Vision - Eye Dominance

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EYE DOMINANCE

Child holds tube   ____ teacher holds tube    ____ flashlight used                    

First trial:   Right   ____Left                    

Second trial:   Right   ____  Left                    

Third trial:   Right      ____ Left                    

 

EYE CONTACT

Maintains  ____ momentary  ____                                                             

Eye contact at several feet   ____                              

Eye contact within one foot    ____                 

Eye contact if turn child’s head toward examiner  ____                   

Eyes avert direct eye contact  ____        

 

RESPONSE TO NATURAL LIGHT

Child seeks shaded  areas     ____ 

Child creates shaded areas     ____      

Child moves to source of light     ____       

Child turns head to source of light  ____           

Child moves away from source of light   ____                  

Child turns head from source of light   ____

 

RESPONSE TO ARTICIAL LIGHT – flashlight pursuit 

Observe:  blinking, head movements, eye jerkiness, ability to locate, light-gazing, etc.

Description:

 

IMPROVING VISUAL FUNCTIONING

Moves material close to eyes   ____                  

Moves head close to the materials     ____               

Closes one eye     ____                

Moves eyes to left    ____                 

Moves eyes to right     ____                

Squints      ____  

Contorts face     ____                

 

GLASSES

Accepts glasses      ____               

Looks over top of glasses   ____                  

Adjust glasses       ____              

Removes glasses     ____                

 

HEAD POSITION

Child improves visual function by:

Tilting head to left    ____                 

Tilting head to right     ____                

Tilting head up    ____                 

Tilting head down   ____                  

Shakes head   ____                  

No head adjustment    ____                 

 

SCANNING

Child scans objects across room     ____                

Child scans objects within 8-10 feet     ____                

Child scans objects on table   ____                  

Does not visually explore environment   ____                  

 

TRACKING OBJECT

Dangling ring    ____  plastic ring   ____ ring and light      ____               

Pursues ring with good fixation for 180 degrees (20 wks)   ____                           

Follows 180 degree arc with blinking or jerking eye movement (12 wks) ____

Prompt midline regard (12 wks)      ____

Delayed midline regard (8 wks)   ____    

Follows to midline – other eye takes over (0-4 wks)     ____  

Moves head    ____          

Regards when brought in line of vision only   (0-4 wks)    ____                                        

 

DETECTING SMALL MOVING OBJECTS

Jumping bean  (0-4 wks)  ____red ball  (0-4 wks)  ____wind-up toy  (0-4 wks)  ____               

Child can detect small moving object   ____                                

At 10 feet    ____                              

At 5 feet   ____                               

At arm’s length ____                                 

At less than one foot   ____                               

Cannot detect  ____                               

 

DETECTING SMALL STATIONARY OBJECTS

Raisin  ____ bead  ____                                

Child can detect small stationary objects  ____                                

At 10 feet     ____                             

At 5 feet  ____                                

At arm’s length   ____                               

At less than one foot    ____                              

Cannot detect    ____                              

 

DETECTING LARGE MOVING OBJECTS

Child can detect large moving objects      ____                            

At 10 feet     ____                             

At 5 feet        ____                          

At arm’s length     ____                             

At less than one foot     ____                             

Cannot detect      ____                            

 

DETECTING LARGE STATIONARY OBJECTS

Child can detect large stationary objects     ____                             

At 10 feet    ____                              

At 5 feet     ____                             

At arm’s length   ____                               

 

COLOR AGAINST COLOR BACKGROUND

Large object v ____ small   ____buttons  ____ raisins and marshmallows                                 

Black on black     ____                             

White on white    ____                              

White on black     ____                             

Red on red      ____                            

Blue on blue    ____                              

Yellow on yellow     ____                             

 

FIGURE-GROUND

Number(s) of plate (s) used                                 

Sock   ____ car   ____spoon ____ chair                                 

 

VISUAL CLOSURE

Number of templates used  ____                                

Apple  ____ bed ____sneakers  ____sink  ____pants                                 

 

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