| Condition |
T |
B |
F |
VP |
| Skip lines while reading or copying |
X |
X |
|
|
| Lose your place while reading or copying |
X |
X |
|
|
| Reread words or lines |
X |
X |
|
|
| Tilt head in an unusual posture when reading or writing |
|
X |
|
|
| Eyes hurt or feel tired after close work |
X |
X |
X |
|
| Vision blurs at distance when looking up from near work |
|
X |
X |
|
| Crooked or poorly spaced writing |
|
|
|
X |
| Print moves or goes in and out of focus when reading |
|
X |
X |
|
| Poor spelling skills |
|
|
|
X |
| Clumsiness or poor coordination |
X |
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 |
| Totals |
19 |
28 |
16 |
15 |
| Maximum Possible |
69 |
84 |
54 |
55 |
