Specialized Population Protocols

A semi-structured interview that identifies the occupations a child or family values most and rates current performance and satisfaction.

Use: Administer at baseline, mid-point, and discharge. A change of ≥ 2 points on performance or satisfaction is considered clinically meaningful.

Use child/adolescent or caregiver-proxy version as appropriate. Purchase and use per publisher guidelines.

A standardized way to score how much a child achieves on individually written goals, from much worse than expected (−2) to much better than expected (+2).

Use: Write 1–3 goals, set baseline at −1 or −2, expected outcome at 0, and above/below outcomes at +1/−1 or +2/−2. Convert raw scores to a T-score at discharge.

Works well for IEP-aligned goals and small-N clinical progress monitoring.

A 15-item questionnaire about near-work symptoms such as headache, blur, double vision, tired eyes, and loss of concentration.

Use: Give to the child (usually age 8+) or as a parent proxy. Each item is scored 0–4. Total ≥ 16 for children or ≥ 21 for adults indicates a symptomatic near-work load. Re-administer to track change.

Built into the VPA clinical intake. It is a symptom screen, not a diagnosis by itself.

A 12-item school-based symptom log for teachers, parents, or students that captures observable near-work signs (rubbing eyes, losing place, head tilt, avoidance, etc.).

Use: Score each item 0–3. A total ≥ 8 or any single item ≥ 2 indicates a functional near-visual endurance concern that warrants follow-up.

Useful for triangulating with the CISS-15, VOMS, and classroom observation.

A normed test of saccadic/pursuit-like scanning using vertical and horizontal arrays of numbers.

Use: Administer per the publisher’s manual. Compare horizontal and vertical times and errors. Use as a screening or progress measure, not a diagnostic vision test.

Often co-administered or reviewed with developmental optometry.

A timed test of saccadic efficiency and cognitive processing speed; commonly used in concussion management.

Use: Have the student read numbers across a series of cards as quickly and accurately as possible. Compare to a personal baseline or age norms.

Sideline and clinical versions exist; OT can use it to track return-to-learn recovery.

A clinical rating scale of fixation, pursuits, and saccades in children.

Use: Use a standardized target and rate the quality of each movement on the publisher’s scale. Often administered by optometrists; OTs may observe or co-measure.

Training is recommended to maintain reliability. Not a substitute for a full optometric exam.

A norm-referenced test of visual-motor integration using shape and form copying.

Use: Administer per publisher instructions. Use the standard score and associated visual and motor subtests to describe VMI status and track change over time.

OT- or OD-collected; coordinate with the IEP team on re-eval intervals.

A brief drawing task that samples visual-spatial planning, executive function, and construction.

Use: Ask the child to draw a clock face and set the hands to a specific time. Score against a standard rubric and use as a serial probe, not a diagnostic screen.

In older students, marked failure should prompt neuropsychology or medical referral.

A framework for assessing and describing visual functioning in children with cortical/cerebral visual impairment.

Use: Typically administered by the TVI; OT contributes functional observations about how the child uses vision during daily occupations.

Guides environmental complexity, preferred field, color, and movement supports.

A symptom inventory tracking vision-related complaints after concussion (e.g., headache, light sensitivity, motion sensitivity, reading difficulty, screen intolerance).

Use: Administer at baseline and weekly during rehab. A score ≥ 20, or photophobia / motion sensitivity, supports opening the concussion protocol branch. Use alongside CISS-15 and VOMS.

Often used alongside the CISS-15 and VSS-School. Track change, not just absolute score.

A 15-item questionnaire about near-work symptoms such as headache, blur, double vision, tired eyes, and loss of concentration.

Use: Give to the child (usually age 8+) or as a parent proxy. Each item is scored 0–4. Total ≥ 16 for children or ≥ 21 for adults indicates a symptomatic near-work load. In concussion, pair with the Post-Concussion Vision Symptom Scale to separate near-work load from post-trauma symptom load.

Built into the VPA clinical intake. It is a symptom screen, not a diagnosis by itself.

The closest point at which the eyes can maintain a single, fused image without double vision.

Use: Move a small target (penlight or accommodative target) along the midline toward the nose. Record the break point (when the image doubles) and the recovery point (when it single again). Co-measure with developmental optometry when possible.

A break point receded beyond 6 cm, or recovery beyond 10 cm, often supports convergence-insufficiency concerns.

The ergonomic near-working distance from the sternum to the elbow — roughly the distance from the child’s chin/chest to the knuckles when the elbow is bent at a right angle.

Use: Teach the child to place the page or screen at that distance, which reduces accommodative and convergence load while keeping posture upright.

Sometimes misspoken as “Harmen distance.” OT scope: training and accommodation; not a medical prescription.

A chart with columns of letters or numbers used to train and measure saccadic scanning.

Use: Have the student read each column top-to-bottom, then move left-to-right across columns. Time the run and count errors. Increase density as performance improves.

Curriculum-neutral; can be made with simple paper or purchased from vision-therapy suppliers.

A ball on a string used to train pursuits, fixation, and gaze stability.

Use: Swing the ball in horizontal, vertical, and circular planes while the child keeps the eyes on the ball and minimizes head movement. Progress from slow to fast and from single to dual planes.

Stop if dizziness, nausea, or headache occur.

A string with colored beads used to teach awareness of convergence and single vision at near.

Use: Hold one end to the nose, place beads at various distances, and ask the child to look at one bead so it appears single and the other beads split into two images. Use under optometric direction.

Stop if diplopia or headache persists. OT-scope only; does not replace office-based vision therapy.

A rate measure used most often for accommodative facility (lens flipper tasks).

Use: Count how many times the child can clear a plus lens and then a minus lens in one minute while looking at a near target. Compare to optometrist target or age expectation.

Administered by optometry; OT may track the result.

A brief, validated clinical screen of smooth pursuits, saccades, convergence, and vestibular-ocular reflex (VOR) used in concussion and mild TBI assessment.

Use: Use as a documented rule-out screen within the first 90 days after injury. OTs may administer the oculomotor components (pursuits, saccades, convergence) within scope; vestibular components are typically administered or reviewed with the medical concussion team, PT, or neuro-optometrist. A positive finding supports opening the post-concussion vision protocol.

VOMS is a screening tool, not a diagnostic test. Positive results should be triangulated with the Post-Concussion Vision Symptom Scale, CISS-15, and clinical observation.

A self-management habit: every 20 minutes, look at something 20 feet away for at least 20 seconds.

Use: Embed into classroom routines, visual timers, or student checklists. Start with shorter intervals for students with poor near endurance.

Reduces accommodative and vergence fatigue; does not replace optometric treatment.

A large multisite randomized controlled trial that established office-based vergence therapy as the most effective treatment for convergence insufficiency.

Use: Cite as evidence when referring a child to optometric vision therapy. OT’s role is functional generalization, accommodation, and habit training — not delivery of the CITT protocol itself.

The full CITT protocol is optometry-led.

A supervised, office-based rehabilitation program for accommodative, vergence, oculomotor, and visual-perceptual problems.

Use: OT can supplement VT with functional home programs, school accommodations, and endurance generalization, but OT does not replace office-based VT.

Refer to developmental optometry when VT is indicated.

A primary-eye-care provider who evaluates refractive, accommodative, vergence, ocular-health, and developmental vision concerns.

Use: “OD-directed” in a protocol means the optometrist leads the medical/vision-therapy component; OT supports carryover, accommodations, and occupational performance.

OT does not prescribe, diagnose, or modify refractive management independently.

An educator who specializes in vision-related accommodations, braille, assistive technology, and Expanded Core Curriculum.

Use: Partner with the TVI for students with CVI, low vision, or blindness. OT focuses on occupational performance; TVI focuses on vision-specific instruction and access to curriculum.

A specialist who teaches safe, independent travel to children with visual impairment.

Use: Coordinate with COMS when low vision or field loss affects safe mobility in school or community.

The reflex that keeps images stable on the retina while the head moves.

Use: “VOR × 1” exercise: the child keeps the eyes fixed on a target while moving the head side-to-side or up-down. Used in post-concussion vision-vestibular rehab.

Stop if dizziness or nausea worsens; coordinate with PT/physician when indicated.

A mild traumatic brain injury, commonly called concussion, that can disrupt visual, oculomotor, and vestibular function.

Use: Use symptom-guided dosing and return-to-learn staging. OT operates within scope on occupational participation; physician clearance is required for return-to-play.

Brain injury caused by insufficient oxygen and blood flow around birth.

Use: One of several medical conditions associated with CVI risk. Document history; do not attribute current functional vision solely to HIE without medical input.

Brain injury affecting white matter near the ventricles, a common CVI-associated diagnosis.

Use: Note in the medical history and coordinate with medical, TVI, and early-intervention teams.