| Condition |
T |
B |
F |
VP |
| Skip lines while reading or copying |
X |
X |
|
|
| Skip words while reading or copying |
X |
X |
|
|
| Substitute words while reading or copying |
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 |
|
|
| Eyes hurt or feel tired after close work |
X |
X |
X |
|
| Unusually tired after completing a visual task |
X |
X |
X |
|
| Crooked or poorly spaced writing |
|
|
|
X |
| Uses fingers to count for math |
|
|
|
X |
| Does not know math facts automatically |
|
|
|
X |
| Difficulty following instructions (written or verbal) |
|
|
|
X |
| Restless when working at a desk |
X |
X |
X |
X |
| Car sickness or motion sickness |
X |
X |
X |
|
| Dry eyes |
X |
X |
X |
|
| Sensitivity to light |
X |
X |
X |
|
| Totals |
21 |
27 |
18 |
17 |
| Maximum Possible |
69 |
84 |
54 |
55 |
