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The Optometric Clinical Practice Guideline for Care of the Patient with Accommodative and Vergence Dysfunction provides for more detailed assessment information.21TaStandard testing procedures for the evaluation of visual system integrity can be used in patients with learning related vision problems. ForThe Care Process 17additional information consult the Optometric Clinical Practice Guideline for the Pediatric Eye and Vision Examination.89D. VISUAL INFORMATION PROCESSING EVALUATION1. General ConsiderationsThe visual information processing skills that require testing are visualspatial orientation skills, visual analysis skills, including auditory-visual integration, visual-motor integration skills and rapid naming.1226 Whenavailable, norm-referenced tests are preferred for this purpose.127 Testing should be conducted uniformly and according to the exact methods specified in the test instructions. Specified rule-based scoring procedures should be followed. Qualitative insights from observation of the test taker's behavior can provide important supplementary information for diagnosis and management. Attention to task, ability to understand the instructional set, cognitive style, problem-solving ability, frustration tolerance, and excessive motor activity are some of the behaviors worth observing.Testing should be done without interruption in a relatively quiet environment. Individuals with attention deficits may require rest periods between tests or multiple testing sessions. For a comprehensive visual information processing evaluation, one or two tests from each category can be selected for administration. For a detailed or problem-focused evaluation of a specific visual information processing skill, multiple tests from the same category can be administered.2. Visual Spatial Orientation SkillsVisual spatial orientation is the awareness of one's own position in space relative to other objects, as well as the location of objects relative to each other. It includes body knowledge and control, as well as bimanual integration and is understood as a component of overall perceptual-motor integration development. Visual spatial orientation skills involve the ability to understand directional concepts, both internally and projected into external visual space. These skills are important for balance and coordinated body movements, navigation in the environment, following18 Learning Related Vision Problemsspatial directions, and understanding the orientation of alphanumeric symbols. The clinical signs and symptoms of visual spatial orientation skill deficiencies can be found in Table 3.• Difficulty in tasks requiring crossing of the midlineVisual spatial orientation skills are frequently subdivided into bilateral integration, laterality, and directionality. Bilateral integration is the awareness and use of the extremities, both separately and simultaneously in unilateral and bilateral combinations. Laterality is the internal representation and sensory awareness of both sides of one's own body. Directionality is the ability to understand and identify right and left directions in external visual space, including orientation specificity of written language symbols.
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