| Condition |
T |
B |
F |
VP |
| Skip words while reading or copying |
X |
X |
|
|
| Substitute words while reading or copying |
X |
X |
X |
|
| Reread words or lines |
X |
X |
|
|
| Reverse letters, numbers or words |
|
|
|
X |
| Read very slowly |
X |
X |
X |
|
| Close (within 7‐8″) to reading and/or writing material |
|
X |
X |
|
| Squint, close or cover one eye while reading |
|
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 |
|
| Unusually tired after completing a visual task |
X |
X |
X |
|
| Crooked or poorly spaced writing |
|
|
|
X |
| Poor spelling skills |
|
|
|
X |
| Uses fingers to count for math |
|
|
|
X |
| Does not know math facts automatically |
|
|
|
X |
| Feel sleepy while reading |
X |
X |
X |
|
| Dislike tasks requiring sustained concentration |
X |
X |
X |
X |
| Confuse right and left directions |
|
|
|
X |
| Restless when working at a desk |
X |
X |
X |
X |
| You must feel things to “see” them |
|
|
|
X |
| Car sickness or motion sickness |
X |
X |
X |
|
| Totals |
29 |
38 |
26 |
26 |
| Maximum Possible |
69 |
84 |
54 |
55 |
