| Condition |
T |
B |
F |
VP |
| Skip lines while reading or copying |
X |
X |
|
|
| Lose your place while reading or copying |
X |
X |
|
|
| Reverse letters, numbers or words |
|
|
|
X |
| Use a finger or marker to keep place while reading/writing |
X |
X |
|
|
| Tilt head in an unusual posture when reading or writing |
|
X |
|
|
| Headaches after intense visual activities such as reading or computer work |
X |
X |
X |
|
| Eyes hurt or feel tired after close work |
X |
X |
X |
|
| Letters or lines “run together” or words appear to “jump” when reading |
X |
X |
|
|
| Clumsiness or poor coordination |
X |
X |
X |
X |
| Difficulty following instructions (written or verbal) |
|
|
|
X |
| Dislike tasks requiring sustained concentration |
X |
X |
X |
X |
| Confuse right and left directions |
|
|
|
X |
| Losing awareness of surroundings when concentrating |
X |
X |
X |
X |
| Totals |
25 |
28 |
13 |
15 |
| Maximum Possible |
69 |
84 |
54 |
55 |
