Vision in OT Practice

Transition: "Case Walkthroughs: Three Common Occupational Performance Patterns."

Open here. "Case Walkthroughs." Four real student profiles, worked through together — then one on your own.

Say why this section matters for their caseload, then advance.

Ask the poll: "Which of these three presentations shows up most on your caseload?"

Options:

• Board copying breaks down, near work is fine

• Reading endurance collapses after a few minutes

• Handwriting is illegible with intact motor control

• All three, on different students

Take a show of hands or the on-screen tally, then name the pattern you see before advancing.

Read the scenario aloud, slowly:

Maya, age 8, has glasses worn consistently and a current eye exam. She copies the first two lines from her worksheet accurately, then loses her place, skips lines, and stops after 5 minutes. Her teacher says the first problems on a math page are always her best work.

Then put these questions to the room:

• What does the drop-off after 5 minutes tell you that a single accuracy score does not?

• Do you treat, refer, or both?

Answer to Q1: Accuracy is intact, so the skill exists — what fails is holding it over time. That points to efficiency and endurance (Levels 2–3), not to a missing skill.

Answer to Q2: Treat. Her eye exam is current and her correction is worn, so there is no undiagnosed finding to route out. Build endurance with timed near tasks and reduce the visual load on the page.

Read the scenario aloud, slowly:

Elijah, age 7, tracks smoothly, keeps his place while reading, and has 20/20 corrected acuity. His letters vary in size, drift above and below the line, and spacing collapses when he copies from the board.

Then put these questions to the room:

• Which level do you target first?

• How do you tell whether it is the visual part or the motor part?

Answer to Q1: Start at the lowest level that is unstable — here that is visual-motor integration (Level 4). Do not start at handwriting output itself; that is the symptom, not the floor.

Answer to Q2: Grade the task: have him copy from a paper model at his desk instead of the board. If near copying is clean and far copying is not, the breakdown is in the shifting and spatial demand, not in hand control.

Read the scenario aloud, slowly:

Aiden, age 10, scores low on every task you present. He was up late, has no eye exam on file, and his teacher reports he "gives up on everything," not just visual work.

Then put these questions to the room:

• What do you check before you interpret any of these scores?

• What is your obligation about the missing eye exam?

Answer to Q1: Rule out validity threats first: sleep and state, effort, task setup and lighting, and whether he even has correction. Flat-low profiles are usually a testing condition problem before they are a vision problem.

Answer to Q2: Refer. There is no diagnosed acuity or contrast finding here — it is undiagnosed. Route to eye care first; you do not build vision-specific goals on an unexamined visual system.

Read the scenario aloud, slowly:

Sofia, age 14, reads at grade rate with clean acuity and efficiency. She cannot find a labeled part on a diagram, loses items in a full locker, and misreads graphs in science.

Then put these questions to the room:

• Before you write a goal on figure-ground, what must you confirm?

• How do you tie this to something the IEP team cares about?

Answer to Q1: Confirm it shows up in real tasks, not just in your testing — locker, diagram, graph. One low score alone is not a goal.

Answer to Q2: Write the goal at the occupation: locating labeled information on a science diagram or textbook page within a set time, with the figure-ground skill as the "why," not the goal itself.

Read the scenario aloud, slowly:

Noah, age 5, holds books about 4 inches from his face, squints at the whiteboard, and has a documented diagnosis of albinism with reduced acuity managed by his ophthalmologist. He engages well and works hard for 15 minutes at a time.

Then put these questions to the room:

• Is this a referral or something you address? Say why in one sentence.

• Name the first two supports you would put in place tomorrow.

Give 60 seconds of think time before you take answers. Model answers are in the panel beside this script.

Frame the slide: "How to read any profile in four steps."

Walk each point, one sentence each:

• Rule out validity threats: setup, state, effort, correction.

• Clear the floor: acuity and contrast at the measured distances.

• Find the lowest unstable level and stop there.

• Tie that level to the occupation in the referral question.

Point at the figure while you talk — name the parts before the labels.

Close with: "If you only take one of these back, take the first one."

Contrast the two columns: OT acts versus OT routes out.

OT acts:

• Direct service on the unstable floor

• Accommodation and environmental change

• Teacher/caregiver hand-off with one support to keep

• Scheduled re-probe with the baseline task

OT routes out:

• Eye-care referral for any ocular trigger

• Adjunct standardized testing for depth in one skill

• Team referral when language or attention confounds

• Monitor with a defined re-check date

Ask: "Which column is your student living in right now?"

Set up the clip in one sentence, play it, then debrief with "what did you notice?"

Describe what belongs here: Profile chart from a completed VPA™ showing the shape you are discussing..

Describe what belongs here: De-identified handwriting or copy sample that illustrates the case..

Land the "so what": Three patterns cover most school referrals — near endurance, page navigation, and visual-motor output. Recognizing the pattern gets you to the right first probe in minutes.

Explain the mechanism plainly: Each pattern has a different latency signature: minutes to fatigue, loss across lines, or breakdown as motor precision rises.

Then give them the moves — say each one as something they can do Monday:

• Name the pattern out loud before you choose a tool.

• Match the first probe to the pattern rather than running the whole battery.

• Re-check the pattern at the 9-week mark; patterns shift as demand changes.

Tell them what success looks like: A student who fits two patterns — that is usually a Level 1 or Level 2 issue driving both.

Ask: "Who has a student this describes right now?" Take one answer, then move.

Two-minute case. Read it aloud:

A Grade 4 student starts written work strongly, then within six minutes his letter size grows, spacing collapses, and he asks to take a break.

Put the question to them: "Which pattern is this, and what is your first probe?" Give 60 seconds, no talking.

Model answer (reveal after they commit): Near endurance, not visual-motor capacity: performance was intact at the start and degraded with time on task. Probe sustained near work with a timed baseline, check working distance and posture, and compare a 3-minute and 10-minute sample before touching handwriting instruction.

Close with the rule: Degradation over time is endurance. Breakdown from the first line is capacity.

Reflection prompt: "For the vignette we just worked, what would you have done differently before today, and what will you do now?"

Offer the sentence starter: "Before today I would have... Now I will..."

Think for one minute, write, then take two shares.

Knowledge check: "Reading endurance collapses after four minutes but single-word accuracy is intact. What does that pattern point to first?"

Options:

• Visual processing (Level 3)

• Visual efficiency and near endurance (Level 2)

• Visual-motor integration (Level 4)

• Acuity (Level 1)

Correct answer: option 2. Rationale: Accuracy intact, endurance failing, is the signature of an efficiency and sustaining problem — not a processing one. Refer for eye examination in parallel.