visual-motor integration (vmi) and graphomotor (handwriting) problems … · 2015-05-19 ·...

©Mind Moves Institute, Johannesburg. 2015

1

Visual-Motor Integration (VMI) and Graphomotor (Handwriting)

Problems as a Barrier to Learning.

Julie Wiid

Difficulty in producing legible handwriting is so visible and yet is often overlooked and poorly

understood. Students who are reluctant to produce written work are often dismissed as ‘lazy’,

‘unmotivated, or ‘oppositional’ (Thorne, n.d). Mental, social and emotional inadequacies are

also often inferred from poor handwriting (Beery, 1997), yet for children with graphomotor

problems: “neat handwriting at a reasonable pace is often not a choice” (Thorne, n.d).

“Handwriting is the natural vehicle of teaching” (Beery, 1997). A child who can neither capture

work content adequately in written form nor produce written outputs that reflect her

understanding or verbal abilities therefore experiences significant barriers to learning.

VMI has been identified in

numerous studies as a more

important factor than general

intelligence, finger dexterity and

visual perception in determining

handwriting performance (Berry,

1997, Tseng & Murray 1994, Weil

& Armundson, 1994, Williams et al,

1993, in Beery, 1997).

VMI is: “the degree to which visual perception and

finger-hand movements are well coordinated” (Beery,

1997). Through integration of visual input and motor

output, motor tasks (e.g. writing) are planned,

executed, monitored (Visual Integration Skills, n.d )

and adjusted (Visual Motor Integration, n.d). While

VMI may therefore be affected by deficits in visual

perception and/or motor coordination, some children

with adequate visual perceptual and motor co-

ordination skills still perform poorly in VMI

assessments (Kulp, Mazzola & Mazzola, 2003),

suggesting that VMI “ is greater than the sum of its

parts” (Beery, 1997) and that “the hyphen in visual-

motor” (Beery, 1997) represents the integrated

complexity of interactions between factors such as

cognition, visual perception, shoulder stability

(Calder, 2010) ; proprioception, directionality and

planning (van der Zee, 2010); and fine motor control,

co-ordination and psychomotor speed (Sanghavi,

2005).

http://www.childrensvision.com/reading.htm

©Mind Moves Institute, Johannesburg. 2015 2

In considering this definition of VMI and the developmental objectives of the primitive

reflexes (Appendix 1), it can be seen that development of VMI is dependent upon the

inhibition of these reflexes. Wilkinson’s study (1994, in Goddard-Blythe, 2001) identified

primitive reflexes as a contributing factor to learning disabilities and underachievement.

Furthermore, children with learning disabilities have a high prevalence of VMI deficiencies

(Beery, 1997; Tranopol in Sanghavi, 2005; Visual Integration Skills, n.d.). Underachievement

may, in many cases, therefore be a direct result of inability to produce adequate written

outputs for accurate assessment of progress.

VMI manifests in graphomotor problems as difficulties in:

Spatial organisation on paper

Letter/number formation

Following/staying in lines

Alignment e.g. numbers in columns

Recognising mistakes

Pencil grip and desk posture

(Visual Integration Skills, n.d)

Poor spatial organisation on

paper (positioning of name);

poor letter formation

(approx 6yrs 3 months)

Difficulty in drawing on lines; poor spatial

organisation; poor number formation

(approx 6 yrs 2 months)

Poor spatial organisation of

written output

(approx 6 yrs 11 months)

Fig1: Examples of written outputs exhibiting typical characteristics of poor VMI – Occupational

Therapy commenced when child was 5years 8 months and specific reflex inhibition interventions

commenced at the age of 7 years and 2 months

Note midline crossing

Note: due to poor pencil grip some lines were too light to be reproduced. They have therefore been

darkened and so do not reflect the child’s pencil grip in terms of pressure applied to paper.


The ability to copy basic shapes ( / \ X ) is a prerequisite

for writing (Van der Zee, 2010) and an indication of the extent to which an individual’s visual

and motor abilities have been integrated (Beery & Buktenica, 1997) ( Figure 2).

Fig 2: Comparison of performance over time on the Developmental Test of Visual-Motor Integration

(Beery and Buktenica, 2005) to illustrate development of VMI ability plus changes in drawn and

written output with development of VMI

Geometric form to be copied

Developmental Test of Visual

Motor Integration Items 4-6

( Beery & Buktenica, 2005)

Age 5years 8 months

Age 6years 7 months

Age 8years 2 months





Age 5years 8 months

Age 6years 7 months

Age 8years 2 months

Intended to draw

a square

Application of

developing skill in

drawing tasks

Note: Test not administered for assessment purposes at 8 yrs 2 months, but only for comparative purposes as

illustration for the topic of this essay. The child completed the task in test conditions.


Fig 2: Continued





Age 5years 8 months

Age 6years 7 months

Age 8years 2 months





Age 5years 8 months

Age 6years 7 months

Age 8years 2 months


Figure 2: Continued





Age 5years 8 months

Age 6years 7 months

Age 8years 2 months

Comparison of skills required for reproduction of such shapes with reflex-driven development

further highlights the importance of primitive reflexes in development of VMI and thus

graphomotor abilities (Appendix 2).

It is observed, however, that even when handwriting skills develop, the discrepancy between

written and verbal skills may remain marked as production of written words to reflect

thoughts appears to be at the expense of flow and correctness of content and sentence

structure (Figure 3).


Power On Rub the indentation just below the collar bone in line with the left eye. This move re-establishes the electrical flow via the Vagus nerve to the speech organs and stomach to help relax butterflies and talk with ease. It switches the brain ON for improved concentration without anxiety.

This suggests that representing thoughts and ideas through handwriting (i.e. written output

driven by thought/language as opposed to copying, but monitored and corrected using VMI)

entails more complex processing. If, however, production of legible, meaningful handwriting

is an indication of improved VMI abilities, it is surely also an indicator that the reflex-driven

neurodevelopment required to support development of higher, more complex processes is

becoming established. The development of graphomotor abilities is therefore the

fundamental starting point for production of written output.

USING MIND MOVES® TO DESIGN A HOME PROGRAMME TO ADDRESS GRAPHOMOTOR

PROBLEMS DUE TO POOR VMI ABILITIES

Graphomotor problems and their impact are highly visible and resulting low self-esteem/self-

confidence and behaviours associated with physical and emotional immaturity present

additional barriers to learning.

As graphomotor skills require VMI and VMI is dependent upon inhibition of primitive reflexes,

a home programme based upon a ‘bottom-up and ‘top –down’ approach in parallel is to be

most effective.

The ‘bottom-up approach’ refers to systematic identification and inhibition of aberrant

reflexes, starting with the earliest aberrant reflex in the developmental order and progressing

up through the order to develop the essential sensory-motor neural pathways and

interconnections between the physical, emotional and cognitive brains. This is achieved

through specific Mind Moves exercises mimicking reflexive movements and additional

activities to stimulate the appropriate senses and muscles. The objective of developing these

pathways and interconnections is to build a solid neural foundation for sustained skill

development.

The ‘top-down’ approach incorporates Mind Moves exercises to ‘prime’ existing pathways to

support production of an output in class. As the output here would be legible, meaningful

handwriting, the following exercises would be recommended (De Jager, 2010):

Rise and Shine Fling the arms wide open while breathing in deeply and slowly. Close the arms over the chest in a hug, breathe out deeply and slowly. The parent may simultaneously hug from behind. This move boosts relaxation, rhythmic breathing and a sense of wellbeing.


Bilateral integrator

Move the arms in a mirror image as though conducting a choir. This is a

fun way to develop rhythm, eye-hand coordination, focal and peripheral

vision, left and right integration in preparation for fluent speaking,

reading and writing.

Finger fight

Push the forefinger against the thumb, maintaining the pressure for a count of

eight, then let go. Repeat for each finger. This move differentiates the parts of the

hands. It also improves muscle tone in both hands, penmanship, fine motor

control and communication skills.

Palm stretch

Extend the fingers as wide as possible for a count of eight, then relax. Make a tight

fist, hold for a count of eight, relax. This move improves muscle tone in the hands,

penmanship, fine motor control and bilateral integration. It also promotes fluent

speech.

Mousepad

Visual Workout

Bi-lateral Walk

Movement moulds the brain. Repetition makes it effective

Melodie de Jager

Move with purpose, move with Mind Moves! Beery, K, Buktenica, N 1997. Developmental Test for Visual Motor Integration: New Jersey. Modern Curriculum Press Calder, C. 2010 Visual and Sensory Perception: An Occupational Therapy Perspective. Presentation – Seeing Your Way to Reading (SAALED). 11 /09/10 De Jager, M. 2009 Mind Moves Advanced Instructor Training Course Manual. Linden Johannesburg. Mind Moves Institute De Jager, M. 2010. Mind Moves – moves that mend the mind. Johannesburg: Mind Moves Institute. Goddard Blythe, S. 2001. Neurological Dysfunction as a Significant Factor in Children Diagnosed With Dyslexia. Paper presented at the 5th BDA International Conference. [online]. http://www.bdainternational conference.org/2001/presentations/sat_s1_a_1.htm [accessed 10 August 2010] Kulp, M, Mazzola S, Mazzola, J 2003. Clinical Value of the Beery Visual Motor Integration Supplement Tests of Visual Perception and Motor Integration. Optometry and Vision Science April 2003 – Volume 80 Issue 4: 312-315 Sanghavi, R, Kelkar, R, 2005 Visual Motor Integration and Learning Disabled Children. Indian Journal of Occupational Therapy Vol. XXXVII: No 2: 33-2 [accessed 17 July 2010]. Thorne, G. n.d.. Graphomotor Skills – Why Some Kids Hate to Write. [online]. www.icdl.org/resource-library/articles/graphomotor.php [accessed 10 August 2010]. Van der Zee, F. 2010. Occupational Therapy Report (August 2010) and Discussion Visual Integration Skills. n.d. [online]. http://www.visionand learning.org/visualintegration.html [accessed 04 July 2010] Visual Motor Integration. n.d. [online]. http://www.childrensvision.com/reading.htm [accessed 17 September 2009.)

http://www.icdl.org/resource-library/articles/graphomotor.php

http://www.icdl.org/resource-library/articles/graphomotor.php

http://www.childrensvision.com/reading.htm


APPENDIX 1: Developmental objectives of intra-uterine, primitive and bridging reflexes

REFLEX DEVELOPMENTAL OBJECTIVE

Sensory Brain Muscle

Withdrawal Touch Proprioception

Receptive/back

Moro Vestibular system (balance) Kinesis Auditory

Receptive/back Expressive/front

Entire motor system

Rooting and Sucking

Olfactory Gustatory Primitive vision

Receptive/back Emotional/bottom

Neck Mouth

Tonic Labyrinthine

Vestibular system Auditory Primitive vision

Receptive/back Expressive/front Emotional/bottom Cognitive/top

Neck Core

Palmar Touch Receptive/back Expressive/front Left and Right Cognitive

Hands Fingers Fine Motor

Plantar Touch Receptive/back Expressive/front Left and Right Cognitive

Feet- balance and weight bearing Gross and fine motor

Asymmetrical Tonic Neck

Vestibular system Vision and sight

Receptive/back Cognitive/top

Neck Core Limbs Eye – hand Head stability

Spinal Galant Touch Hearing - vibrational


Core Trunk rotation

Symmetric Tonic Neck

Balance Vision


Neck Core – flexion and extension Shoulder Hip

(De Jager, 2009)


APPENDIX 2: Alignment of reflexive development with the ability to copy basic shapes as

pre-requisite skills for writing as illustrated using Beery & Buktenica’s Development Tests of

Visual-Motor Integration (1997)

Ability to hold a pencil and organise output on paper are assumed

Directionality required for all below: near sensory system – Withdrawal, Moro, TLR,

ATNR, STNR

Basic Shape

Comment Reflex-driven developmental

requirement

Vertical line easier to draw than

Directionality - up and down; away from/towards Cross horizontal midline TLR

Horizontal line

Directionality – left /right; away from /toward Laterality Cross vertical midline ATNR

Children <6yrs tend to draw away from self – perception that centre of universe. 6 + yrs – draw circle from top towards body – left/right centre seems to be forehead i.e. top brain – corresponds with development of bi-lateral integration

Directionality – away from/toward Proprioception and balance Withdrawal, Moro, TLR, ATNR, STNR

4-6 year olds – horizontal line weaker than vertical line. Frequent segmenting of horizontal midline at midline.

Directionality Laterality& Bilaterality Crossing of horizontal and vertical midlines TLR, ATNR

Develop later because requires co-ordination of vertical and horizontal movement and midline crossing Typically left to right mastered before right to left

Directionality Laterality & Bilaterality Crossing of horizontal and vertical midlines TLR, ATNR

First form requiring drawing in one direction, stop, then change direction. Requires perception of spatial relations among sides. Required to draw vertical and horizontal lines, see corners and organise the components as such. A tendency to therefore circularize is therefore common in older children



Basic Shape

Comment Reflex-driven developmental

requirement

X

Vertical and horizontal lines and oblique lines in each direction must be mastered to produce this shape


Co-ordination of oblique lines Tendency to circularize if this not mastered


visual-motor integration (vmi) and graphomotor (handwriting) problems … · 2015-05-19 ·...

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