Assistive Technology
Intervention Worksheet
Electronic Magnification Device
Student: _____________________________ Age/Grade: ______
Evaluator: ___________________________
Other Information: _____________________________________
Write the name of the device, such as VisioBook or SmartView 360, that is being
trialed. Trials are for up to 6 weeks (or less when possible). After the 6 weeks, a
team decision should be made as to whether the school district will purchase the
device. At the end of the 6-week trial, the device should be returned to the Assistive
Device Center.
Name of Device __________________________________________
Use the table below to keep data regarding use of the device. More than one
date/score column is provided so that you may use the chart for data collections at
the beginning, middle, and end of the trial.
This intervention assessment is general in nature. Specific skill development goals
may be written and rubrics for assessment may be developed upon purchase of
equipment by the local education agency.
Feel free to change the information to meet the needs of your particular situation.
For example, expectations for a student in preschool may be quite different from
expectations that you would have of a student in middle or high school
Use the information generated from the worksheet to write a recommendations
report regarding the assistive technology being trialed.
I = independent
V = verbal cue(s)
P = physical assist(s)
F = possible future use
N = not applicable at this time
Skill/Concept
General Use
1. use appropriate posture and seating.
2. Use self determination in order to make use of device at
times when needed.
3. Set up device as needed.
4. Take device down and store appropriately.
5. If appropriate, transport device to other areas as needed.
6. Charge device as required.
7. Turn device on/off independently.
8. Pair device (such as Transformer) with laptop or monitor.
9. According to device requirement, operate computer software.
9. Handle device with care, keep clean, etc.
Other
Other
Near Viewing
10. Adjust near magnification as needed.
11. Adjust color/contrast as appropriate.
12. Demonstrate ability to use device for sustained reading
appropriate for age.
13. Use device for short reading tasks.
14. Make adjustment and use device for writing.
Other
Other
Far Viewing
15. Adjust camera and device for distance viewing.
16. Locate object in distance to view.
17. Toggle between far and near viewing independently. to
meet requirements of tasks being completed.
Other
Other
Total Independent
Date
Date
Date
Score
Score
Score
Think about…
1. Did the device allow the student to complete near viewing tasks appropriate for
his/her age? Explain.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
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2. Was the student efficient at using the device for reading material at close range?
Explain.
_______________________________________________________________
_______________________________________________________________
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3. Was the student able to view with the distance camera to meet required tasks?
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
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4. Did the student show improvement during the trial? Explain.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
5. If the student did not show improvement, could he/she with time and training?
Explain.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
6. Considering the above data, what would your next steps be? Why? Outline the
data that helped in your decision making if possible.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
7. Will this device “grow with” the student? Based on the data, your observations,
ect. Explain.
_______________________________________________________________
_______________________________________________________________
9. Though the VisioBook or other device might be the first choice for staff, have you
considered allowing trial of other devices to ensure preference of student and specific
features of various devices are explored? Explain why or why not.
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
10.. What is your plan to communicate results to team members?
_______________________________________________________________
_______________________________________________________________
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Rosa Mauer 12-6-2012