We 21st-century vision rehabilitation therapists can trace our roots in the United States back to the early 20th-century pioneer home teachers who instructed homebound blind adults in one or more finger-reading systems ... and in methods of coping with the demands of daily (Koestler, 2004). Although braille and technology have enhanced the range and scope of accessible reading-and-writing systems during the past 100 years, itinerant vision rehabilitation therapists are continually challenged with the mission established by our predecessors to provide therapeutically oriented instruction as a means through which adult clients develop methods to cope successfully with the demands on daily living imposed by their unique vision loss, learning challenges, and lifestyle needs. Since the ongoing process of adjusting to vision loss naturally has an impact on learning for our adult clients, and vice versa, vision rehabilitation therapists need to determine how to assess and address therapeutically the degree to which issues related to vision loss might be affecting reluctant readers. Although there is no single formula that applies to every reader, the following case may offer a few factors for vision rehabilitation therapists to consider in similar situations. Elayne, a recently retired 60-year-old human service professional and self-professed assistive technology geek, engaged in an intensely defiant and unsuccessful struggle in making the transition from using ZoomText screen magnification software to the JAWS for Windows screen reader for reading, word processing, e-mail, and web navigation. Although Elayne was capable, self-motivated, and resilient, and had enthusiastically requested JAWS instruction, she was not benefiting from the supplemental, multisensory teaching approaches and tools I had devised for her. Finally, her increasingly defensive and argumentative behavior during lessons became a time-consuming diversion that sabotaged the learning process, making impossible for me to continue instruction with her. Both Elayne and I knew she had reached a defining moment in her personal rehabilitation program. We needed to determine whether or not her ambitious goals for learning communications skills were still realistic and, if they were not, how her goals should be modified according to her abilities. In response to our mutual concerns, I talked with Elayne about how we might functionally apply the following premise as a means to identify and respond to factors that had the potential to block her progress: is what you're capable of doing. Motivation determines what you do. Attitude determines how well you do it (Holtz, n.d.). Because Elayne trusted that our mutual intention was to do everything we could to help her succeed, I arranged a meeting with her so we could discuss her progress, during which we respectfully, thoroughly, and candidly discussed all the following considerations to determine if some of them could be contributing to Elayne's frustrating lack of progress and incomplete homework assignments: * Ability (Did Elayne have an undiagnosed auditory processing or memory challenge or both?) * Motivation (Was Elayne devoting sufficient time and effort to study or practice in spite of her fears of failure?) * Attitude (Since Elayne was embarrassed to admit that she was confused and needed additional help during and between lessons, would she be able to commit to the rigorous effort required to develop meticulous aural and keyboard navigation skills?) We agreed that motivation was a realistic factor to measure because we could create a quantifiable structure to measure the content, quality, and rates of training; homework performance; and learning progress. To ensure that the functional teaching strategies and rehabilitation goals would be continually responsive to her learning ability, motivation, and attitude, together we formally incorporated and documented Elayne's new responsibilities in the Statement of Method section of her Rehabilitation Teaching Individualized Written Service Plan, effectively committing Elayne and me to the process of measuring her progress and identifying the causes of her learning challenges. …