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Vision in OT Practice — participation guide

3 contact hours · 0.3 AOTA CEUs · Module 2 — follow along, take notes, and complete the reflection prompts.

Module 2

The Five-Level Visual Performance Framework

Follow along

What this module covers

Visual development milestones OTs should know
How the Five-Level Framework was built
Two rules for choosing where to start
The same four-part shape, every level

Key ideas

Capture these as you listen

The Framework has five levels, Access, Efficiency, Processing, Visual-Motor Integration, Functional Integration, each with its own assessment and intervention logic.
Never intervene above an unstable level. Stabilize the floor, then build up.
Every OT goal names Level 5 (occupation) as the outcome, even when the intervention targets a lower level.
The floors map (imperfectly but usefully) onto two neural pathways: magnocellular / dorsal stream (motion, low contrast, gaze control, Level 2 and spatial Level 3) and parvocellular / ventral stream (high-contrast form, color, memory, object Level 3 and Level 4). The tracts explain transmission only — OT does not treat or train a pathway; we address the functional components it supports and the task and environment around them.
Each level has its own functional signature in the school day and its own OT intervention direction: Level 1 adapt-and-refer, Level 2 remediate efficiency, Level 3 reduce visual load and teach strategy, Level 4 separate visual from motor before treating, Level 5 write the goal.
Run two threads at once, remediation on the unstable floor and compensation that keeps the occupation running while that floor is rebuilt.
Every session follows the same four-part shape: baseline probe, graded work on the unstable floor, the same skill inside real classroom material, and a written hand-off to the teacher.
VML resources are organized by the same five floors, screener and acuity/contrast ladders at Level 1, interactive oculomotor stimuli and anaglyph packets at Level 2, processing activities with matched worksheets at Level 3, handwriting-readiness and visual-motor packets at Level 4, and grade-banded reading/writing probes plus treatment templates at Level 5.

Notes

My notes for this module

Reference figures

Keep these for practice

Beyond 20/20 — the Visual Performance System™. Level 1 Visual Access → Level 2 Visual Efficiency → Level 3 Visual Processing → Level 4 Visual-Motor Integration → Level 5 Functional Integration.

Vision's two highways in the school day. Ventral "what" signs versus dorsal "where" signs, side by side with the classroom behaviors each one produces.

One example per level

Level 1 · Access

You seeHolds the packet 10 cm from the face; misses every item on the faded copy.You probeNear acuity and contrast trial at the desk.You doHigh-contrast original, 16 pt, glare control; eye-exam referral if undiagnosed.

Level 2 · Efficiency

You seeLoses place three times per paragraph; accurate until minute 8, then falls apart.You probeTimed passage with line-loss count, near–far transitions.You doGraded scanning in real class text; fade finger → card → typoscope.

Level 3 · Processing

You seeCannot find the item on a crowded page; b/d confusion past the developmental window.You probeSame target on a loaded vs. de-loaded page, timed.You doCut visual load, teach a narratable search pattern, preview the page.

Level 4 · Visual-motor

You seeLegible when traced, drifting and uneven when copied from the board.You probeTrace vs. copy vs. dictation on the same sentence.You doShrinking model, part-to-whole, spatial scaffolds; reduce copy volume.

Level 5 · Functional

You seeReads 4 minutes before quitting; writes far below what he can say aloud.You probeThe classroom occupation itself, timed and scored.You doGoal in minutes, accuracy, and output; intervene on the unstable floor beneath it.

One worked example per level — what you see, the probe that confirms it, and the OT move that follows.

Apply it

Case prompt

A first grader cannot finish copying the morning message before the class moves on; the teacher reports he looks up, looks down, and has lost his place. On follow-up he has 20/20 acuity, PASSes saccades and convergence, but scores 2 of 5 on a visual-memory copy task. Which contributing level is limiting the occupation, and which is intact?

Practice

Mini exercise

Sketch the continuum from memory, left to right: five stations running from access to occupation. Label each with one word and one skill. Compare against the diagram above. Anything you missed is a note-to-self, not a failure.

Take it to work

Action step this week

Pull three current caseload students. On a sticky note for each, write which single Framework level is their primary limiter. Post them where you plan next week.