Adult and Childrens Opticians
Cardiff Est. 1989

02920 228 144

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Traumatic Brain Injury Questionnaire

Traumatic brain injury comes in many forms and disability extremes and in order to assess a person’s visual performance in a limited amount of time it is important understand their current capabilities and expectations. For example, it would be beneficial to know in advance if there is there a significant physical, mental or communication aspect to the injury so that testing may be adapted appropriately. To this end, please fill in the following questions as fully as possible – and add anything else that you feel might be useful to the assessment or in understanding the patient.

What to bring to the assessment

  • Please bring any (and all) glasses that the patient has with you – even if they do not currently wear them.
  • Please bring any magnifiers that the patient uses regularly.
  • Please bring an example of text that the patient would usually read and a sample of their writing if they would usually write.
  • Bring a sample of what they read easily and anything they struggle with but would like to read.

Please ensure that all questionnaires are completed at least 2 weeks in advance of the appointment date. Without them a full examination may not be possible in the allocated time.

If you have any queries concerning this questionnaire, or you need a print version, please contact us.


Prefer to download?

Download a Word document instead.
What is more important than any label is understanding the severity of any disability and how it impacts upon this particular patient. For example, is the injury recent and the patient still adapting or is the injury developmental or longstanding? How long ago did the injury occur? Is it stable or changing/degenerative?
For example, if it is a head injury due to an accident two years ago how did it impact upon performance initially - and how has performance improved or deteriorated since.
For example, how does the patient live - with family or in specialist accommodation? How much living support do they need during the day? Can they occupy themselves? Take care of themselves? Prepare food? If they were given simple visual activities to do could they manage alone – or is support available?