Clinician's Manual

The Visual Performance Assessment (VPA™) is a criterion- and norm-referenced instrument for characterizing a learner's functional visual processing across oculomotor, visual-perceptual, and visual-motor domains. It is designed to be administered by occupational therapists, developmental optometrists working alongside OTs, and appropriately trained educators.

Intended population

• Ages 4 through adult, banded as Early Childhood, Elementary, Middle, High School, Adult.
• Learners with suspected visual-processing difficulty affecting reading, writing, or classroom performance.
• Clients receiving OT services for whom vision-related contributors to occupation are hypothesized.

Intended uses

• Screening and triage into a full vision workup.
• Baseline and re-assessment for OT plans of care and IEP documentation.
• Contributing to interdisciplinary case formulation alongside developmental optometry.

The VPA™ is not

• A substitute for a developmental optometric or ophthalmologic exam.
• A diagnostic test for medical conditions of the eye or brain.
• A stand-alone determination of educational eligibility.

The VPA™ organizes items around Warren's hierarchical model of visual perceptual development — oculomotor control and visual attention support pattern recognition, which in turn supports visual cognition — and Skeffington's four-circle model of binocular integration. Composite indices align with these constructs:

• Oculomotor Index — fixation, saccades, pursuits, near point of convergence.
• Visual Perceptual Index — discrimination, memory, closure, figure-ground, form constancy, spatial relations.
• Visual-Motor Index — visual-motor integration and handwriting readiness, sequencing, motor planning under visual guidance.

Vision, handwriting, and literacy

Two functional occupations sit downstream of these indices and are named explicitly throughout the VPA™:

• Handwriting readiness — the Visual-Motor Index carries a dedicated Handwriting Readiness subsection covering alignment, spacing, sizing, board-to-paper copy, postural support, and pencil-grasp fatigue under visual-motor demand. It is curriculum-neutral and routes to the Handwriting Visual Foundations packets.
• Literacy — the Oculomotor and Visual Perceptual indices form the visual substrate of decoding, fluency, and worksheet navigation. Discrepancy analysis is designed to trace reading breakdown to a specific visual contributor rather than collapse it into "reading trouble."

The VPA™ does not measure literacy, decoding, or reading comprehension directly; it measures the visual and ocular-motor substrate (endurance, efficiency, accuracy, and spatial processing) that must be intact for literacy to develop. A high score on a reading endurance item, for example, describes ocular-motor stamina during a text task, not the student's reading ability.

Warren M. (1993). A hierarchical model for evaluation and treatment of visual perceptual dysfunction in adult acquired brain injury. AJOT. Skeffington A.M. (1963). Optometric Extension Program Foundation clinical papers.

Norms are built continuously from live, opt-in administrations that meet inclusion criteria. The refresh_vpa_norms() procedure rebuilds normative distributions per skill × age band × breakdown (grade, setting) and is versioned to the protocol and item bank in force at administration.

Inclusion rules

• Submissions from admin accounts are excluded.
• Only the most recent submission per student per protocol version contributes.
• Rows require a non-empty per-skill VPL map, a recorded age band, and a protocol version.
• Cells with n < 30 are hidden from reports and reported as "insufficient sample."

Bank versioning

Item banks are immutable once any scored submission references them. Editing an item ships a new bank version and starts a new normative pool. Reports state both the protocol version and bank version so results are always interpretable in context.

Setup

• Well-lit, quiet room. Table height so the student's forearms rest comfortably.
• Working distance: 16 in. for near tasks; 10 ft. for near-far shift tasks.
• Habitual correction worn (glasses/contacts). Note if not.

Age-graded entry

The adaptive engine starts each skill at the difficulty level appropriate for the student's age band (Early = L1, Elementary = L2, Middle = L3, High/Adult = L4). Do not override without cause; deviations are logged and flag the protocol.

Basal & ceiling stop rules

• Basal: three consecutive rubric ratings ≥ 2 → credit earlier items.
• Ceiling: three consecutive rubric ratings ≤ 1 → discontinue skill.

Verbatim scripts

Every item has a script. Read it verbatim. Allowable prompts are one repetition of the instruction and one neutral encouragement ("Keep going."). Anything further is a deviation.

Paper administration

The printable worksheets and the per-age-band Administration Kit (available inside the app) produce a fully paper-equivalent record. Enter scores into the digital tool afterward to generate scaled and composite indices.

Raw rubric (per item)

• 0 — no meaningful response.
• 1 — emerging; partial response with substantial support.
• 2 — adequate; goal met with minor error or slow speed.
• 3 — mastery; accurate, efficient, and self-monitored.

Visual Performance Level (VPL 1–5)

The highest difficulty level at which the student earns rubric ≥ 2 becomes their VPL for that skill. VPL is the raw, criterion-referenced score.

Scaled scores (M = 10, SD = 3)

Where the peer cell has n ≥ 30, VPL is transformed to a scaled score via a percentile-to-z transform against the age-band distribution. Scaled scores carry a 95% confidence interval derived from the current internal-consistency estimate.

Composite indices (M = 100, SD = 15)

Skill scaled scores are combined into the three composite indices above. A composite is only reported when at least two contributing subtests have valid scaled scores.

Graceful degradation

When the peer cell is under-sampled, the tool reports raw VPL only and states that scaled/composite scores are unavailable. It never fabricates a scaled value.

Examiner Protocol appendix

Every generated PDF ends with an Examiner Protocol appendix: a plain-English validity summary, a per-skill basal/ceiling table (with credited and skipped levels), and an item-by-item response log including elapsed time and any examiner deviations. This makes each administration fully auditable.

Classification bands (composite indices)

• ≥ 130: Very superior
• 120–129: Superior
• 110–119: High average
• 90–109: Average
• 80–89: Low average
• 70–79: Below average
• ≤ 69: Well below average

Discrepancy analysis

A difference of ≥ 15 points (1 SD) between composite indices is flagged as clinically significant. Common patterns: Oculomotor << Perceptual (suggests referral to developmental optometry), Perceptual << Motor (consider visual-cognitive load), Motor << Perceptual (consider praxis or handwriting workup).

Validity flags

Reports mark a protocol invalid when rapid-clicking, all-same-response, or repeated timeouts are detected, or when examiner-recorded deviations exceed threshold. Invalid protocols must not be used for eligibility decisions.

Reliability estimates are computed from live pooled data and published on the research page as each cell clears n ≥ 30. Until then the page reports the current sample size and withholds the estimate. No placeholder values are used.

• Internal consistency: Cronbach's α per bank version across all valid submissions.
• Test-retest: Pearson r per skill from admin-linked retest pairs, minimum interval 7 days.
• Standard error of measurement (SEM): SD·√(1−r), reported per skill on the admin reliability dashboard.

Convergent validity work with established batteries (TVPS, DTVP, Beery VMI) is planned for the v1.x cycle and will be reported openly when complete.

• Use only within your scope of practice and licensure.
• Obtain informed consent, including consent for de-identified data to contribute to norming and reliability work (opt-in).
• Do not report scaled or composite scores when the peer cell is under-sampled; report raw VPL and state the limitation.
• Refer to developmental optometry or ophthalmology when oculomotor findings are abnormal or when the student reports symptoms (double vision, headaches, loss of place).
• Interpret in context: culture, language, hearing, attention, and prior instruction all shape performance.

• v1.0 (2026) — Initial release. Protocol v1.0, bank v1.0-elementary. Adaptive engine, scaled/composite scores, printable kit, and Clinician's Manual.

© Visual Minds Learning · Jeff Foster, MS, OTR/L, EdD(ABD). VPA™ is a pilot-stage instrument in active development. Feedback: jfosterot@gmail.com.