| Condition |
T |
B |
F |
VP |
| Lose your place while reading or copying |
X |
X |
|
|
| Skip words while reading or copying |
X |
X |
|
|
| Substitute words while reading or copying |
X |
X |
X |
|
| Read very slowly |
X |
X |
X |
|
| Close (within 7‐8″) to reading and/or writing material |
|
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 |
|
| Crooked or poorly spaced writing |
|
|
|
X |
| Misalign letters or numbers |
|
|
|
X |
| Clumsiness or poor coordination |
X |
X |
X |
X |
| Difficulty following instructions (written or verbal) |
|
|
|
X |
| Feel sleepy while reading |
X |
X |
X |
|
| Dislike tasks requiring sustained concentration |
X |
X |
X |
X |
| Avoid near tasks such as reading |
X |
X |
X |
|
| Totals |
27 |
33 |
24 |
17 |
| Maximum Possible |
69 |
84 |
54 |
55 |
