Assistive Technology for Students Who Are Blind or Visually Impaired

Ike Presley and Frances Mary D'Andrea

Appendix D

Assessment Forms



BACKGROUND INFORMATION FOR ASSISTIVE TECHNOLOGY ASSESSMENT

Student's Name: _______________________             Birthdate: ____________            Grade: _______

Name of parent(s)/guardian(s): _________________________________________________________

School: __________________________________________________________________________

Teacher of students with visual impairments: _______________________________________________

Referred by: ___________________________            Reason for Referral: ______________________

_________________________________________________________________________________

Initial or Ongoing Assessment: I / O

Additional Disabilities:   Y / N Describe: __________________________________________________

Current medication(s):________________________________________________________________

Reported/observed visual side effects: ____________________________________________________

_________________________________________________________________________________

Eye Report Summary (see Eye Report)

Dr.: _______________________________ O.D.           Date of last examination: __________________

Eye condition: ______________________________________________________________________

Prognosis: _________________________________________________________________________

Visual Acuity

                                Distance                                                          Near

              Without Correction              With Correction             Without Correction             With Correction

OD         _________________         ______________         _________________         ______________

OS         _________________         ______________         _________________         ______________

OU         _________________         ______________         _________________         ______________

Field Restriction(s): Y / N   Degrees: ________   Location:_________________

Recommendations

Eyeglasses     _ Wear/Use Constantly     _ Wear/Use as Needed

Contact Lenses

       For distance?         Y / N       _ Wear/Use Constantly       _ Wear/Use as Needed

       For near?               Y / N       _ Wear/Use Constantly       _ Wear/Use as Needed

Low Vision Device(s) (specify): _________________________________________________________

Other: ____________________________________________________________________________

Information from Learning Media Assessment

Primary learning channel:        _ visual     _ tactile    _ auditory

Secondary learning channel:    _ visual    _ tactile    _ auditory

Other: _____________________________________________________________________________

Other current accommodations and technology ___________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Reading Preferences (if reported):

Preferred visual format without device (specify): ______________________________________________

      Point size: ____________                   Font: ____________                Distance: ____________

                Approximate reading rate: _______ wpm

Preferred visual format with device (specify): _________________

      Point size: ____________                   Font: ____________                Distance: ____________

                Approximate reading rate: _______ wpm

Lighting preferences: ___________________________________________________________________

Braille: approximate reading rate: _______ wpm oral       _______ wpm silent

Experiences visual/physical fatigue after reading ____ minutes

Relevant information from functional low vision assessment: _________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Relevant information from medical, psychological, and academic evaluations: ____________________

____________________________________________________________________________________

____________________________________________________________________________________

Relevant information from teachers' observations and assessments: ___________________________

_____________________________________________________________________________________

Additional comments: __________________________________________________________________

____________________________________________________________________________________


ASSISTIVE TECHNOLOGY CONSIDERATIONS CHECKLIST

Student: _______________________________ School: _______________________________

DIRECTIONS

  1. 1.  Complete the student information section below to provide information on the student's needs, abilities, and difficulties as   well as environments and barriers to success.
  2. 2.  Please check (__) the instructional or access areas in Column A that are appropriate for the student. Please leave  blank  any areas that are not relevant to the student. Specify all relevant tasks (for example, copying notes from board,  responding to teacher questions, and so on) within each area in the space provided. Check the settings in which the task is  required. GEC: General Education Classroom; SEC: Special Education Classroom; COM: Community; and HOM:  Home.
  3. 3.  In Column B, specify the standard classroom tools (low technology to high technology) used by the student to complete  relevant tasks identified in Column A. Place a check (__) in the boxes in Column B if the student is able to independently  complete the tasks with standard classroom tools. For areas in which the student can complete the tasks independently, it  will not be necessary to complete Columns C or D.
  4. 4.  In Column C, specify the accommodations/modifications and assistive technology solutions that are currently being utilized.  Place a check (__) in the boxes in Column C if the student can adequately complete the tasks specified in Column A using  the identified accommodations/modifications and assistive technology solutions.
  5. 5.  Complete Column D if the student cannot adequately complete the task with accommodations/modifications and assistive  technology solutions specified in Column C.

Student needs, abilities, and difficulties: _________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Student environments:

_ General Education Classroom (List all classes): _________________________________________________

_______________________________________________________________________________________

_ Special Education Classroom (List all classes): _________________________________________________

_______________________________________________________________________________________

_ Community (List all settings): _______________________________________________________________

_______________________________________________________________________________________

_ Home: _______________________________________________________________________________

_______________________________________________________________________________________

Barriers to student performance and achievement: _________________________________________________

_______________________________________________________________________________________

Source: Reprinted with permission from the Georgia Project for Assistive Technology, Georgia Department of Education, Atlanta.

A. Instructional or Access Areas B. Independent with Standard Classroom Tools C. Completes Tasks with Accommodations/Modifications and/or Assistive Technology Solutions Currently in Place D. Additional Solutions/Services Needed, Including Assistive Technology
Accommodations/Modifications Assistive Technology Solutions
_ Writing
_ GEC    _ SEC
_ COM   _ HOM
       
_ Spelling
_ GEC    _ SEC
_ COM   _ HOM
       
_ Reading
_ GEC    _ SEC
_ COM   _ HOM
       
_ Math
_ GEC    _ SEC
_ COM   _ HOM
       
_ Study/Organizational Skills
_ GEC    _ SEC
_ COM   _ HOM
       
_ Listening
_ GEC    _ SEC
_ COM   _ HOM
       
_ Oral Communication
_ GEC    _ SEC
_ COM   _ HOM
       
_ Aids to Daily Living
_ GEC    _ SEC
_ COM   _ HOM
       
_ Recreation and Leisure
_ GEC    _ SEC
_ COM   _ HOM
       
_ Prevocational/ Vocational
_ GEC    _ SEC
_ COM   _ HOM
       
_ Seating, Positioning, and Mobility
_ GEC    _ SEC
_ COM   _ HOM
       
_ Other (specify):
_ GEC    _ SEC
_ COM   _ HOM
       
Consideration Outcomes:
_ Student independently accomplishes tasks in all instructional areas using standard classroom tools. No assistive     technology is required.
_ Student accomplishes tasks in all instructional areas with accommodations and modifications. No assistive     technology is required.
_ Student accomplishes tasks in all instructional areas with currently available assistive technology. Assistive     technology is required.
_ Student does not accomplish tasks in all instructional access areas. Additional solutions including assistive     technology may be required.
Specify any assistive technology services required by this student.
____________________________________________________________________________________
____________________________________________________________________________________
Consideration Checklist Completed by:    Position:      Date:
__________________________________     _______________________      _____________________

Narrative description


ASSISTIVE TECHNOLOGY ASSESSMENT CHECKLIST FOR STUDENTS WITH VISUAL IMPAIRMENTS

Student's Name __________________________    Person Completing Checklist _________________

Student's Grade __________________________    Position _________________________________

Student's Date of Birth _____________________     Date(s) of assessment ______________________

This document is a summary of information collected during the above-named student's assistive technology evaluation. Information for this assessment was obtained from the student's learning media assessment, the clinical low vision evaluation, the functional low vision evaluation, and from observation and assessment of the student's use of specific devices, as outlined below.

The assessment covers three main areas:

  • Section I: Accessing Print, which covers how the student uses visual, tactile, and/or auditory tools to access textbooks, workbooks, assigned novels, and other printed information generally used in the classroom, including information presented on chalkboards or whiteboards
  • Section II: Accessing Electronic Information, which covers how the student uses visual, tactile, and/or auditory tools to obtain information from electronic means, such as computers, electronic dictionaries and similar devices, digital books, and electronic braille devices
  • Section III: Communication through Writing, which includes manuscript (print) and cursive writing, braille writing, and the use of electronic writing tools

The assessment sections of this document are followed by a recommendations section. The notations made will become part of the final written report detailing the rationale for each recommendation submitted to the student's Individualized Education Program team.

Directions: Indicate in the space provided the date each section is completed. All items not assessed should be marked NA.

Section I: Accessing Print

A. Visual Access

1. Regular Print                                                                                            Date completed _______________

When accessing print information visually, the student is able to read passages on his or her independent reading level in regular print (12 point)

_ without prescribed eyeglasses or contact lenses at a distance of

     ____ inches, at approximately     ____ words per minute (wpm).

_ with prescribed eyeglasses or contact lenses at a distance of

     ____ inches, at approximately     ____ wpm.

_ When reading this size print with or without prescribed eyeglasses or contact lenses the student experiences visual or physical      fatigue after ____ minutes (as reported by student or teacher).

Comments: ___________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

From this point forward all items should be attempted with student's prescribed spectacles or contact lens in use.

2. Enlarged Print Produced on a Photocopier                                     Date completed _______________

When accessing print information visually the student is able to read

    _ materials enlarged to _____% on

    _ 8½ × 11 inch paper              _ 8½ × 14 inch paper              _ 11 × 17 inch paper

        at approximately _____ inches and at approximately _____ words per minute (wpm).

When reading this size print with or without prescribed eyeglasses or contact lenses the student experiences visual or physical fatigue after ______ minutes (as reported by student or teacher).

The student is willing to use materials enlarged by a photocopying machine on

    _ 8½ × 11 inch paper              _ 8½ ×14 inch paper              _ 11 × 17 inch paper

    _ to complete assignments in the regular classroom.

    _ at home to complete school assignments.

    _ while working with the teacher of students with visual impairments.

Comments: __________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

3. Large Print                                                                          Date completed _______________

The student is able to identify the following pictures of common objects:

_____ -inch high color photograph at a distance of approximately _____ inches.

 _ 3-inch high black-and-white line drawing at a distance of approximately ____ inches.

 _ 2-inch high black-and-white line drawing at a distance of approximately ____ inches.

 _ 1-inch high black-and-white line drawing at a distance of approximately ____ inches.

When accessing large print with prescribed eyeglasses or contact lenses (if appropriate) the student is able to read

_  72-point print at a distance of approximately _____ inches.

_  60-point print at a distance of approximately _____ inches.

_  48-point print at a distance of approximately _____ inches.

_  36-point print at a distance of approximately _____ inches.

_  30-point print at a distance of approximately _____ inches.

_  24-point print at a distance of approximately _____ inches.

_  18-point print at a distance of approximately _____ inches.

_  14-point print at a distance of approximately _____ inches.

_  12-point print at a distance of approximately _____ inches.

The student's preferred font is    _ Arial    _ APHont    _ Tahoma    _ Verdana

     _ Other (specify): ________________________

The student's preferred point size with prescribed eyeglasses or contact lenses is

     _ 14   _ 18    _ 24    _ 30    _ 36    _ 48    _ 60    _ 72

The student prefers text in

     _ regular style.

     _ bold style.

The student is able to read continuous text in preferred font and point size at approximately

      _____ words per minute.

When reading this size print with or without prescribed eyeglasses or contact lenses the student experiences visual or physical          fatigue after ___ minutes (as reported by student or teacher).

The student is willing to use materials printed in the preferred font and point size on 8½ × 11 inch paper

       ___ to complete assignments in the regular classroom.

       ___ at home to complete school assignments.

       ___ while working with the teacher of students with visual impairments.

Comments: __________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

4. Nonoptical Devices                                                                         Date completed _______________

When reading print information, the student prefers

     _ text written with a pen or pencil on standard lined notebook paper.

     _ text written with felt-tip pen on standard lined notebook paper.

     _ text written with felt-tip pen on bold-lined notebook paper.

     _ text written with felt-tip pen on unlined paper.

     _ other (specify): ___________________________________________.

When reading handwritten information the student prefers

     _ manuscript (printed) writing.

     _ cursive writing.

When reading, the student

     _ prefers overhead lighting

          _ from an incandescent bulb.

          _ from a fluorescent bulb.

          _ from a halogen bulb.

          _ adjusted with a dimmer switch.

     _ prefers window lighting adjusted with

          _ blinds.

          _ shades.

          _ other (specify): ________________.

     _ experiences glare problems on

          _ paper.

          _ desktop.

          _ computer or video magnifier monitor.

          _ whiteboard.

          _ chalkboard.

           resulting from

                 _ overhead lighting.

                 _ window lighting (natural light, sunlight).

     _ prefers less lighting than currently available.

     _ prefers additional lighting from a

          _ desk lamp with a/an

                 _ incandescent bulb.

                 _ fluorescent bulb.

                 _ halogen bulb.

                 _ LED bulb.

          _ floor lamp with a/an

                _ incandescent bulb.

                _ fluorescent bulb.

                _ halogen bulb.

                _ LED bulb.

      _ prefers the location of the lighting source to be

          _ over the left shoulder.

          _ over the right shoulder.

      _ prefers to have materials placed on a

          _ desktop reading stand.

          _ portable reading stand.

          _ floor-standing reading stand.

The student is willing to use these devices and accommodations (the examiner may wish to list them individually)

      _ to complete assignments in the regular classroom.

      _ at home to complete school assignments.

      _ while working with the teacher of students with visual impairments.

Comments: __________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

5. Optical Devices                                                                         Date completed _______________

When accessing print materials with the use of a prescribed optical device, the student uses

_ eyeglasses.

_ contact lenses.

_ handheld magnifier.

    type _____________

    power ___________

   _ illuminated             _ nonilluminated

_ stand magnifier.

    type _____________

    power ___________

   _ illuminated             _ nonilluminated

_ telescope.

    type _____________

    power ___________

_ video magnifier (specify type):

    _ desktop video magnifier.

    _ flex-arm camera model.

    _ portable model with handheld camera.

    _ head-mounted display model.

    _ electronic pocket magnifier.

    _ digital imaging system.

    _ other (specify): ________________________________________________.

The student is able to read continuous text using the prescribed optical device at approximately

     _____ words per minute without a reading stand.

     _____ words per minute with a reading stand.

When reading regular-size print with the prescribed optical device the student experiences visual or physical fatigue after _____       minutes (as reported by student or teacher).

The student is willing to use these devices (the examiner may wish to list these separately)

    _ to complete assignments in the regular classroom.

    _ at home to complete school assignments.

    _ while working with the teacher of students with visual impairments.

Comments: _________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

6. Video Magnifier (CCTV)                                                      Date completed ___________

Desktop Video Magnifier

When accessing print materials with the use of a desktop video magnifier (closed-circuit television or CCTV), the student is able to view a (insert a number to indicate the size)

     ___-inch-high graphic and ___-inch-high text on a ___-inch-monitor

     at a working distance of approximately 10–13 inches.

     ___-inch-high graphic and ___-inch-high text on a ___-inch-monitor

     at a working distance of approximately ___ inches.

The student's polarity preference when viewing text on a video magnifier is

    _ dark on light.

    _ light on dark.

The student's color preference is

     __________ text on a __________ background.

The student is able to manipulate the controls of the video magnifier, with instructions from the examiner, to

     _ adjust the size of the image.

     _ focus the image if the unit does not have auto focus.

When using the video magnifier, the student is able to

     _ write a short sentence legibly on regular notebook paper while

              _ looking at the screen or monitor.

              _ looking at the paper.

     _ write a short sentence legibly on bold-lined paper while

              _ looking at the screen or monitor.

              _ looking at the paper.

When using the video magnifier, the student is able to read a 3- to 5-day-old sample sentence of his or her handwriting on

     _ blue-lined notebook paper.

     _ bold-lined writing paper.

The student is able to

     _ independently use an X-Y table for viewing materials with friction brake and margin stops are adjusted by examiner.

     Comments: ___________________________________________________________________________

     ____________________________________________________________________________________

     _ independently adjust friction brake and margin stops after demonstration by examiner.

     Comments: ___________________________________________________________________________

     ____________________________________________________________________________________

     _ independently manipulate the controls of the unit (knobs, buttons, switches, etc.).

     Comments: ___________________________________________________________________________

     ____________________________________________________________________________________

The student is able to read approximately _____ words per minute (wpm) when the friction brake and margin stops are adjusted properly by the examiner.

When reading this size print with or without prescribed eyeglasses or contact lenses the student experiences visual or physical fatigue after _____ minutes (as reported by student or teacher).

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ___________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Flex-Arm Camera Video Magnifier

When accessing print materials with the use of a flex-arm camera model video magnifier, the student is able to

     _ locate and operate the controls.

     _ use the device's X-Y table or manipulate the reading material without a table.

     _ rotate and adjust the camera for distance viewing.

     _ locate the distance target.

     _ identify the distance target.

The student is able to read approximately ___ wpm when the friction brake and margin stops are adjusted properly by the examiner.

When reading this size print with or without prescribed eyeglasses or contact lenses the student experiences visual or physical fatigue after ___ minutes (as reported by student or teacher).

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: _________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Portable Video Magnifier with Handheld Camera

When accessing print materials through the use of a portable video magnifier with a handheld camera, the student is able to

     _ locate and operate the controls.

     _ maintain an angle of the camera with the text that is adequate for reading while moving the camera.

The student is able to read approximately ___ wpm when using this device.

When reading this size print with or without prescribed eyeglasses or contact lenses the student experiences visual or physical fatigue after ___ minutes (as reported by student or teacher).

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Head-Mounted Video Magnifier

When accessing print materials through the use of a video magnifier with a head-mounted display, the student is able to

     _ locate and operate the controls.

     _ locate the distance target.

     _ identify the distance target.

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Electronic Pocket Video Magnifier

When accessing print materials through the use of an electronic pocket video magnifier, the student is able to

     _ locate and operate the controls.

     _ maintain the camera at an adequate angle to the text for reading while moving the device.

     _ operate a model with the camera on the side of the unit.

     _ operate a model with the camera in the middle of the unit.

The student is able to read approximately _____ wpm when using this type of device.

When reading this size print with or without prescribed eyeglasses or contact lenses the student experiences visual or physical fatigue after _____ minutes (as reported by student or teacher).

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Digital Imaging System

When accessing print materials through the use of a digital imaging system video magnifier, the student is able to

     _ locate and operate the controls.

The student is able to read approximately _____ wpm when using this type of device.

When reading this size print with or without prescribed eyeglasses or contact lenses the student experiences visual or physical fatigue after _____ minutes (as reported by student or teacher).

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

7. Systems for Accessing Print Information Visually                              Date completed _______________

When viewing print materials scanned into the computer using a standard imaging program (Microsoft Imaging, PaperPort, etc.), the student is able to

     _ operate the scanner.

     _ navigate the enlarged screen with the

         _ keyboard.

         _ mouse.

When viewing print materials scanned into the computer with a specialized scanning system (such as Kurzweil 1000 or 3000, OpenBook, or WYNN), the student is able to

     _ operate the scanner.

     _  adjust the magnification to the desired size using the

         _ keyboard.

         _ mouse.

     _ adjust the rate and other speech parameters.

     _ navigate the image horizontally and vertically using the

         _ keyboard.

         _ mouse.

     _ select items from the menus and tools from the toolbar with the

         _ keyboard.

         _ mouse.

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

8. Visual and Physical Fatigue                                         Date completed _______________

The student experiences visual/physical fatigue after reading

     _ for ___ minutes without adaptations.

     _ for ___ minutes with adaptations.

Comments:

(Please indicate fatigue factors for each visual access tool used by the student.)

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

B. Tactile Access and Braille                                           Date completed _______________

When accessing graphical information the student is able to discriminate tactilely

     _ solid lines of various thickness.

     _ dashed lines.

     _ dotted lines.

     _ raised-line drawings of simple shapes.

     _ the boundary between two clearly defined textured fill patterns.

     _ the boundary between three clearly defined textured fill patterns.

     _ the boundary between four clearly defined textured fill patterns.

The student is able to identify tactile information most accurately when it is presented as a simple tactile graphic

     _ tooled onto braille paper.

     _ produced as a collage of varying textures.

     _ thermoformed onto plastic.

     _ embossed as dots and lines onto braille paper by a computer-controlled braille embosser.

     _ produced as raised lines and patterns on capsule paper.

The student is able to read materials in

     _ uncontracted braille.

     _ contracted braille.

_ Results of formal or informal braille assessments conducted by the teacher of students with visual impairments are attached.

     Student's oral braille reading rate is _____ words per minute (wpm).

     Student's silent braille reading rate is _____ wpm.

When accessing print information with a refreshable braille display, the student is able to

     _ read instructional-level text.

     _ press correct key combination to issue forward and reverse navigation commands

         _ with verbal prompt.

         _ without verbal prompt.

     _ read ____ wpm orally and ____ wpm silently.

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

C. Auditory Access

1. Live Readers and Recorded Information                                 Date completed __________

When listening to instructional level information read aloud by the evaluator, the student is able to

     _ repeat words and simple phrases without having them repeated more than twice.

     _ paraphrase the information (a sentence or story).

     _ answer simple comprehension questions.

When listening to an analog or digital recording of a story, the student is able to

     _ repeat words and simple phrases without having them repeated more than twice.

     _ paraphrase the information (a sentence or story).

     _ accurately answer simple comprehension questions.

When using an analog or digital player-recorder, the student is able to

     _ insert and remove a tape or CD from the player-recorder.

     _ inactivate play, pause, stop, fast forward, and rewind functions (underline those demonstrated).

     _ understand and comprehend compressed or "fast" speech.

     _ manipulate variable speed and pitch controls.

     _ identify index tones, bookmarks, and page locators.

The student is able to

     _ listen to recorded speech and follow along with a print copy of the text.

     _ listen to recorded speech and follow along with a braille copy of the text.

     _ listen to synthesized speech and follow along with a print copy of the text.

     _ listen to synthesized speech and follow along with a braille copy of the text.

The student is able to read approximately

     _____words per minute (wpm) when listening and reading print or braille.

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

2. Specialized Scanning Systems for Accessing Print Information Auditorily     Date completed __________

When accessing print materials scanned into the computer with a specialized scanning system (such as Kurzweil 1000 and 3000, OpenBook, and WYNN), the student is able to

     _ adjust the rate and other speech parameters.

     _ navigate through the document when provided instruction by the evaluator.

     _ select items from the menus or tools from the toolbar when provided instruction by the evaluator.

When listening to text read by the program, the student is able to

     _ repeat words and simple phrases without having them repeated more than twice.

     _ paraphrase the information (sentence or story).

     _ accurately answer simple comprehension questions.

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

When accessing printed materials using audio-assisted reading the student is able to read ______ words per minute (wpm).

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

D. Reading Rates                                                                           Date completed __________

Optional; may be used to support use of various adaptations.

When accessing print information, the student is able to read

     _____words per minute (wpm) orally when reading materials in 12-point type using prescribed spectacles or contact lenses.

     _____wpm orally when reading materials in the optimum point size and font:

     ___-point print and ___________ font.

     _____wpm orally when reading with a prescribed optical device.

     _____wpm orally when reading with a video magnifier (CCTV).

     _____wpm orally when reading braille.

     _____wpm when using audio-assisted reading.

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

E. Accessing Information Presented at a Distance   Date completed __________

When accessing information presented at a distance on a chalkboard or whiteboard or by an overhead or computer projector or TV/VCR/DVD, the student reported that he or she

     _ sits close enough to view the information, at a working distance of approximately _____ feet.

     _ uses a handheld or spectacle-mounted telescope.

     _ uses a video magnifier with distance-viewing capabilities.

     _ gets an accessible copy from the teacher.

     _ uses a peer notetaker.

     _ uses an electronic whiteboard connected to an accessible computer.

     _ has information read aloud by a peer or paraeducator and

         _ brailles information on a braillewriter.

         _ writes information on paper.

         _ inputs information into computer or accessible personal digital assistant.

         _ records information on tape recorder or digital recorder.

     _ other (specify): _________________________.

Are these options working adequately?

     _ Yes

     _ No

     Explain briefly:

     _________________________________________________________________________________

     _________________________________________________________________________________

     _________________________________________________________________________________

     _________________________________________________________________________________

The student is willing to use these devices and accommodations (the examiner may wish to list them individually)

     _ to complete assignments in the regular classroom.

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Section II: Accessing Electronic Information

A. Computer Access: Output Devices

1. Visual Access                                                                             Date completed __________

The student is able to view electronic information on a desktop computer or in the computer lab without additional adaptations and identify or read

     _ text  _ icon titles  _ menus  _ dialog boxes  _ other system items on a

         _ 17-inch monitor at approximately ___ inches.

         _ 19-inch monitor at approximately ___ inches.

         _ 21-inch monitor at approximately ___ inches.

         _ other (specify): _________________________

The student prefers viewing text in a word-processing program on the computer in

     ___-point type in  _ regular  _ bold print

     _ Arial

     _ APHont

     _ Tahoma

     _ Verdana

     _ other (specify): _________________________

     displayed on a ___ -inch monitor at approximately ___ inches.

The student is able to view electronic information on a

     ___ -inch computer monitor with the use of

              _ screen magnification hardware at approximately ____ inches.

              _ an articulated flexible monitor stand at approximately ___ inches.

The student is able to view electronic information using the computer operating system's screen enhancements such as

     _ screen resolution (specify): ______________________

     _ Windows Display Appearance Scheme (specify): __________________

     _ Windows Display Appearance Settings. (Record specific settings selected on the Windows Display Appearance         Checklist appendix to this form.)

     _ Microsoft Magnifier

         _ magnification level: _______________________

         _ other setting (specify): _______________________

          The student is able to use the Microsoft Magnifier to

                     _ identify screen elements.

                     _ read text in menus, dialog boxes, and text documents.

                     _ navigate around the screen.

                     _ locate the file names listed in the Open file dialog box.

                     _ select a requested file to open.

(If the school district uses Macintosh computers, complete the previous sections for the accessibility features provided in the computer's operating system.)

When using a dedicated screen magnification program, the student is able to

     _ read 12-point print enlarged to ___ magnification at a working distance of approximately 13 inches.

     _ locate and select menu items, buttons, and other screen elements with the mouse or other pointing device.

     _ locate and select menu items, buttons, and other screen elements using keyboard commands.

     _ navigate around the screen and maintain orientation.

     _ use an automatic reading feature at a speed setting of _______.

The student's color preference is _______ text on a ________ background.

_ The student is unable to access the computer visually.

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: __________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

2. Tactile Access                                                                         Date completed __________

When accessing electronic or computer-based information tactilely, the student is able to

     _ read braille text displayed on a dedicated braille display connected to a computer.

     _ read braille text displayed on an accessible PDA braille display connected to a computer.

     _ execute navigation commands with instruction.

     _ enter text through the braille keyboard, if available.

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

3. Auditory Access                                                                         Date completed __________

When accessing electronic information auditorily, the student is able to understand synthesized speech produced by

     software synthesizers:

     _ Intellitalk            _ Write:Outloud                  _ Kurzweil

     _ TrueVoice         _ DECTalk Access 32        _ Eloquence (JAWS)

     _ OpenBook        _ Microsoft Speech Engine

     _ Other (specify): ______________________

     hardware synthesizers:

     _ Type 'n Speak, Braille 'n Speak, Braille Lite      _ DECTalk Express

     _ Double Talk LT                                                _ Other (specify): ____________________

When accessing electronic information auditorily through synthesized speech and a screen reader the student is able to understand and identify

     _ sentences and lines.

     _ words.

     _ distinctive sounding letters (such as a, f, h, o, s, w) when spelled in words.

     _ similar sounding letters (b, c, d, e, p, t, z) when spelled in words.

     _ distinctive sounding letters (such as a, f, h, o, s, w) when spelled in isolation.

     _ similar sounding letters (b, c, d, e, p, t, z) when spelled in isolation.

When accessing electronic information auditorily through synthesized speech and a screen reader the student is able to execute navigation commands with instruction to

     _ read by characters.

     _ read by words.

     _ read by sentence and lines.

     _ move forward (to the next character, word, line).

     _ move backward (to the prior character, word, line).

_ When accessing electronic information auditorily, the student was not able to grasp the concept of navigation.

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: _________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

B. Computer Access: Input Devices

1. Keyboard Use                                                                     Date completed __________

_ The student is able to use a standard keyboard without adaptation.

     The student

     _ demonstrates keyboard awareness (has a general knowledge of the key locations).

     _ is able to search for keys and type individual letters.

     _ is able to locate and identify alphanumeric keys.

     _ is able to locate and identify function keys.

     _ is able to activate two keys simultaneously.

     _ is able to touch type while looking at his or her hands

         _ from dictation.

         _ from braille copy.

         _ from copy that is presented in the student's preferred font and point size and positioned on a flexible-arm copy holder.

     _ is able to touch type without looking at his or her hands

         _ from dictation.

         _ from braille copy.

         _ from copy that is presented in the student's preferred font and point size and positioned on a flexible-arm copy holder.

     _ does not demonstrate excessive miss-hits or key repeats.

     _ uses good mechanics when typing (posture, wrist elevation, etc.).

     _ types with ___ fingers of right hand and ___ fingers of left hand.

     _ is able to type approximately ___ words per minute (wpm)

         _ from dictation.

         _ from braille copy.

         _ from copy that is presented in the student's preferred font and point size and positioned on a flexible-arm copy holder.

_ The student is able to utilize a standard computer keyboard with the following adaptations: (Seek assistance from an occupational or physical therapist as needed.)

     _ zoom caps          _ keyguard            _ tactile locator dots

     _ other (specify): ____________________________

_ The student is able to utilize a standard computer keyboard with the following keyboard utilities: (Seek assistance from an assistive technology specialist, occupational therapist, or physical therapist to complete this section.)

     _ sticky keys         _ repeat keys          _ slow keys

     _ mouse keys        _ toggle keys

_ The student is not able to utilize a standard keyboard with or without adaptations. (If checked, refer student for a computer access evaluation.)

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

2. Pointing Device (Mouse)                                                     Date completed __________

The student is able to visually locate the pointer on the screen when it is set to

     _ standard size

     _ standard large

     _ standard extra large

     at approximately ___ inches on a ___-inch monitor.

The student is able to visually locate the pointer on the screen when it is set to

     _ black

     _ black large

     _ black extra large

     at approximately ___ inches on a ___-inch monitor.

The student is able to visually locate the pointer on the screen set to

     _ inverted

     _ inverted large

     _ inverted extra large

     at approximately ___ inches on a ___-inch monitor.

     _ other enlarged pointer (specify): ___________________

     at approximately ___ inches on a ___-inch monitor.

The student is able to

     _ use the mouse to navigate the desktop and place the pointer on the desired screen element.

     _ maintain the mouse or pointer position while clicking or double-clicking.

     _ maintain eye contact with the mouse or pointer while navigating the desktop.

The student is able to select the following items with the mouse:

     _ pull-down menus

     _ toolbar buttons

     _ scroll bars

     _ tabs in multipage dialog boxes

     _ radio buttons

     _ edit fields

     _ edit combo box

     _ combo box

     _ edit spin box

     _ left-right slider

     _ checkbox

     _ other controls

_ The student is able to perform most mouse functions using keyboard commands.

_ The student is not able to physically use a standard mouse. (If checked for a student with low vision using an enlarged     pointer or screen magnification software, refer student for a computer access evaluation to determine a more     accessible pointing device.)

Comments: ________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

C. Personal Digital Assistants (PDAs)                              Date completed __________

The student is able to

_ read the text displayed on a standard PDA.

_ read the text displayed on a portable word processor with scalable fonts.

     Specify font ______________and point size _____.

_ understand speech produced by a talking PDA, including

    _ sentences or lines.

    _ words.

    _ distinctive sounding letters (such as a, f, h, o, s, w).

    _ similar sounding letters (b, c, d, e, p, t, z).

_ read the braille produced by a PDA with a refreshable braille display.

_ execute navigation commands with instruction.

_ execute navigation commands without instruction.

_ enter text through the  _ braille or  _ QWERTY keyboard.

The student prefers using a/an

     _ portable word processor with scalable fonts.

     _ accessible PDA with speech output only.

     _ accessible PDA with refreshable braille display and speech output.

The student was able to answer simple comprehension questions about information presented on a/an

     _ portable word processor with scalable fonts.

     _ accessible PDA with speech output only.

     _ accessible PDA with refreshable braille display and speech output.

The student was able to read approximately

     ____ words per minute (wpm) when using a portable word processor with scalable fonts.

     ____ wpm when using an accessible PDA with speech output only.

     ____ wpm when using an accessible PDA with refreshable braille display and speech output.

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

D. Electronic Calculators and Dictionaries                                      Date completed __________

The student is able to

_ use a calculator with an enlarged display containing ___-inch numerals.

_ accurately locate and press the keys on the calculator keypad.

_ perform basic operations

     _ with prompting.

     _ without prompting.

_ use a talking calculator and

     _ demonstrate understanding of the synthesized speech by repeating

         _ single digits spoken by the calculator.

         _ whole numbers spoken by the calculator.

     _ accurately locate and press the keys on the calculator keypad.

     _ perform basic functions

         _ with prompting.

         _ without prompting. When using a talking dictionary, the student is able to

     _ understand and identify distinctive sounding letters (such as a, f, h, o, s, w).

     _ understand and identify similar sounding letters (b, c, d, e, p, t, z).

     _ understand and identify individual words.

     _ understand definitions spoken as continuous speech.

     _ accurately locate and press the keys on the dictionary's keyboard.

     _ perform basic functions

         _ with prompting.

         _ without prompting.

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Section III: Communicating Through Writing

A. Nonelectronic Tools for Producing Written Communication

1. Writing Tools for Students Using Visual Access                                Date completed __________

When using standard writing tools (pencil, pen, etc.), the student is able to

_ write manuscript (print) legibly at the rate of

     ____ words per minute (wpm) from dictation,

     ____ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ write cursive legibly at the rate of

     ____ wpm from dictation,

     ____ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ space appropriately between letters and words.

_ sign his or her name legibly in cursive using

     _ a signature guide.

     _ the edge of a card, ruler, or some other similar device.

_ The student produces legible writing laboriously and with great difficulty when using standard writing tools.

Comments: ________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

The student is able to produce legible manuscript (print) writing using

_ bold-lined paper at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and:

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ raised-lined paper at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ an erasable pen or  _ a thick, dark pencil such as a primary pencil at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ a felt-tip pen at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ a whiteboard and erasable marker at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ a video magnifier (specify writing tools and adaptations being used) ________________________________ at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

___ other (specify): _________________________

The student is able to produce legible cursive writing using

_ bold-lined paper at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ raised-lined paper at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and:

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ an erasable pen or  _ a thick, dark pencil such as a primary pencil at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ a felt-tip pen at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ a whiteboard and erasable marker at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ a video magnifier (specify writing tools and adaptations being used) __________________________________________________ at the rate of

     ___ wpm from dictation,

     ___ wpm from copy, and

         _ read his or her handwriting.

         _ read a sample of his or her handwriting from 3 to 5 days earlier.

_ other (specify): _________________________

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: ________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

2. Writing Tools for Students Using Tactile Access                           Date completed __________

When using a manual braille-writing device, the student is able to use

     _ a standard Perkins Brailler to emboss characters, words, and sentences at the rate of

          ___ words per minute (wpm) from dictation.

          ___ wpm from copy.

     _ a manual brailler with extension keys to emboss characters, words, and sentences at the rate of

          ___ wpm from dictation.

          ___ wpm from copy.

     _ a unimanual brailler to emboss characters, words, and sentences at the rate of

          ___ wpm from dictation.

          ___ wpm from copy.

     _ a slate and stylus to emboss characters, words, and sentences at the rate of

          ___ wpm from dictation.

          ___ wpm from copy.

_ The student is able to sign his or her name legibly in cursive using

     _ a signature guide.

     _ the edge of a card, ruler, or some other similar device.

The student is willing to use these devices (the examiner may wish to list these separately)

     _ to complete assignments in the regular classroom.

     _ at home to complete school assignments.

     _ while working with the teacher of students with visual impairments.

Comments: _________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

B. Electronic Tools for Producing Written Communication

                                                                                                                     Date completed __________

When using a computer with a scanner and imaging software, the student is able to

     _ scan a worksheet or form.

     _ use the software text tool to insert text into the worksheet.

When using an accessible computer running a word-processing program, the student is able to enter characters, words, and sentences at the rate of

     ___ words per minute (wpm) from dictation.

     ___ wpm from copy.

When using the Mountbatten Brailler or another electronic braillewriter, the student is able to emboss characters, words, and sentences at the rate of

     ___ wpm from dictation.

     ___ wpm from copy.

When using an accessible PDA with a QWERTY keyboard, the student is able to enter characters, words, and sentences at the rate of

     ___ wpm from dictation.

     ___ wpm from copy.

When using an accessible PDA with a braille keyboard, the student is able to enter characters, words, and sentences at the rate of

     ___ wpm from dictation.

     ___ wpm from copy.

Comments: ________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Additional Assessment Information:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Appendix: Windows Display Properties Appearance Checklist

Items Adjusted

_ 3D Objects

               Color _______

_ Active Title Bar

               Size _________  Color __________

               Font _________

                        ____Size ________Color ____Bold ____Italic

_ Active Window Border

               Size _________ Color __________

_ Application Background

               Color _________

_ Caption Buttons

               Size _________

_ Desktop

               Color _________

_  Icons

               Size _________

               Font _________

                    ____Size ____Bold ____Italic

_ Icon Spacing (Vertical)

               Size _________

_  Icon Spacing (Horizontal)

               Size _________

_ Inactive Title Bar

               Size _________ Color __________

               Font _________

                    ____Size ____Bold ____Italic

_ Inactive Window Border

               Size _________ Color __________

_ Menu

               Size _________ Color __________

               Font _________

                    ____Size ____Bold ____Italic

_ Message Box

               Font _________

                    ____Size ____Bold ____Italic

_  Palette Title

               Size _________

               Font _________

                    ____Size ____Bold ____Italic

_ Scrollbar

               Size _________

_ Selected Items

               Size _________ Color __________

               Font _________

                    ____Size ____Bold ____Italic

_ ToolTip

               Color _________

               Font _________

                    ____Size ____Bold ____Italic

_ Window

               Color _________


ASSISTIVE TECHNOLOGY RECOMMENDATIONS FORM

Student Name: ___________________________

Date(s) of Assessment: __________________________

Based on the results of the assistive technology assessment, the following recommendations are made regarding assistive technology to support this student's educational objectives.

Section I: Accessing Print

Students with visual impairments will use a combination of tools and strategies to access printed information. Some will be appropriate for short reading passages and others will be necessary for longer assignments.

A. Accessing Print Visually

Check all that apply.

     _ Student should use regular print materials with the following optical devices:

         _ prescribed eyeglasses or contact lenses

         _ prescribed handheld magnifier

             type: ______         ______ power          _ illuminated

         _ prescribed stand magnifier

             type: ______         ______ power          _ illuminated

         _ prescribed handheld telescope

             type: ______         ______ power

         _ prescribed spectacle-mounted telescope

             type: ______         ______ power

         _ other optical devices recommended in clinical low vision evaluation

             specify: _____________________________________________________

     _ Student should use materials written with felt-tip pen on regular blue-lined notebook paper.

     _ Student should use materials written with felt-tip pen on bold-lined paper.

     _ Student should use materials written with felt-tip pen on unlined paper.

     _ Student should use regular print materials enlarged on a photocopying machine.

         Specify: ______times at ______% enlargement

     _ Student should use large-print books.

     _ Student should use regular print materials scanned into a computer, edited, and printed in ___ point print in the           ____________ font.

     _ When possible, student should be provided with overhead lighting

         _ from an incandescent bulb.

         _ from a fluorescent bulb.

         _ from a halogen bulb.

         _ adjusted with a dimmer switch.

     _ When possible, student should be provided with window lighting adjusted with

         _ blinds.

         _ shades.

         _ other (specify): _________________________________________________

     _ When possible, student should be provided with additional lighting from

         _ desk lamp with a/an

                 _ incandescent bulb.

                 _ fluorescent bulb.

                 _ halogen bulb.

                 _ LED bulb.

         _ floor lamp with a/an

                 _ incandescent bulb.

                 _ fluorescent bulb.

                 _ halogen bulb.

                 _ LED bulb.

     _ Student should use a book stand or reading stand (specify type):

         _ braille book stand

         _ desktop model

         _ portable model

         _ floor model

     _ Student should use regular print materials with a video magnifier (CCTV) (specify type):

         _ desktop model

         _ flex-arm camera model

         _ head-mounted display model

         _ portable model

         _ electronic pocket model

         _ digital imaging model

         Specify essential features: ____________________________________________________________

         ________________________________________________________________________________

         ________________________________________________________________________________

         ________________________________________________________________________________

_ Student should use regular print materials with the following type of scanner and imaging   software:

     _ standard imaging program

     _ specialized scanning program

Additional comments or recommendations: _________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

B. Accessing Print Tactilely

Check all that apply.

     _ Student should use materials in braille.

     _ Student should use an electronic refreshable braille display to access print and electronic information.

     _ Student should be provided opportunities to use tactile graphics created by various production techniques and in a variety of          media, including real objects, models, collage, tooling and stenciling, thermoform, capsule paper and fuser, computer-         generated, and commercially produced.

     _ Student should use tactile graphics to access maps, charts, and diagrams.

Additional comments or recommendations: _________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

C. Accessing Print Auditorily

Check all that apply.

     _ Student should use a live reader for accessing certain materials (specify):

     ________________________________________________

     _ Student should use recorded materials for accessing some print information (specify):

     ________________________________________________

     _ Student should use a computer-assisted reading system such as Kurzweil 1000 or OpenBook.

Additional comments or recommendations: _________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

D. Accessing Information Presented at a Distance

Check all that apply.

     _ Student should be provided an accessible copy of information presented on chalkboards or whiteboards, overhead          projectors, computer projection systems, and so forth.

     _ Student should use a handheld telescope for accessing chalkboards or whiteboards overhead projectors, computer          projection systems, and so forth.

     _ Student should use a video magnifier with distance viewing capabilities for accessing chalkboards or whiteboards, overhead          projectors, computer projection systems, and so forth.

     _ Student should use a digital video camera connect to an appropriate size monitor for accessing chalkboards or whiteboards,          overhead projectors, computer projection systems, and so forth.

     _ Student should use an electronic whiteboard connected to an accessible computer.

     _ Student should be provided audio-described videos when available.

     _ Student should be provided a separate ____-inch monitor for viewing DVDs, movies, and other video presentations.

Additional comments or recommendations: _________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Section II: Accessing Electronic Information

A. Computer Access—Output Devices

1. Visual Access

Check all that apply.

     _ Student should use a standard computer monitor: Optimal size: ______________________

     _ Student should use a standard computer monitor with the following hardware adaptations:

         _ adjustable monitor arm

         _ hardware screen magnifier

     _ Student should use a standard computer monitor with the following Windows or Macintosh

     _ Display Appearance Settings (list on separate page if needed): _________________________________

          ________________________________________________________________________________

     _ Student should use the following Accessibility options in the computer's operating system:

         _ Macintosh               _ Windows Accessibility

     _ Student should use the following screen magnification program provided in the computer's operating system:

         _ Macintosh Zoom     _ Microsoft Magnifier

     _ Student should use a dedicated screen magnification program.

          Specify essential features: ____________________________________________________________

2. Tactile Access

     _ Student should use a refreshable braille display.

            Specify essential features: ___________________________________________________________

3. Auditory Access

Check all that apply.

     _ Student should use a talking word processor to develop basic computer skills.

     _ Student should use the following screen-reading program provided in the computer's operating system:

         _ Macintosh VoiceOver      _ Microsoft Narrator

     _ Student should use a dedicated screen-reading program.

          Specify essential features: ________________________________________________________

      Additional comments or recommendations: _____________________________________________

      ______________________________________________________________________________

      ______________________________________________________________________________

B. Computer Access-Input Devices

1. Keyboard Use

Check all that apply.

     _ Student should use a standard keyboard.

     _ Student should use a standard keyboard with

         _ large-print labels, white text on black background.

         _ large-print labels, black text on white background.

         _ braille labels.

     _ Student should use a standard keyboard with locator dots to develop or improve keyboarding skills.

     _ Student should receive individual keyboarding instruction.

     _ Student should use a talking word processor for keyboarding instruction.

     _ Student should use a talking typing program for keyboarding practice and reinforcement of skills taught by instructor.

     _ Student should use a standard keyboard with Windows Accessibility or Macintosh Universal Access options:

     _ StickyKeys

     _ FilterKeys

     _ ToggleKeys

     _ Other (specify): __________________________________________________________________

     _ Student should use a standard keyboard with hardware adaptations.

          Specify:_________________________________________________________________________

     _ Student should use an alternative keyboard.

          Specify:_________________________________________________________________________

2. Pointing Devices and Other Tools

Check all that apply.

     _ Student should use a standard pointing device like a mouse or trackball.

     _ Student should use an alternative pointing device.

          Specify:_________________________________________________________________________

     _ Student should use a voice recognition system to control the computer.

     _ Student should have access to a copyholder that allows printed materials to be positioned at a comfortable viewing distance.

     Additional comments or recommendations: ________________________________________________

     _________________________________________________________________________________

     _________________________________________________________________________________

C. Accessing Other Electronic Information

1. Specialized Scanning Systems

     _ Student should have access to a specialized scanning system.

         Specify essential features: _________________________________________________________

2. Accessible Personal Digital Assistant (PDA)

     _ Student should have access to a personal digital assistant with the following features:

         _ scalable font display

         _ screen magnification capability

         _ synthesized speech output

         _ refreshable braille display

          Specify essential features: _________________________________________________________

3. Other Electronic Tools

     _ Student should use a     _ basic or     _ scientific talking calculator.

     _ Student should use a computer-based calculator program with

         _ screen-magnification software.

         _ screen-reading software.

     _ Student should use a dictionary or thesaurus program on a computer with

         _ screen-magnification software.

         _ screen-reading software.

     _ Student should use a portable talking dictionary.

     Additional comments or recommendations: ________________________________________________

     _________________________________________________________________________________

     _________________________________________________________________________________

Section III: Communicating Through Writing

Students who are blind or visually impaired will use a combination of tools and strategies to produce written communication. Some will be appropriate for short writing assignments and others will be necessary for longer assignments.

Check all that apply.

     _ Student should use pen or pencil and paper

         _ for short writing assignments.

         _ for most writing assignments.

     _ Student should use felt-tip pen or other bold marker.

     _ Student should use     _ bold-lined     _ raised-lined notebook paper.

     _ Student should use     _ bold-lined     _ raised-lined graph paper for math.

     _ Student should use crayons and a screen board for beginning handwriting.

     _ Student should use a whiteboard with erasable markers.

     _ Student should use a computer with a math writing and editing program.

     _ Student should use a computer with a scanner and imaging software to complete forms.

     _ Student should use an accessible computer with word-processing software.

     _ Student should use manual braillewriter.

     _ Student should use manual braillewriter with extension keys.

     _ Student should use a unimanual (one-handed) braillewriter.

     _ Student should use unimanual (one-handed) braillewriter with extension keys.

     _ Student should use slate and stylus.

     _ Student should use an electronic braillewriter.

        Specify: ________________________________________________________________________

     _ Student should use an adaptive analog or digital recorder for notetaking.

     _ Student should use an accessible PDA for notetaking and other short writing tasks.

     _ Student should use an accessible laptop or notebook computer for notetaking.

     Additional comments or recommendations: ________________________________________________

     _________________________________________________________________________________

     _________________________________________________________________________________

Section IV: Additional Hardware and Software

Student should be provided with access to the following hardware and software:

     _ Macintosh computer system with

          ____MB memory         ____ GB hard drive      _ CD/DVD drive

     _ Windows-compatible computer system with

          ____MB memory         ____ GB hard drive      _ CD/DVD drive

     _ word processor    _ printer

     _ Internet access     _ flatbed scanner

          other: __________________________________________________________________________

          _______________________________________________________________________________

          _______________________________________________________________________________

Equipment needed to produce materials for student in appropriate format:

     _ Macintosh or Windows-compatible computer system with

          ____MB memory         ____ GB hard drive      _ CD/DVD drive

         _ Internet access          _ flatbed scanner          _ OCR software

         _ word-processing software          _ braille translating software

         _ inkjet or laser printer                  _ braille embosser or printer

         _ tactile graphics production equipment:

             Specify:_______________________________________________________________________

Additional comments or recommendations: ___________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

The recommendations made here do not all have to be implemented immediately. These suggestions are designed for a two- to three-year plan in which the student masters certain skills and is provided access to additional technologies that can facilitate his or her educational program. During that time, new technologies are likely to become available that will enhance the student's ability to maximize his or her educational potential. The specific devices recommended may no longer be the most appropriate, but the assistance that they provide will continue to be a need for this student.

___________________________________      _______________________________

Assessment Completed by (signature)                    Position

____________________________________      ______________________________

Assessment Completed by (signature)                    Position

___________________________________      _______________________________

Assessment Completed by (signature)                    Position

__________________________________      ________________________________

Assessment Completed by (signature)                    Position

Assistive Technology for Students Who Are Blind or Visually Impaired: A Guide to Assessment, by Ike Presley and Frances Mary D'Andrea, copyright © 2009, AFB Press, New York. All rights reserved. This page may be copied for educational use only.

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