��>� DF���C�������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������Q ��9"bjbjEE� .@'e'e9���������AAAAA����UUUU$yTU6$���������������$Z �#��A������AA����ddd� A�A��d��dd�)�����K$E������ ��06�,�#�D�#))�#A=d��d�������d���6�������������������������������������������������������������������������#���������� : Student Name: D.O.B: District: Campus: Date of Evaluation: Evaluation Environments: Conducted by: Etiology of Eye Condition: Other Handicapping Conditions: SOURCES OF DATA: The following evaluation tools and/or procedures were used to assess the student's orientation and mobility skill level. Orientation & Mobility Checklist TAPS O&M Assessment TAPS Infant Assessment Low Vision Evaluation Functional Vision Evaluation Concept Assessment Cane Chang Board Low Vision Aids - Telescope Informal Observation O&M Screening Teacher Interview Student Interview Parent Interview Other: PROCEDURE AND RESULTS: Functional Vision (Visual Efficiency Skills): Functional Mobility Tasks (Home): Attending Behaviors: Auditory Abilities: Receptive Language: Expressive Language: Posture and Gait: Body Image: Laterality: Turns: Directionality: Quantitative Concepts: Directional and Positional Concepts: Colors: Geometric Shapes: Basic Skills: Landmarks and Clues: Basic Spatial Awareness: Functional Mobility Tasks (Campus Environment): Attitude and Behavior: Adaptive Mobility Devices: Cane Techniques: On-Campus Orientation and Mobility: Cardinal Directions: Wheelchair Use: Walker Use: Use of Crutches: Use of Support Canes: Distance Low Vision Devices: Functional Mobility Tasks (Residential Environment): Modified Protective Technique: Vehicle Familiarization: Residential Area Travel: Residential Street Crossings: Address Systems: Rural Travel: Night Travel: Travel in Adverse Weather Conditions: Functional Mobility Tasks (Commercial Environment): Business Area Travel: Business Area Street Crossings: Community Experiences: Public Transportation: SUMMARY: Based on the findings of theOrientation and Mobilityevaluation, which includes relevant visual, functional, developmental, and academic information, Student continues to require indirect services in the area of O&M. � Spatial and environmental concepts and use of information received by the senses to establish, maintain, or regain orientation and line of travel. To use the long cane to supplement visual travel skills or as a tool for safely negotiating the environment. To understand and use remaining vision and low vision devices To learn concepts, techniques and tools needed for safe independent travel Based on this evaluation, does not need direct orientation and mobility training at this time to benefit from instruction. Based on this evaluation, ____ does need direct orientation and mobility training to benefit from instruction. It is suggested that the ARD consider direct services ___ minutes, __ times per _ week _month. The student is capable of safe and independent travel in familiar indoor environmental situations and consistently demonstrates appropriate __ independent travel skills OR __ cane skills. However in a more complex situation, additional direct orientation and mobility instruction will be required. Continued direct orientation and mobility instruction will enable the student to travel with confidence in a greater variety of travel situations. Current appraisal indicates that ___'s present needs can be met most appropriately through consultative assistance designed to monitor maintenance of skills and level of independence previously attained. The student is capable of safe and independent travel in _ familiar indoor environments _ various indoor environments _ _ a variety of environmental situations. Realistic appraisal of current educational program, academic schedule, and commitments, indicate that off-campus instructional objectives can be addressed most appropriately during the summer months. Therefore, it is recommended that ____'s present need be met through consultative assistance designed to monitor maintenance of the skills and level of independence previously attained, and that ___ receive direct orientation and mobility instruction during the summer months. It is suggested that the ARD consider direct O&M services ___ sessions during the summer months. In conclusion, it is recommended that ___ continue to travel under supervision in unfamiliar or potentially dangerous situations when traveling off campus. Consultative assistance will be provided in order to monitor the student's independent travel skills. An appropriate sighted guide technique is recommended and, as ____'s experiences in off-campus travel increase, it is anticipated that he/she will be capable of supervised travel in a variety of community areas. However, in more complex travel situations (traffic-light controlled intersections, right turn lanes, business areas, parking lots, etc.) additional direct orientation and mobility instruction will enable the student to travel with confidence in a greater variety of travel situations. RECOMMENDATIONS: 1. Orientation and mobility consultation is recommended __ time(s) a month/year. 2. Direct orientation and mobility instruction is recommended __ time(s) a week for __ minutes. 3. Continued direct orientation and mobility instruction is recommended __ times a week for __ minutes. 4. Discontinue direct orientation and mobility training. 5. Orientation and mobility services are not recommended. 6. An Orientation and Mobility Specialist will attend the ARD upon request. 7. The physical education teacher needs to be aware of the student's limited eyesight. 8. Re-evaluation is available upon request as student matures and/or needs or environment change. 9. Refer for OT/PT evaluation. 10. Encourage use of Low Vision Aid. Provided the student continues to demonstrate the appropriate use of the monocular aid, as was evidenced during this period of evaluation, the student is capable of a greater degree of independent travel. It is recommended that the student be encouraged to use the monocular aid in a variety of environmental situations. 11. The student should apply mastered cane skills when traveling in the school environment. 12. The student should apply an appropriate sighted guide technique when physical assistance is required. 13. The student should be supervised when traveling to and from classes, within the school environment, in unfamiliar off-campus situations. 14. Summer orientation and mobility instruction is recommended for __ sessions in June, __ sessions in July and/or __ sessions in August (prior to school starting). 15. Other: __ _______________ Certified Orientation and Mobility Specialist Date Mansfield Independent School District %'(/;PQhly}~�����������T Y z � � � � � � � � � ƽƤtn� hBk�CJhBk�5�>*OJQJh%m�5OJQJhPl�5OJQJh/Z�OJQJhLYNhBk�OJQJhBk�5OJQJhLYNOJQJhBk�OJQJhLYNOJQJ\�hPl�OJQJhLYNh��OJQJhLYNh��5OJQJh��OJQJ\�h��OJQJh��5OJQJ);Qkl}���������������x�x�� ���T � h1$@&]h ���T � h1$]h ����T � h1$]h ���T � h1$@&]hgd�� ����T � h1$@&]hgd�� ����T � h1$]hgd�� ��T W z � � � � � � ( ? 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