in planning the assessment):

SLK Form 2: Arousal State Profile (completed if student arousal periods in question):

SLK Form 3: Sensory Response Record (results of assessment). This student demonstrated positive responses regarding sensory items presented.

Responsive Level: The four responsiveness levels identified in the SLK are: extended state (fussy, upset, angry, asleep), quiet alert (in a general state of alertness), active alert (alert and curious about the activity), partial participation (alert and taking some part in the activity). This indicates at what level of responsiveness the student performed during the assessment and sets the starting point for the level of the instructional activity routines selected.

(Please indicate # of presentations eliciting responses below)

Total Items Presented / Extended State / Quiet Alert / Active Alert / Partial Participation
# Items / # / # / # / #
% Items / % / % / % / %
The responsive level most frequently observed:

SLK Form 4: Appetite/Aversion List (based on assessment)

Appetite Items: These are items presented to the student in all appropriate sensory channels for which a positive response (liked the item) was demonstrated.

Delayed Response Time. The amount of time it took for the student to respond to the item.

Appetite Items (likes) identified during Sensory Response Record presentations and average delayed response time per sensory channel:

Vest/Prop. (move.) / Olfactory-observed not tested / Gustatory(taste) / Tactual(touch) / Auditory(sound) / Visual (sight)
Appetite Totals / # / # / # / # / # / #
Avg. Delayed Response Time
Sensory channels with most positive responses:

Top ten sensory appetite items (Items eliciting strongest positive response): These items represent appropriate learning media for this student.

Appetite Items (likes) / Sensory Channel/Response
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Aversions:

SLK Form 5: Level & Strategy Guide (appropriate level & strategies to begin teaching)

Results & Recommendations: Environmental Factors Related To Learner’s Orienting Responses:

Lighting, Temperature, Odors, Noise Level, Visual Clutter, Positioning, Movement, Other: (address all that apply):

Results And Recommendations: Social Factors Related To Learner’s Orienting Responses:

Presence or absence of peers/adults, Direct attention to peers/adults, Preferred peers/adults, Others: (address all that apply):

Recommended Referrals:

Visual, Auditory, Gross Motor, Communication, Medical, Nutritional, Sleep, Dental, Psychological: (address all that apply):

General Programming Recommendations Based On SLK Results:

Learning Media Assessment Results:

This student responded most frequently on the ______(extended state, quiet alert, active alert, or partial participation) level of responsiveness. Positive responses to sensory items were elicited in the following sensory channels: (list sensory channels) :

Appetite items are real objects and activities in the student’s home or educational environment, for which the student has shown a positive response. Educational programming (activity routines) on the student’s responsiveness level, incorporating items from the appetite list (above) are recommended as the most appropriate instructional strategy for this student. Ongoing assessment via additional learning media probes is recommended.

The following 3 activity routine topics have been selected for this student, based on the assessment data reported above.

1. 

2. 

3. 

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