Vision Therapy Practice Builder Manual







The following is a complete set of the forms we utilize during the first hour of an Initial Evaluation appointment. This would be the portion completed by a therapist just prior to seeing the doctor. They are also listed in the order in which we use them. Please reference your Initial Evaluation transcript for the manner in which we present the tests to the patient. 


**We reference the patient and parent in our explanations of the Testing Forms, we also use these forms for our adult patients being tested.


*If noted with an asterisk we obtained a variation of this test/form from Dr. Steve Ingersoll, OD at the Excel Institute in Michigan which we have since modified to use in our program. 





1. Questions & Observations 

  Start with this form; we address the patient, telling the parent we will ask them for comments after we get the patient’s response. These questions help us assess if there are any visual learning problems in addition to visual efficiency problems.  



2. History Summary 

          While the patient is taking the Gardner’s Test of Reversals, we ask the parent these questions; when asked orally it often triggers answers not on the written history form. While we are asking, we also are observing the patient as they perform this test, marking the appropriate boxes on the Scoring Form.




3. Scoring Form* 

          As the tester observes, they are noting or marking the appropriate boxes for behaviors they are seeing during each specific test. Tester notes total score, then looks at age under the Age column (age of patient) to see if the score is within that age range, ranked from 1 (good) to 3 (below age level). If they did not score in Rank 1, find the score and note the age level scored. Any score not ranked 1 is below their age level and gets scored accordingly. Also note any compensations used such as auditory rehearsal, motor rehearsal, or developmental thumb. 



4. Reversal Test 

          After instructions are given (“please cross out any number or letter that looks backwards or wrong”) this test is completed while the parent is asked questions on the History Summary. The tester is making observations and noting them on the Scoring Form during the questioning of the parent.      



5. Number Line*

          This test is used to determine whether the child is seeing the “big picture” or only concentrating on details. 



6. Saccadic/Tracking Test Reference Sheet 

          Score sheet used by tester while patient is taking these tests. 



7. Saccadic/Tracking Test Cards* 

          Saccadic test: This variation of the King Devick test is timed and the scores (number of seconds) for each test are totaled with the number of seconds for both tests (the first ‘demo’ card is not scored but is only used for practice).

        Pursuit test: This variation of the Groffman Trackingtest is scored with the number of correct answers given in one minute. 



8. Visualization Test Reference Sheet 

           Scoring sheet for raw scores and notations.



9. Visualization Test Cards*

          This variation of the Getman Visualization test shows the patient’s ability to interpret and visualize spatial relationships and mentally manipulate objects in space. Can they do this by visualizing or do they resort to auditory or motor rehearsal



10. Visual Memory Test Cards* 

        This variation of the Monroe Visual Memory test assesses the patient's ability to recall and reproduce a series of geometric forms after a 10-second presentation.  



11. Wold Sentence Copy Test & Scoring 

        The patient is asked to copy the words above onto the lines below. The number of letters copied in one minute is recorded. Just as important are the observations made by tester (grip, distance to paper, reversals, etc.)         



12. Color Fields Sample 

          A functional color field test (as used in syntonics testing) is given at this point to determined if the patient’s functional field is constricted. This includes a sample print and interpretation from our computer testing program.  



13. Visagraph Sample 

          Grade level appropriate visagraph reading is taken with comprehension questions following.  



14. Reflex Testing Sheet 

          The Moro, ATNR, STNR, TLR, and Spinal Galant reflexes are tested and noted on the assessment sheet if they were present or not present.