| Condition |
T |
B |
F |
VP |
| Skip lines while reading or copying |
X |
X |
|
|
| Lose your place while reading or copying |
X |
X |
|
|
| Skip words while reading or copying |
X |
X |
|
|
| Reread words or lines |
X |
X |
|
|
| Use a finger or marker to keep place while reading/writing |
X |
X |
|
|
| Read very slowly |
X |
X |
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 |
|
| Vision blurs at distance when looking up from near work |
|
X |
X |
|
| Print moves or goes in and out of focus when reading |
|
X |
X |
|
| Uses fingers to count for math |
|
|
|
X |
| Does not know math facts automatically |
|
|
|
X |
| Unable to remember a series of tasks |
|
|
|
X |
| Below grade level on standardized tests |
X |
X |
X |
X |
| Car sickness or motion sickness |
X |
X |
X |
|
| Sensitivity to light |
X |
X |
X |
|
| Totals |
30 |
36 |
21 |
12 |
| Maximum Possible |
69 |
84 |
54 |
55 |
