University of Edinburgh

Cerebral Palsy and Visual Impairment in Children: Experience of Collaborative Practice in Scotland

Appendix II

An Approach to Functional Vision Assessment in Special School

by Lynn Lymer

Who is present?

  • Child
  • Parents or carers
  • School doctor
  • Visiting teacher (visual impairment) (VTVI)
  • Consultant community paediatrician

Advantages of testing in school

  • Child is less stressed
  • Parents may be less stressed
  • Less time lost in child's school day
  • Access to learnign materials used by child
  • Appropriate seating available

Parents fill in a questionnaire, prior to this assessment, to help with gathering information

  • This can give very detailed observations of the childÍs use of his vision.
  • It can help to start the conversation about the child and raise any anxieties.

Several pairs of eyes, experienced in observing children with visual or processing difficulties, can monitor the assessment and raise issues of concern.

Information is noted and shared by all present and the implications can be discussed immediately.

Children are seen on entry to nursery and reviewed on moving into primary, again in mid/upper primary and before they leave school. They may be seen for additional assessment at any time if they or their parents or school staff raise concerns.

Tests used depend on the age and abilities of the child

  • Preferential Looking
  • Cardiff Cards
  • Hiding Heidi
  • BUST-LH playing cards
  • Maclure Reading Type for Children
  • Manual for Teachers of Children with Learning Difficulties
  • Crowded Symbol Book
  • Low Contrast Test
  • Colour vision
  • Stycar Ball
  • Materials from the Reynell-Zinkin Scales

The findings can be discussed with parents and the young person immediately and the community paediatrician will follow this with a formal written medical report.

At the end of the report she will include a short list of recommendations agreed by those present. This might include comments on:

  • the type of toys appropriate;
  • the kind of text or pictures most likely to be suitable;
  • the use of magnifiers or referral to the low vision aid clinic;
  • positioning the child;
  • positioning the work;
  • VTVI involvement;
  • further assessment or follow-up.

A summary of the functional vision information is then prepared, on a single page, for the classroom staff, under the headings:

Distance vision Near vision Visual fields Mobility Colour Contrast Crowding Other (attention, processing, lighting) Glasses or other equipment used for seeing work.

This page has a column for teaching strategies which might help the classroom staff to alleviate the difficulties noted.

The page has a date at the top and is kept under review.

Staff are encouraged to comment on the findings and help to adjust them as appropriate - the child may perform differently in class and under assessment with less familiar adults present.

At the initial meeting, parents are given contact details for the visiting teacher (visual impairment), so that they can let her know if there are problems, eg: with accessing text or picture material at home.

The young person can raise concerns, eg: if there are particular difficulties in certain subjects and the visiting teacher can then meet with relevant staff and ensure they are aware of the difficulties and strategies available to compensate.

This system may be far from perfect, but it allows us to learn from one another (child, parents and professionals) and develop our practice. It sets the scene for useful communication.


Woodhouse, J M Cardiff Acuity test. Windsor: Keeler Ltd

Hyvärinen, Lea Crowded symbol book. Illinois: Precision Vision. Cat No: 2507

Hyvärinen, Lea Hiding Heidi: low contrast face test. Precision Vision. Cat No: 2535

Hyvärinen, Lea Low contrast symbol test. Illinois: Precision Vision. Cat Nos: 2511-2513, 2520.

Keeler Acuity cards (Preferential Looking). Windsor: Keeler Ltd

Kinsley-Crisp, Ronald (1998) Do you have a child with a visual dysfunction in your classroom? Ipswich: JAG Enterprises.

Lindstedt, Eva (1986) BUST-LH playing cards: Playful vision testing. Stockholm, Sweden: Elisyn

Maclure Reading Type for Children. Harlow: Clement Clarke International Ltd

Reynell, J and Zinkin, P (1979) Reynell-Zinkin developmental scales for visually handicapped children. Chicago, IL: Stoelting Co.

Sheridan, Mary D (1976) Stycar vision. Windsor: NFER-Nelson.


Clement Clarke International Ltd, Edinburgh Way, Harlow, Essex, CM20 2TT. Tel: 01279 414969 Fax: 01279 635232

Keeler Ltd, Clewer Hill Road, Windsor, Berkshire, SL4 4AA. Tel: 01753 857177 Fax: 01753 827145

Ronald Kinsley-Crisp, JAG Enterprises, Brookfield, High Road, Swilland, Ipswich, IP6 9LP. Tel: 01473 785452

Precision Vision UK Distributor: Insight UK, Tony Ainscough, 8 Greencroft, Romiley, Stockport, SK6 4LW. Tel/Fax: 0161 430 522