The beauty of the art of the clinician, and of the observant therapist, is her ability to “go off label”. To know when to adhere to printed guidelines or directions when administering a standardized test to derive standardized scores, as opposed to letting a child do what they habitually do in order to make observations about performance that helps explain behaviors.
As you can see from the discussion above, such is the case when looking at tests or probes of fine eye-hand coordination. But I am frequently reminded of the same question even when the test being administered is non-standardized and involves head and/or body position. How does one handle the patient’s head position when conducting clinical tests?
Let’s take a specific example of measuring free space phoria or fusion, as referenced in this article on prescribing prism. Is it “the right way” to measure phoria to allow the patient to adopt their habitual or natural head position? Or, should the examiner be positioning the patient’s head so that it is “straight” without any tilt or turn? From the standpoint of measurement you may wish to know what the absolute numbers look like as referenced to deviating from the straight position. However when it comes to performance and prescribing, you should want to know the impact of the patient’s measurements and ranges in the habitual state.
So if I had to summarize this clinical pearl it would be that adhering to a standard set may be suitable or even required for measuring, but it is inadequate for probing.