Visual-motor Integration

Question 1

Visual-motor integration

Answer 1

• Visual and proprioceptive information are integrated in the brain
• Integration of information allows for motor judgments to be made
• Tracing something, driving

Question 2

Visual motor functions:

Answer 2

• Expressive function: output / production of a movement
  o includes non-verbal communication
• Receptive function: intake of information
  o Receiving environmental cues
  § Visual information: spatial relationships, closure, tracking
  o Combining sensory and proprioceptive cues

Question 3

Observing visual-motor integration
Provides information about the child’s:

Answer 3

• Fine and gross motor skills
• Intactness of sensory and motor modalities
• Possible neurological deficits / impairments
  o Cerebral palsy (CP)
  o ADHD
  o Traumatic brain injury (TBI) - ⅓ of children will show deficits in visual motor integration and skills
  o Learning disabilities (SLD)

Question 4

How the child carries out the test can be critical

Answer 4

Child’s style of responding:
* Dealing with frustration
* Correcting of errors
* Concentration and attention
* Planning and organization
* Motivation
* Encouragement
* Time to complete… perfectionism?

Fine motor skill:
* How the child holds the pencil
* Handedness
* Signs of tremor / holding pencil tightly
* Shifting posture / arm position

Visual integration:
* Traces designs with finger before drawing them
* Reorients paper or card so design is on a tilt
* Difficulty with the parts of designs
* What part of the design does the child draw first?
* Are parts integrated into the whole?
* Does the child spot differences between his drawing and the example?

Question 5

How does the brain
integrate information?

4 NETWORKS FOR EVERYDAY FUNCTION

Answer 5

Brain networks share information with one another constantly
Several brain networks are involved in everyday function

• Default mode network (DMN)
  o Maintenance of the self
  –Most active when you are not engaged in task- task-negative network
  –Autobiographical, integrate sensory to add to self awareness
• Sensory-motor network
  o Processing of sensations and movements
  —Sensory info and motor responses - make interpretations about sensations in our environment
  —Develops much earlier than higher-order networks
• Salience network
  o Monitors the environment for important information
  –Alarm system of the brain
  –When info is detected - help redirect our attention
• Central Executive Network
  o Involved in decision-making and planning
  –Higher order executive functioning skills
  —Near the end develops

Disruptions (due to injury, psychological distress, illness) can cause
poor information integration within a network and between networks

• Can result in deficits in information integration à visuomotor
  dysfunctions can ensue

Question 6

Visual-perceptual / Visual-motor Tasks

Answer 6

1. Visual perception with motor response
2. Visual perception without motor response

Question 7

How does the brain integrate information?
White matter

Answer 7

Axon bundles - highways that connect one brain region to another

Question 8

Visual-perceptual / Visual-motor Tasks
1. Visual perception with motor response

Answer 8

Visual perception with motor response:
1. The Bender-Gestalt Test
2. Beery Visual-Motor Integration
* Pencil and paper copying tests
* Untimed
3. NEPSY II > NEuroPSYchological test for children
o Route finding subtest

Question 9

Visual Perceptual Tests
without motor response

Answer 9

Visual perception without motor response
1. NEPSY II (Arrows subtest – which arrow will hit the bullseye?)
* Identification of poor visuospatial skills: judging line orientation, direction,
angularity, and estimating distance
–Test whether a child can judge line orientation visually - which arrow points directly to the target

2. Kaufman Assessment Battery for Children
   * Gestalt Closure subtest - what shape is this?

Question 10

Tests of Motor Skills

Answer 10

Motor skills impaired due to:
* Motor planning
* Physical dexterity
* … Or combination of both

TBI:
* Ability to perform motor tasks quickly decreases corresponding to the severity of closed head injury
* Common effect = reduced fine motor skills – particularly timed motor tasks

To assess:
* Use tests that do not have a visual-perceptual component so that poor visualperceptual skills do not confound the findings (e.g. Halstead-Reitan Finger Oscillation
Test)

Question 11

Interpreting performance

Answer 11

Visual-motor tests require fine motor skills, perceptual discrimination
ability, and ability to integrate perceptual and motor processes

Poor performance may reflect:
* Misperception
* Poor fine motor control
* Integrative processing difficulties
* Impulsivity / poor planning
(executive function)

Poor performance can be associated with:
* Maturational delay
* Limited intellectual stimulation
* Unfamiliarity with testing situations
* Neurological impairment

Question 12

The Bender Visual-Motor Gestalt Test

Answer 12

• Most widely used neuropsychological test
• Popular test of the visual-motor function
• Developed in 1938 by Lauretta Bender for use as a visual-motor test with adult clinical populations and as a developmental test with children
• Individually administered, paper-and-pencil test
• 9 geometric figures
• Serves as a good icebreaker with which to begin the test session
  o Task is innocuous, non-threatening, interesting, and appealing to children

Bender-Gestalt outcomes and interpretations:
* Child must copy pencil drawings
* Scored based on errors
* Koppitz (1975) generated a scoring method

Question 13

Koppitz Method

Answer 13

Four category system used to classify errors
1. Distortion of shape
2. Rotation
3. Integration difficulties
4. Preservation

Scoring:
* 1 point per error
* Points are summed to obtain a total error score which is compared to aged normative data. Percentile norms are available for children aged 5 through
11-11 years.

Question 14

Koppitz Method
Four category system used to classify errors

Answer 14

1. Distortion of Shape
   * Destruction of the Gestalt
   * Misshapen figures
   * Disproportions between sizes of the component parts
   * Substituted shapes (e.g. circles or dashes for dots, substitution of angles,
   curves, or total lack of curves where they should exist)
   * Extra angles or missing angles
2. Rotation
   * Rotation of figure or any part by 45 degrees or more
   * Rotation of the card (even if the child’s drawing is copied correctly)
3. Integration
   * Failure to connect parts of figure
   o (> 1/8 inch between parts or overlap)
   * Failure to cross lines or crossing incorrectly
   * Omission or addition
4. Preservation
   * Increase, continuation, or prolongation of the number of units in the design

Question 15

Compensatory mechanisms

Answer 15

Even in the absence of errors, clinicians can observe deficits by noticing a number of compensatory mechanisms

• More time needed for completion
• “Anchoring” designs by placing finger on them while drawing
• Constant checking of original
• Child rotates page
• Drawing rushed, then painstakingly corrected

Question 16

Visual-motor tests require 3 skills/abilities

Answer 16

fine motor skills,

perceptual discrimination
ability, and

ability to integrate perceptual and motor processes