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MIVI
O&M CHECKLIST
Heidi
Anderson, COMS and This
checklist was recently developed for assessing children with blindness and
multiple impairments. Please read
and provide feedback to Ms. Anderson and Ms. Martinez at
andersonh@tsbvi.edu.
Guidelines
for Requesting O&M Evaluation for MIVI Students
Purpose
of checklist: To determine the need for an orientation and
mobility evaluation for a student with multiple impairments by a certified
O&M specialist. Please fill out this form and send it to your O&M
specialist for consideration of evaluation for this student. Student _______________ Date
_______________ Teacher_______________ Yes____
No ____Does the student make purposeful movements (walk, crawl, reach, turn
head, scoot, etc.) toward a stimulus (auditory, visual, tactual, and olfactory)?
Explain:
____________________________________________________ Yes
____ No____ Is the student able to use objects appropriately in relation to
their body (i.e. opening door and going through, using a spoon, using a
toothbrush, putting on a hat)? Explain:____________________________________________________ Yes____
No____ Does the student’s motor development appears to be comparable to same
age sighted peers? Yes____
No ____ Can the student relocate a desired object within arms reach after losing
contact with it (cup, favorite toy, spoon)? Yes____
No____ Does the student react to familiar environments (gets excited when
entering cafeteria, turns toward her classroom consistently, cries when entering
the bathroom)? Yes____
No___ Does the student show reluctance/fear when interacting /moving in familiar
environments? If
yes, describe behavior: ____________________________________ Yes____
No___Is the student able to go around obstacles? Yes____
No_____ Can the student visually or auditorally follow a group or person? Yes____
No____ Does the student need assistance (sighted guide or hand-held) to travel
in the school or classroom? Yes____
No____ Does the student consistently turn or indicate the correct way when
traveling a familiar route? Yes____
No____ If applicable, can the student use a walker or wheelchair with minimal
assistance? Yes____
No____ Can the student hold an object while walking? |