1. Visual Motor Integration CCSD Evidence Based Practice
Anna Suchy, OTS

2. PICO Question
For children, 7-10 years old, who are receiving school based occupational therapy services, does providing 15 minutes of visual motor training, with paper/pencil tasks or tangrams, once a week, for seven weeks, improve visual motor integration of spatial-relations and eye-hand coordination, as determined by a pre and post eye-hand coordination and spatial relations subtests of the DTVP-2?

3. Research
Research Article
Findings
Relationship Analysis Between Visual-Motor Integration Ability and Academic Performance
Relationship between:
Visual Perception and Reading
Motor Coordination and Writing
Relationship Between Visual Motor Integration Skill and Academic Performance in Kindergarten Through Third Grade
Student’s Beery VMI score is significantly related to the teacher’s evaluation of the student in each subject.
Handwriting Difficulties in Primary School Children:
A Search for Underlying Mechanisms
2 different underlying mechanisms that affect the quality of handwriting
Fine Motor Coordination
Visual Motor Integration
Before I start talking about the research I want to remind everyone of 2 definitions.
Visual Perception- is the ability to interpret your environment by processing information you see with your eyes.
Visual-motor integration-The extent to which an individual can coordinate vision with body movement or parts of the body; for example: being able to copy words from the board.
Article 1: This study had 77, 2nd grade students took the Beery VMI and the Academic performance test-measures writing, reading, arithmetic. Comparing the results of these 2 tests, verified the relationship existence between visual motor integration and academic skills (reading, writing, arithmetic). A relationship between visual perception ability and reading performance, and the relationship between motor coordination and cursive writing were found. It reiterated the point that good handwriting requires appropriate fine motor control, visual motor integration, motor planning, proprioception, visual perception, sustained attention, and sensory awareness in the fingers. If these skills are impaired, the result can be illegible handwriting which can compromise academic performance.
Article 2: 191, 7-9 year old students from an elementary school in Ohio participate din the study. First graders were assessed with the Beery VMI test on visual motor integration, reading, writing, and math. 2nd and 3rd graders were assessed in the same areas but also in spelling. Then, Experienced teachers were asked to rate the students in each of these areas (look at their current grades in each course). How a student performed on the Beery VMI is significantly related to the teacher’s evaluation of the student in each subject.
Article 3: 29 children with handwriting problems and 20 control students from grades 2 and 3, were chosen from 23 regular schools.
The aim of this study is to investigate the role of lower level processes (such as visual perception, visual-motor integration, and fine motor
coordination), and higher level processes (cognitive planning) involved in a handwriting task (like copying text) in children with Handwriting problems and matched controls.
Findings of the present study show that children with handwriting difficulties appear to perform less proficiently on measures of visual perception, fine motor coordination, visual-motor integration, and cognitive planning in comparison with children without handwriting problems. 65% of the children with handwriting problems were identified as slow writers although no significant correlation between quality and speed of handwriting was found.
This study found that there are 2 different underlying mechanisms that affect the quality of handwriting in children with and without handwriting problems.
The best predictor of the quality of handwriting in children without handwriting problems appeared to be fine motor coordination, whereas visual-motor integration was the best predictor in children with handwriting problems. These findings suggest that interventions for children with handwriting difficulties should focus on improving both fine motor coordination and visual motor integration.

4. Pre-Post test Measurements
Visual Perception
Visual-Motor Integration
Ages 4-10 years old
8 subtests
Eye-Hand Coordination
Spatial Relations
Figure Ground
Visual-Motor Speed
Copying
Position in Space
Visual Closure
Form Constancy
The DTVP-2 provides scores for both pure visual perception and visual-motor integration abilities.
Ages 4-10 years old
8 subtests
Eye-Hand Coordination
Spatial Relations
The scores for all subtests are reliable (.8 or .9 levels) for all age groups. Standardized on 1,972 children from 12 states, the DTVP-2 yields scores for both pure visual perception (no motor response) and visual-motor integration ability, and has been shown to be unbiased relative to race, gender, and handedness

5. Type of Visual Perception Measured
Explaining the DTVP-2
Eye-Hand Coordination Subtest- Requires student to to draw a line within a straight broad band. Subsequent bands are increasingly narrow and involve angles or curves.
Spatial Relations Subtest-Student is shown a grid of evenly spaced dots with lines drawn connecting some of the dots. Student must draw lines and connect dots to form the given pattern directly below the given pattern.
Eye-Hand Coordination Subtest- Requires student to draw a line within a straight broad band. Subsequent bands are increasingly narrow and involve angles or curves. It measures the ability to draw precise, straight or curved lines in accordance with visual boundaries. Student must be able to see the boundaries and monitor the hand movements to ensure the line stay within the boundaries.
Spatial Relations Subtest-Student is shown a grid of evenly spaced dots with lines drawn connecting some of the dots. Student must draw lines and connect dots to form the given pattern directly below the given pattern. This measures the ability to connect dots to reproduce visually presented patterns. To be able to connect dots, students must perceive the pattern, organize it, plan to respond, and execute by drawing the pattern.
DTVP-2 has motor enhanced versus motor reduced subtests. Motor enhanced subtests emphasize pencil-paper tasks while the motor reduced subtests involve pointing to correct answer. Both subtests I administered were motor enhanced.
Subtest
Type of Visual Perception Measured
Motor Involvement
Eye-Hand Coordination
Spatial Relations
Motor Enhanced

6. DTVP-2 Standard Scores 0-3=Very Poor 4-5 = Poor 6-7=Below Average
13-20 =Above Average
All of the students fell in in the standard scores ranged from very poor to average, with the highest score at 8, compared to others their age.

7. Week by Week Week Warm-Up Activity 1 None DTVP-2 Pre-test
Subtests (Eye-Hand Coordination/Spatial Orientation) 2
Prone on Scooter Board
T: Cards 1-3 or4
PP: R/L Car Worksheet 3
Zoom Ball
T:Cards 3-4,5, or 6
PP: Maze/ Figure Ground WS  4
Dice Gross Motor Game 
T: Cards3-4-8
PP: Maze/ Dot-to-Dot WS  5 
“Fipper” Game
T: Cards 9-18
PP: Copy figures, On/Off Worksheet  6
Ball Game 
T: Choice
PP: Hidden Picture, Maze, Copy figures   7
GM coordination
PP:L/R WS, Patterns
DTVP-2 Post -test
Throughout the weeks, we did the same warm-up with the students and the same activities depending if they were in the tangram group or the PP group
2 Out of 10 students missed one day each during the entire testing time-but their minutes were made up throughout the weeks.
Generally tried to make the warm-ups gross motor related. Activities for the students were the same during the first few weeks, but based on how fast the student worked, depended on which worksheet I would give him.

8. Subjects Name Classroom Grade School Tangrams Pencil/Paper Enjoyment
1 (Ry**) GE 4
Smalley X N
2 (Jo**) Y
3 (Isa**)
SLD 2
Sewell -
4 (Ar**)
5 (Ga**)
Autism SC/GE
Morrow
6 (Ty**)
Kesterson
Not Asked
7 (Jac**) 1
8 (M**) 3
9 (Ch**)
10 (Li**)
MCS 5
Who was involved in the study?
Originally tested 12 students from 4 different schools, but chose to do the study on 10 students because 2 of the students required assistance to understand the directions of the spatial relations subtest and required max prompting throughout the subtest.
Coded their names by assigning them a number (students 1-5 completed tangrams worksheets while students 6-10 completed the pencil/paper tasks)
4 General Ed students (2 of which did pencil/paper tasks and 2 of which did tangrams)
4 SLD students (2 of which did pencil paper tasks and 2 of which did Tangrams)
1 Student MCS- did Pencil Paper tasks
1 Student (Self-Contained/Autism)-Tangram tasks
All students were seen for a total of 1 hour and 45 minutes or 2 hours over a 7 week period

9. Eye-Hand Coordination Tangrams and Pencil Paper Tasks
Standard
Score
This graph is looking at all students- regardless of which group they were in.
Blue line = pre test, redline= post test

10. Eye-Hand Coordination Tangrams

11. Eye-Hand Coordination Paper/Pencil Tasks

12. Spatial Relations Tangrams and Pencil/Paper

13. Spatial Relations Tangrams

14. Spatial Relations Paper/Pencil

15. Variables Time of Day Classroom Variables OTS Attention span Age
Interest/Attention to Task and Subtests
Worksheets Provided to Student
Holiday break
Absences
Time
Warm-up variations
Test-familiarity

16. Conclusion
Variables
Tangrams versus Pencil/Paper

17. References
Hammill, D., Pearson., & Voress, J. ( 1993). Developmental Test of Visual Perception Second Edition. Austin, Texas: Pro-ed. Kulp, T. (1999). Relationship between visual motor integration skill and academic skill and performance in kindergarten through third grade. Optometry and Vision Science: Official Publication of the Academy of American Optometry, 76 (3), Pereira, Debora M., Araujo, R., Braccialli, L (2011). Relationship analysis between visual-motor integration and academic perfromance. Journal of Human Growth and Development, 21 (3), Retrieved from Volman, M.J., Schendel, B., & Jongsmans, M.J., (2006). Handwriting Difficulties in Primary School Children: A Search for Underlying Mechanisms. American Journal of Occupational Therapy, 60 (4), doi: /ajot