Administering the VPA™ over telehealth

Do not score acuity from a screen. Rendered size depends on the student's display resolution, zoom level, and seat distance, none of which you can verify. Print the acuity ladder in advance at 100% scale (no 'fit to page') and treat any remote result as a screening observation only.

Facilitator: Print the acuity card at 100% scale, verify the printed reference bar against a ruler, hold it at a tape-measured 40 cm, and keep room lighting even and glare-free.

Document this: Even facilitated, remote acuity is an observation, not a measurement. Route to a comprehensive eye exam rather than reporting an acuity value.

Contrast sensitivity cannot be validly administered through video compression. Codecs re-render low-contrast edges unpredictably and brightness varies by display. Print the Sloan contrast sheet in advance or defer.

Facilitator: Print on matte white paper with a laser printer if available, present at a tape-measured 40 cm under even lighting, no backlight or window behind the sheet.

Document this: Video compression alters low-contrast targets. Do not report a contrast threshold obtained over a live video feed.

Strong remote probe. Ask the student to move the device so the camera frames the face from mid-forehead to chin, then hold still. Use the presenter tab for the fixation target and watch for drift, refixation saccades, and head movement substituting for eye movement.

Document this: Note the device type. A held phone introduces target motion that a propped laptop does not.

Excellent over video, and in some ways better than in-person: you are looking straight at the eyes rather than over the target. Share the presenter tab, set excursion to the full screen, and use the slowest speed first. Watch for head movement, loss of pursuit at midline, and blink-outs at the end points.

Document this: Screen size sets the angular excursion. Record the student's screen size and seat distance so a re-test can reproduce it.

Runs well remotely. Camera on the face, stimulus on their screen. Because you are viewing the eyes head-on you can often count under- and over-shoots more accurately than at bedside. For the reading-based levels, use the printed sheet plus a face-framed camera so you see the eyes and hear the reading together.

Document this: Ask them to disable any camera 'auto-framing' feature, which crops and smooths eye motion.

Screening observation only, and it requires hands. The facilitator moves the midline target toward the bridge of the nose at roughly 2 cm per second while you watch the eyes on camera and the student reports doubling.

Facilitator: Sit beside, not behind, the student. Move the target slowly along the midline toward the nose. Stop when the student reports two, or when you see one eye swing outward. Read the break distance off the tape.

Document this: This is an OT screening observation of a functional near-point behavior, not a clinical NPC measurement. Report the observation and the referral decision, not a value.

Share the stimulus and take verbal or pointer responses. If the student points at their own screen, ask them to say the position out loud (top left, second row) so you are not guessing at a mirrored gesture.

Present through the presenter tab and take verbal responses plus a count. Set a visible timer so latency is comparable to in-person norms.

Document this: If the student's screen is under about 11 inches, print the sheet instead; crowding changes the task.

Multiple-choice format transfers cleanly. Have the student name the choice letter rather than pointing.

Runs directly. Be explicit that left and right are from the student's own point of view, since the video mirror flips your reference.

Document this: Turn off the student's camera 'mirror' setting, or at minimum know that it is on.

Presenter tab controls exposure duration precisely, which is actually more consistent than hand-timed card exposure. Ensure the facilitator does not leave the printed sheet in view during the recall interval.

Transfers well. For the L4 b/d/p/q level, take verbal letter naming rather than pointing so you can separate a form error from a naming error.

The student must write on paper, not on screen. Print the copy ladder in advance. Use a second camera angle, or have the facilitator reposition the device to a top-down view of the page while the student works, then photograph the finished page and send it.

Facilitator: Print at 100% scale. Set up a stable top-down view of the writing surface. Do not correct, prompt, or reposition the paper during the item. Photograph the page flat, in daylight, and send it before the session ends.

Document this: Score from the photographed page, not from the video image. Document that the sample was obtained remotely.

Same as visual-motor: paper, top-down camera, photograph the product. The planning behavior you are watching for (where they start, whether they anchor 12-3-6-9, whether they crowd the numbers) is visible on video even when the fine detail is not.

Facilitator: Blank unlined paper, top-down view, no verbal cues, photograph the finished clock.

Document this: Note whether the drawing was scored from the photograph or from the live view.

The single most valuable remote probe, because you are watching sustained performance in the student's actual work environment rather than a clinic room. Print the grade-level passage in advance. Frame the camera on the face and upper trunk so you can see head tilt, working distance creep, finger tracking, blink rate, and postural collapse across the trial.

Facilitator: Print the passage at 100% scale. Set the device so the student's face and shoulders are in frame. Then step out of the frame and do not coach.

Document this: Record the actual working distance at the start and at the end of the trial. Distance creep across a reading trial is itself a finding.