Visual Motor Integration

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Introduction[edit | edit source]

The concept of visual-motor integration (VMI) is complex and influenced by various factors, including visual receptive functions, visual cognitive functions, fine motor ability and the coordination of visual, cognitive and motor processess[1].

The VMI encompassess sensory, perceptual and motor components, signifying the coordination of visual perception with motor skills[2]. The sensory component involves processing visual stimuli in a specific environment, while the perceptual component interprets and understands the observed information[3]. Collectively, these components empower an individual to comprehend visual stimuli, and both elements are essential for functional vision. The visual perception is also the ability to copy geometrical shapes, letters, and images within a designated space[4]. This proficiency is deemed crucial for effective Motor Coordination. The motor component entails physical movements in response to the visual stimuli[5].

Background[edit | edit source]

The integration of visual and motor skills holds significance in the development of children. Children are not born with fully developed visual-motor integration skills; instead, these skills evolve from reflexes and gradually gain control and coordination as they age[6]. The developmental milestones for VMI commence at three months of age, marked by an infants's ability to visually track an object while lying on their back (supine position)[7].

The VMI is closely linked to various functional abilities and the capacity to engage in daily tasks[8]. For instance, visual-motor integration plays a crucial role in the acquisition of handwriting skills[9][10]. Approximately 10% to 30% of school-aged children are estimated to encounter difficulties with handwriting[11].Various research has noted that visual-motor integration is a significant predictor of handwriting performance[1][9][12][13][14][15][16].This is especially in the early grades, as younger students often depend more on visual feedback and motor information to guide their movements when forming and replicating letters[17][18][19]. The relationship between the VMI and handwriting seem to deminish after the age of 5 years[20]. Beyond its impact on the development of handwriting, difficulties in visual-motor integration are likely to have repercussions on academic performance in areas such as reading, mathematics and overall academic performance[5][8][21][22][23][24][25][26]. VMI also plays an indirect role in extracurricular activities, sports, recreational performance, social and emotional skills[27][28]. Impairments in VMI skills are diverse, leading to negative consequences on both participation and self-concept[29][30].

Clinical Presentation[edit | edit source]

There are different diagnosis that may influence the visual-motor integration:

  • Children born preterm: several reports have shown that children born preterm have poor VMI and motor function[31][32][33][34][35]
  • Children with Cerebral Palsy (CP): several studies were at a consensus that CP negatively impacts VMI skills[36][37][38][39]. There is an increased risk for having VMI deficits due to dyspraxia and motor coordination limitations[40].
  • Children with Brachial Plexus Injury: several studies were at consensus that brachial plexus injury may have a negative impact on VMI skills[39][41][42]. The extent of impairment in Brachial Plexus Injury is associated with adverse effects on physical functioning, particularly affecting tasks related to VMI[43]. There is an increased risk for having VMI deficits due to dyspraxia and motor coordination limitations[40].
  • Children and adults with Autism Spectrum Disorder (ASD): studies are at consensus that ASD negatively impacts VMI skills[39][44][45][46]. There is an increased risk for having VMI deficits due to dyspraxia and motor coordination limitations[40].
  • Children with Attention Deficit Hyperactivity Disorder (ADHD): children with ADHD exhibited significantly lower visual-motor integration[47] .
  • Children with Developmental Coordination Disorder (DCD): children with DCD score lower compared to typically developing children[48][49]
  • Astigmatic students: unaddressed astigmatism impacts the performance of visual motor and perceptual tasks. Individuals previously treated with corrective spectacles for astigmatism do no exhibit developmental deficits in visual motor or perceptual tasks when assessed with proper correction[50].

Gender[edit | edit source]

In general, gender might influence visual-motor integration skills in children; however, conclusive findings cannot be drawn at this time[51][27][52][53][54]. Notably, one study indicated that females exhibited superior VMI abilities compared to males[16], while another study suggested that males were at a higher risk for VMI deficits[55].

Age[edit | edit source]

All studies unanimously agreed that age had an impact on visual-motor integration scores[56][57][58][59][60][61]. There is a normal improvement associated with maturity[62][63][64][65].

Diagnostic Procedures[edit | edit source]

add text here relating to diagnostic tests for the condition

Diagnostic instruments[edit | edit source]

add links to outcome measures here (see Outcome Measures Database)

Therapy interventions[edit | edit source]

Early implementation of interventions targeting a child's visual-motor intergration skills is crucial. Addressing deficits in VMI skills before formal schooling begins is essential, as these deficits can impact a child's academic journey[24]. By practicing, enhancing, or remediating these skills early on, children can cope better with school-related challenges, preventing potential delays compared to their peers[66][67]. Interventions designed to enhance the VMI skills of children should incorporate activities and exercises that engage their visual senses[22]. Tasks involving visual stimuli, such as objects, encouraged children to actively engage with what they observed[68]. This facilitates the development of Gross Motor Skills through activities involving object manipulation, as well as enhancing the VMI skills. This is because children needed to interpret their visual environment to execute appropriate motor responses while interacting with the objects[68].

  • Early interventions can improve VMI in general school populations[69]and in children born preterm[70]
  • Several studies suggest that occupational therapy intervention improves VMI skills in children with disabilities[71][72][73]
  • The utilization of visual perception exercises, whether motor-independent or motor-dependent, can serve as an effective intervention to enhance the visual-motor integration of children with ADHD[74]
  • Engaging in visual perceptual interventions positively impacted the VMI skills and performance in daily activities for children with Cerebral Palsy[36][37][38]
  • A graphomotor intervention program can significantly change children's visual-motor integration scores[75]

Differential Diagnosis
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add text here relating to the differential diagnosis of this condition

Resources
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add appropriate resources here

References[edit | edit source]

  1. ↑ 1.0 1.1 Dankert HL, Davies PL, Gavin WJ. Occupational therapy effects on visual motor skills in preschool children. American Journal of Occupational Therapy. 2003; 57(5): 542-549
  2. ↑ Afrika E, Van Deventer K. A motor skills programme to enhance visual and motor integration of selected pre-school learners. Early childhood Development and Care. 2016; 187(12): 1960-1970
  3. ↑ Cheatum BA, Hammond AA. Physical activities for improving children's learning and behaviour: A guide to sensory motor development, Human Kinetics. Champaign, IL. 2000
  4. ↑ Lane KA. Developing ocular motor and visual perceptual skills: An activity workbook. Slack Incorporated, Thorofare, NJ. 2005
  5. ↑ 5.0 5.1 Battaglia-Mayer A, Caminiti R. Parieto-Frontal networks for eye-hand coordination and movements. Handbook of Clinical Neurology. 2018; 151: 499-524
  6. ↑ Case-Smith J, O'Brien JC. Occupational therapy for children, 6edn., Elsevier-Mosby, St. Louis, MO, 2010.
  7. ↑ Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatrics in Review. 2016; 37(1): 25-38
  8. ↑ 8.0 8.1 Marr D, Cermak S. Predicting handwriting performance of early elementary students with the developmental test of visual-motor integration. Perceptual and Motor Skills. 2002; 95(1): 661-669
  9. ↑ 9.0 9.1 Volman MJM, van Schendel B, Jongmans MJ. Handwriting difficulties in primary school children: A search for underlying mechanisms. American Journal of Occupational Therapy. 2006; 60(4): 451-460
  10. ↑ Capellini SA, Giaconi C, Germano GD. Relation between visual motor integration and handwriting in students of elementary school. Psychology. 2017; 8(2): 258-270
  11. ↑ Karlsdottir R, Stefansson T. Problems in developing functional handwriting. Perceptual and Motor Skills. 2002; 94(2): 623-662
  12. ↑ Feder KP, Majnemer A. Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology. 2007; 49(4): 312-317
  13. ↑ Taverna L, Tremolada M, Sabattini F. Drawing and Writing. Learning of Graphical Representational Systems in Early Childhood. In Proceedings of the 2nd International and Interdisciplinary Conference on Image and Imagination; Cicalo. Springer Nature: Cham, Switzerland, 2020; 216-229
  14. ↑ Daly CJ, Kelley GT, Krauss A. Relationship between visual-motor integration and handwriting skills of children in kindergarten: a modified replication study. American Journal of Occupational Therapy. 2003; 57(4): 459-62
  15. ↑ Chow S, Tseng M. Perceptual-motor function of school-aged children with slow handwriting speed. The American Journal of Occupational Therapy. 2000; 54: 83-88
  16. ↑ 16.0 16.1 Coallier M, Rouleau N, Bara F, Morin M. Visual-motor skills performance on the Beery-VMI: a study of Canadian kindergarten children. The Open Journal of Occupational Therapy. 2014; 2(2): 1-10
  17. ↑ Klein S, Guiltner V, Sollereder P, Cui Y. Relationships between fine-motor, visual-motor, and visual perception scores and handwriting legibility and speed. Physical & Occupation Therapy in Pediatrics. 2011; 31(1): 103-114
  18. ↑ Overvelde A, Hulstijn W. Handwriting development in grade 2 and grade 3 primary school children with normal, at risk, or dysgraphic characteristics. Research in Developmental Disabilities. 2011; 32(2): 540-548
  19. ↑ Khatib L, Li Y, Geary DC, Popov V. Meta-analysis on the relation between visuomotor integration and academic achievement: Role of educational stage and disability. Educational Research Review. 2021; 35(2): 100412
  20. ↑ Pinto G, Camilloni C. The emergence of writing ability: Drawing and writing differentiating processes. Issues in Writing Research. 2012; 29-44
  21. ↑ Sortor JM, Kulp MT. Are the results of the Beery-Buktenica developmental test of visual-motor integration and its subtests related to achievement test scores? Optometry and Vision Science. 2003; 80(11): 758-763
  22. ↑ 22.0 22.1 Oberer N, Gashaj V, Roebers CM. Executive functions, visual-motor coordination, physical fitness and academic achievement: Longitudinal relations in typically developing children. Human Movement Science. 2018; 58: 69-79
  23. ↑ Banumathe K, Sharma P, Binu V, Guruprasad V. Relationship between visual motor integration and academic performance in elementary school children. Online Journal of Health and Allied Sciences. 2017; 16(1)
  24. ↑ 24.0 24.1 Desoete A, Pieters S, Roeyers H, VanderSwalmen R, Van Waelvelde H. Behind mathematical learning disabilities: what about visual perception and motor skills? Learning and Individual Differences. 2012; 22(4): 498-504
  25. ↑ Chen A, Bleything W, Lim Y. Relating vision status to academic achievement among year-2 school children in Malaysia. Optometry. 2011; 82(5): 267-273
  26. ↑ Pienaar AE, Barhorst R, Twisk JWR. Relationships between academic performance, SES school type and perceptual-motor skills in first grade South African learners: NW-CHILD study. Child: Care, Health and Development. 2013; 40(3): 370-378
  27. ↑ 27.0 27.1 Nicola K, Watter P. Visual-motor integration performance in children with severe specific language impairment. Child: Care, Health and Development. 2016; 42(5): 742-749
  28. ↑ Lim CY, Tan PC, Koh C, Koh E, Guo H, Yussof ND, See CQ, Tan T. Beery-Butenica Developmental Test of Visual-Motor Integration (Beery-VMI): Lessons from exploration of cultural variations in visual-motor integration performance of preschoolers. Child: Care, Health and Development. 2014; 41(2): 213-219
  29. ↑ Lahav O, Apter A, Ratzon NZ. Psychological adjustment and levels of self esteem in children with visual-motor integration difficulties influences the results of a randomized intervention trial. Research in Developmental Disabilities. 2013; 34(1): 56-64
  30. ↑ Sanghavi R, Kelkar R. Visual-motor integration and learning disabled children. Indian Journal of Occupational Therapy. 2005; 37(2): 33-38
  31. ↑ Pereira FL, Gaspardo CM. Neonatal pain and developmental outcomes in children born preterm: An updated systematic review. Psychology & Neuroscience. 2024; 17(1):1-15
  32. ↑ Geldof CJ, van Wassenaer AG, de Kieviet JF, Kok JH, Oosterlaan J. Visual perception and visual-motor integration in very preterm and/or very low birth weight children: a meta-analysis. Research in Developmental Disabilities. 2011; 33(2): 726-36
  33. ↑ Williams J, Lee KJ, Anderson PJ. Prevalence of motor-skill impairment in preterm children who do not develop cerebral palsy: a systematic review. Developmental Medicine & Child Neurology. 2009; 52(3): 232-7
  34. ↑ Van Braeckel KN, Taylor HG. Visuospatial and visuomotor deficits in preterm children: the involvement of cerebellar dysfunctioning. Developmental Medicine & Child Neurology. 2013; 55(4): 19-22
  35. ↑ Setänen S, Lehtonen L, Parkkola R, Matomäki J, Haataja L. The motor profile of preterm infants at 11 years of age. Pediatric Research. 2016; 80(3): 389-94
  36. ↑ 36.0 36.1 Alwhaibi RM, Alsakhawi RS, ElKholi SM. Augmented biofeedback training with physical therapy improves visual-motor integration, visual perception, and motor coordination in children with spastic hemiplegic cerebral palsy: a randomised control trial. Physical & Occupational Therapy in Pediatrics. 2020; 40(2): 134-151
  37. ↑ 37.0 37.1 Alwhaibi RM, Alsakhawi, ElKholi SM. Effects of auditovisual feedback on eye-hand coordination in children with cerebral palsy. Research in Developmental Disabilities. 2020; 101: 103635
  38. ↑ 38.0 38.1 Cho M, Kim D, Yang Y. Effects of visual perceptual interventions in visual motor integration and activities of daily living performance of children with cerebral palsy. Journal of Physical Therapy Science. 2008; 27(2): 411-413
  39. ↑ 39.0 39.1 39.2 Bonifacci P. Children with low motor ability have lower visual-motor integration ability but unaffected perceptual skills. Human Movement Science. 2004; 23(2): 157-168
  40. ↑ 40.0 40.1 40.2 Carsone B, Green K, Torrence W, Henry B. Systematic Review of Visual Motor Integration in Children with Developmental Disabilities. Occupational Therapy International. 2021; 9
  41. ↑ van der Holst M, Steenbeek D, Pondaag W, Nelissen RGHH, Vliet Vlieland TPM. Neonatal Brachial Plexus Palsy in Children Aged 0 to 2.5 Years; Parent-Perceived Family Impact, Quality of Life, and Upper Extremity Functioning. Pediatric Neurology. 2016; 62: 34-42
  42. ↑ Bellows D, Bucevska M, Verchere C. Coordination and balance in children with birth-related brachial plexus injury: a preliminary study. Physiotherapy Canada. 2015; 67(2): 105-112
  43. ↑ Lazzeri de Medeiros D, Agistinho NB, Mochizuki L, Siriani de Oliveira A. Quality of life and upper limb function of children with neonatal brachial plexus palsy. Revista Paulista de Pediatria. 2020; 38: 2018304
  44. ↑ Dowd A, McGinley J, Taffe J, Rinehart N. Do planning and visual integration difficulties underpin motor dysfunction in autism? A kinematic study of young children with autism. Journal of Autism & Developmental Disorders. 2012; 42(8): 1539-1548
  45. ↑ Englund JA, Decker SL, Allen RA, Roberts AM. Common cognitive deficits in children with attention-deficit/hyperactivity disorder and Autism. Journal of Psychoeducational Assessment. 2014; 32(2): 95-106
  46. ↑ Green RR, Bigler ED, Froehlich A, Prigge MBD, Travers BG, Cariello A, Anderson JS, Zielinski BA, Alexander A, Lange N, Lainhart JE. Beery VMI performance in autism spectrum disorder. Child Neuropsychology. 2016; 22(7): 795-817
  47. ↑ Carames CN, Irwin LN, Kofler MJ. Is there a relation between visual motor integration and academic achievement in school-aged children with and without ADHD? Child Neuropsychology. 2022; 28(2): 224-243
  48. ↑ Prunty M, Barnett AL, Wilmut K, Plumb M. Visual perceptual and handwriting skills in children with Developmental Coordination Disorder. Human Movement Science. 2016; 49: 54-65
  49. ↑ Tsai C, Wilson P, Wu S. Role of visual-perception skills (non-motor) in children with developmental coordination disorder. Human Movement Science. 2008; 27(4): 649-664
  50. ↑ Harvey EM, Twelker JD, Miller JM, Leonard-Green TK, Mohan KM, Davis AL, Campus I. Visual Motor and Perceptual Task Performance in Astigmatic Students. Journal of Ophthalmology. 2017; 7
  51. ↑ Cui Y, Zhy Y, Laukkanen H, Rabin J. Evaluation of visual-motor integration skills in preschool and elementary school-aged Chinese children. Journal of Behavioral Optometry. 2012; 23(5-6): 123-128
  52. ↑ Singh CK, Dhanda B, Shanwal P. Gender difference in motor and mental development in children: an impact of stimulating activities. The Antropologist. 2010; 12(2): 153-154
  53. ↑ Lotz L, Loxton H. Visual-Motor integration functioning in a South African middle childhood sample. Journal of Child and Adolescent Mental Health. 2005; 17(2): 63-67
  54. ↑ Lachance J, Mazzocco M. A longitudinal analysis of sex differences in math and spatial skills in primary school age children. Learning and individual Differences. 2006; 16(3): 195-216
  55. ↑ Memisevic H, Hadzic S. The relationship between visual-motor integration and articulation disorders in preschool children. Journal of Occupational Therapy, Schools, & Early Intervention. 2013; 6(1): 23-30
  56. ↑ Ercan Z, Ahmetoglu E, Aral N. Investigating the visual-motor integration skills of 60-72 month children from high and low Socio-Economic status as regard age factor. International Education Studies. 2011; 4(3): 100-104
  57. ↑ Visser M, Nel R, Jansen T, Kinmont L, Terblanché S, van Wyk J. Visual perception of five-year-old English-speaking children in Bloemfontein using the Beery VMI-6, DTVP-3 and TVPS-3. South African Journal of Occupational Therapy. 2017; 47(2): 17-26
  58. ↑ Coutinho F, Bosisio M, Brown E, Rishikof S, Skaf E, Zhang X, Perlman C, Kelly S, Freedin E, Dahan-Oliel N. Effectiveness of iPad apps on visual-motor skills among children with special needs between 4y0m-7y11m. Disability & Rehabilitation: Assistive Technology. 2017; 12(4): 402-410
  59. ↑ Fany Y, Wang J, Zhang Y, Qin J. The Relationship of Motor Coordination, Visual Perception, and Executive Function to the Development of 4-6-Year-Old Chinese Preschoolers' Visual Motor Integration Skills. BioMed Research International. 2017; 8
  60. ↑ Heiz J, Barisnikov K. Visual-motor integration, visual perception and motor coordination in a population with Williams syndrome and in typically developing children. Journal of Intellectual Disability Research. 2016; 60(10): 945-955
  61. ↑ Ng M, Chui M, Lin L, Fong A, Chan D. Performance of the visual-motor integration of preschool children in Hong Kong. Hong Kong Journal of Occupational Therapy. 2015; 25(1): 7-14
  62. ↑ Coetzee D, Pienaar AE, Van Wyk Y. Longitudinal influences of socio-economic status on visual-motor integration: The North-West Child Healt, Integrated with Learning and Development study. South African Journal of Childhood Education. 2019; 9(1)
  63. ↑ Bezrukikh MM, Kreshchenki OY. Psychophysiological correlates of writing and reading difficulties in children of elementary school age. Human Physiology. 2004; 30(5): 521-525
  64. ↑ Decker SL, Englund JA, Carboni JA, Brooks JH. Cognitive and developmental influences in visual-motor integration skills in young children. American Psychological Association. 2011; 23(4): 1010-1016
  65. ↑ Tekok-Kilic A, Elmastas-Dikec B, Chan H. Evaluation of visual-motor integration functions in children between 6-15 years of age. Turkish Journal of Psychiatry. 2010; 21(2): 97-104
  66. ↑ Dunn M, Loxton H, Naidoo A. Correlations of scores on the Developmental Test of Visual-Motor Integration and Copying Test in a South African multiethnic preschool sample. Perceptual and Motor Skills. 2006; 103: 951-958
  67. ↑ Goodwin K. The effects of a gross motor intervention programme on perceptualmotor skills and academic readiness in preschool children. Stellenbosch University. 2015
  68. ↑ 68.0 68.1 Anderson K, Becker D, Duncan R, Lipscomb S, MacDonald M, McClelland M. Relations of pre-schooler's visual-motor and object manipulation skills with executive function and social behaviour. Research Quarterly for Exercise and Sport. 2016; 87(4): 396-407
  69. ↑ Ohl AM, Graze H, Weber K, Kenny S, Salvatore C, Wagreigh S. Effectiveness of a 10-week tier-1 response to intervention program in improving fine motor and visualmotor skills in general education kindergarten students. Am J Occup Ther. 2013; 67: 507-514
  70. ↑ van Hus JW, Jeukens-Visser M, Koldewijn K, Geldof CJA, Kok JH, Nollet F, Van Wassenaer-Leemhuis AG. Sustained developmental effects of the infant behavioral assessment and intervention program in very low birth weight infants at 5.5 years corrected age. The Journal of Pediatrics. 2013; 162: 1112-9
  71. ↑ Case-Smith J. Effects of occupational therapy services on fine motor and functional performance in preschool children. American Journal of Occupational Therapy. 2000; 54(4): 372-380
  72. ↑ Desai AS, Rege PV. Correlation between developmental test of visual motor integration (VMI) and handwriting in cerebral palsy children. Indian Journal of Occupational Therapy. 2005; 37(2): 27-32
  73. ↑ Tanner K, Schmidt E, Martin K, Bassi M. Interventions within the scope of occupational therapy practice to improve motor performance for children ages 0-5 years: a systematic review. American Journal of Occupational Therapy. 2020; 74(2): 7402180060p1
  74. ↑ Sherejini NA, Molanorouzi K, Vakili S. Comparison of the Effect of Motor Independent/Dependent Visual Perception Practice on Visual-Motor Activity Disorder. Journal of Medical Council. 2023; 41(2): 152-159
  75. ↑ Taverna L, Tremolada M, Tosetto B, Dozza L, Renata ZS. Impact of Psycho-Educational Activities on Visual-Motor Integration, Fine Motor Skills and Name Writing among First Graders: A Kinematic Pilot Study. Children. 2020; 7(4): 27
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