Visual-Motor Integration (VMI) and Graphomotor (Handwriting) Problems as a Barrier to Learning.

Transcription

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 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 coordination 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 visualmotor (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). 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). 1

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) 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. 2

3 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 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 Geometric form to be copied Developmental Test of Visual Motor Integration Items 7-9 ( Beery & Buktenica, 2005) Age 5years 8 months Intended to draw a square Age 6years 7 months Application of developing skill in drawing tasks Age 8years 2 months 3

4 Fig 2: Continued Geometric form to be copied Developmental Test of Visual Motor Integration Items ( Beery & Buktenica, 2005) Age 5years 8 months Age 6years 7 months Age 8years 2 months Geometric form to be copied Developmental Test of Visual Motor Integration Items ( Beery & Buktenica, 2005) Age 5years 8 months Age 6years 7 months Age 8years 2 months 4

5 Figure 2: Continued Geometric form to be copied Developmental Test of Visual Motor Integration Items ( Beery & Buktenica, 2005) 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). 5

6 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/selfconfidence 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): re- Power On Rub the indentation just below the collar bone in line with the left eye. This move 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. 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. 6

7 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 Developmental Test for Visual Motor Integration: New Jersey. Modern Curriculum Press Calder, C Visual and Sensory Perception: An Occupational Therapy Perspective. Presentation Seeing Your Way to Reading (SAALED). 11 /09/10 De Jager, M Mind Moves Advanced Instructor Training Course Manual. Linden Johannesburg. Mind Moves Institute De Jager, M Mind Moves moves that mend the mind. Johannesburg: Mind Moves Institute. Goddard Blythe, S Neurological Dysfunction as a Significant Factor in Children Diagnosed With Dyslexia. Paper presented at the 5 th BDA International Conference. [online]. conference.org/2001/presentations/sat_s1_a_1.htm [accessed 10 August 2010] Kulp, M, Mazzola S, Mazzola, J 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: 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]. [accessed 10 August 2010]. Van der Zee, F Occupational Therapy Report (August 2010) and Discussion Visual Integration Skills. n.d. [online]. learning.org/visualintegration.html [accessed 04 July 2010] Visual Motor Integration. n.d. [online]. [accessed 17 September 2009.) 7

8 APPENDIX 1: Developmental objectives of intra-uterine, primitive and bridging reflexes REFLEX DEVELOPMENTAL OBJECTIVE Withdrawal Moro Rooting and Sucking Tonic Labyrinthine Sensory Brain Muscle Touch Proprioception Vestibular system Entire motor system (balance) Kinesis Auditory Olfactory Gustatory Primitive vision Vestibular system Auditory Primitive vision Emotional/bottom Emotional/bottom Cognitive/top Palmar Touch Left and Right Cognitive Plantar Touch Left and Right Cognitive Asymmetrical Tonic Neck Spinal Galant Symmetric Tonic Neck (De Jager, 2009) Vestibular system Vision and sight Touch Hearing - vibrational Balance Vision Cognitive/top Emotional/bottom Cognitive/top Emotional/bottom Cognitive/top Neck Mouth 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 8

9 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 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 4-6 year olds horizontal line weaker than vertical line. Frequent segmenting of horizontal midline at midline. Develop later because requires coordination of vertical and horizontal movement and midline crossing Typically left to right mastered before right to left 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 TLR Directionality left /right; away from /toward Laterality Cross vertical midline ATNR Directionality away from/toward Proprioception and balance Withdrawal, Moro, TLR, ATNR, STNR Directionality Laterality& Bilaterality Crossing of horizontal and vertical midlines TLR, ATNR Directionality Laterality & Bilaterality Crossing of horizontal and vertical midlines TLR, ATNR Directionality Laterality & Bilaterality Crossing of horizontal and vertical midlines TLR, ATNR 9

10 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 Directionality Laterality & Bilaterality Crossing of horizontal and vertical midlines TLR, ATNR Directionality Laterality & Bilaterality Crossing of horizontal and vertical midlines TLR, ATNR 10