| 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 |
|
| Reverse letters, numbers or words |
|
|
|
X |
| Eyes hurt or feel tired after close work |
X |
X |
X |
|
| Unusually tired after completing a visual task |
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 |
|
| Make errors when copying |
X |
X |
X |
X |
| Does not know math facts automatically |
|
|
|
X |
| Difficulty following instructions (written or verbal) |
|
|
|
X |
| Unable to remember a series of tasks |
|
|
|
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 |
| Losing awareness of surroundings when concentrating |
X |
X |
X |
X |
| Totals |
|
|
|
|
| Maximum Possible |
69 |
84 |
54 |
55 |
