Special Education Consultant & Certified Teacher of the Visually Impaired

Environmental Checklist: 1

MARY T. MORSE, Ph.D. Special Education Consultant & Certified Teacher of the Visually Impaired 247 Pembroke Hill Road Pembroke, NH 03275

Phone: (603) 485-7674 Email: [email protected] Fax: (603)-485-1958

ENVIRONMENTAL CONSIDERATION CHECKLIST

The following factors may or may not have an impact on students and adults who have CVI or TBI. They are listed to raise awareness that certain aspects of the environment may need to be modified for specific individuals. It is suggested that systematic data sheets be used (a) to more accurately determine the optimum environment to begin therapies and the healing process and (b) prior to generalizing gains to other situations. Please Note: The word “student” is used because the author developed and uses this form when providing assessments within school and home environments. It is hoped the form is equally helpful when working with adults.

STUDENT : DATE : INVOLVED PERSONS ACTIVITY

1. Is the environment familiar? ___yes ___no

2. Is the person working with the student familiar? ___yes ___no

3. Is the student positioned • safely? ___yes ___no

• in relation to materials and partners such that he/she can communicate visually, auditorally &/or motorically? ___yes ___no

4. ROOM CHARACTERISTICS

• Is the room safe (uncluttered pathways, safe corners/edges, closed doors/cabinets, no protruding objects, appropriate size furniture & appliances, etc.)? ___yes ___no

• Does the room have well defined work areas? ___yes ___no

• Are there clear paths from one work area to another? ___yes ___no

• Are the pathways used in a consistent manner? ___yes ___no

• Are work areas organized, neat, labeled & accessible? ___yes ___no

• Are there patterns on the ___furniture ___walls ___floor ___ceiling?

• Does the room seem visually ___organized or ___disorganized Environmental Checklist: 2

• DOES THE ORGANIZATION OF THE ROOM PROMOTE ANTICIPATION OF SCHEDULED EVENTS? ___yes ___no

5. LIGHTING CONDITIONS : Lighting considerations are not only important as related to visual conditions but also to states of arousal, both of concern for persons with CVI or TBI.

• Is the room ___very bright ___bright ___moderate ___dim ?

• Is there ___diffuse lighting or a ____focal point of light-e.g., window?

• Can light sources be individualized and adjusted? ___yes ___no

6. AUDITORY CONDITIONS present absent

• TV ______

• radio ______

• CD player ______

• air conditioner ______

• clock ticking ______

• phone ringing ______

• appliances (list) ______

• traffic noise ______

• persons moving ______

• people talking loudly ____ softly____

• Overall impressions of noise conditions noisy____ moderate____dim___

intermittent_____ static_____

• other (list) ______

7. STAFF WORKING WITH STUDENT : Persons with CVI or TBI sometimes cannot discriminate what is important to attend to from what is not important.

• shirt / blouse patterned____ plain____ color____

• sweater ___yes ___no

• any points of sharp ___yes ___no contrast to shirt Environmental Checklist: 3

• glasses ___yes ___no

• long earrings ___yes ___no

• mustache or beard ___yes ___no

• perfume or cologne ___yes ___no

• voice tone, volume ___yes ___no

• hands cold ___yes ___no

• hands warm ___yes ___no

8. ROOM TEMPERATURE hot___ moderate___ cool___ cold___

9. Note any unusual ODORS

10. STUDENT CHARACTERISTICS IS THE STUDENT READY IN TERMS OF

• glasses ___yes ___no

• hearing aids ___yes ___no

• auditory trainer ___yes ___no

• proper position ___yes ___no

• medical needs met ___yes ___no

• hunger & toileting needs met ___yes ___no

• seizure status considered ___yes ___no

• sensory-motor tolerance considered ___yes ___no

• fatigue/energy level considered ___yes ___no

 other needs ___yes ___no

11. ACTIVITY CHARACTERISTICS

• number of stimuli presented ______

• on what visual plane ______

• size of materials ______

• spacing of materials ______

• figure-ground contrast ______

• motor-friendly materials ______

• organization of materials (activity sequence boards) ______Environmental Checklist: 4