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

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 (http://www.visionand learning.org/visualintegration.html, n.d ) and adjusted (http://www.childrensvision.com/reading.htm, 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). 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; http://www.visionand learning.org/visualintegration.html, n.d.). Underachievement may, in many cases, therefore be a direct result of inability to produce adequate written outputs for accurate assessment of progress.

©Mind Moves Institute, Johannesburg. 2011

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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

(http://www.visionand learning.org/visualintrgration.html, n.d)

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

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)

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).


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Fig 2: Comparison of performance over time on the Developmental Test of VisualMotor Integration (Beery and Buktenica, 2005) to illustrate development of VMI ability plus changes in drawn and written output with development of VMI

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.

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

Intended to draw a square

Application of developing skill in drawing tasks

Age 8years 2 months


3

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


4

Fig 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). Figure 3: Illustration of discrepancy between verbal and written skills . Verbal skills assessed using WPPSI 3 test

Word order, usage and sentence structure as seen in this example of written output differ markedly from this child‟s verbal communication abilities.

VI = Verbal Intelligence IN = Information VC = Vocabulary WR = Word Reasoning VC – superior range IN – high average WR – high average


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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 selfesteem/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:        

Power ON Rise and Shine Mousepad Visual Workout Bi-lateral Integrator Bi-lateral Walk Finger fight Palm Stretch

(De Jager, 2009)


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APPENDIX 1: DEVELOPMENTAL OBJECTIVES OF INTRA-UTERINE , PRIMITIVE AND BRIDGING REFLEXES

REFLEX

Withdrawal Moro

Rooting and Sucking Tonic Labyrinthine

DEVELOPMENTAL OBJECTIVE Sensory Touch Proprioception Vestibular system (balance) Kinesis Auditory Olfactory Gustatory Primitive vision Vestibular system Auditory Primitive vision

Palmar

Touch

Plantar

Touch

Asymmetrical Tonic Neck

Vestibular system Vision and sight

Spinal Galant

Touch Hearing - vibrational

Symmetric Tonic Neck

Balance Vision

Brain Receptive/back Receptive/back Expressive/front

Muscle

Entire motor system

Receptive/back Neck Emotional/bottom Mouth Receptive/back Expressive/front Emotional/bottom Cognitive/top Receptive/back Expressive/front Left and Right Cognitive Receptive/back Expressive/front Left and Right Cognitive Receptive/back Cognitive/top

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

Neck Core

Hands Fingers Fine Motor Feet- balance and weight bearing Gross and fine motor Neck Core Limbs Eye – hand Head stability Core Trunk rotation

Neck Core – flexion and extension Shoulder Hip

(De Jager, 2009)


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

Vertical line easier to draw than Horizontal line

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

Children