Motor Skills, Visual Motor Integration

Posted by: Invision Optometry in Category Vision Therapy

Child writing in a book

Does Your Child Struggle with Handwriting?

Many parents witness their child’s daily resistance and struggles with writing and wonder why it seems so difficult and how they can help. As they begin their search for answers they may encounter information that makes them question if the handwriting issues are due to a fine-motor weakness, an eyesight problem, a visual perceptual delay, or a combination of all three. Many families gain clarity once commonly used terms such as motor skills, visual skills, perceptual skills and visual motor integration are accurately defined. It is also useful to understand that there is a developmental hierarchy that takes place in building a strong foundation of visual motor integration skills that support good writing ability. From infancy, the first step is gross motor movement skills, then basic eye movement skills are quickly incorporated. Throughout this process, visual perceptual skills start emerging and lead to the development of efficient fine motor skills. The last step is integrating these skills to perform high level visual motor tasks such as drawing, cutting, and writing.

The Eyes Work with the Body as a Whole, Not Just a Separate Part…

Important Skills for Handwriting

Motor skills are important for a child’s growth and independence. Motor skills are a learned sequence of movements that combine to produce a smooth and efficient action, in order to master a particular task. Good motor control helps a child explore the world around them and develop cognitively. Typically, motor skills are divided into two groups, fine motor skills, and gross motor skills. Both help to coordinate movement but in very different ways. Gross motor skills are used for the movement and coordination of larger muscles in the body that are responsible for things like crawling, running, throwing, or jumping. Fine motor skills are used during smaller actions, such as grasping an object between the thumb and finger. Both types of skills usually develop together, because many activities depend on the coordination of gross and fine motor skills.

Visual skills play a significant role in guiding all movements…

Visual Skills

Visual skills play a significant role in guiding all movements. If a child is having problems with handwriting, the difficulty could be due to uncorrected eyesight issues or poorly developed visual skills. If​ there is​ ​a​ ​visual​ ​problem​, ​the​ ​act​ ​of​ ​writing​ ​neatly​ ​will​ ​be​ ​stressful​ ​for​ ​a child. They​ ​may​ ​be​ ​fine​ ​for​ ​a​ ​short​ ​period​ ​of​ ​time,​ ​but​ ​then​ ​start​ ​to​ ​tire​ ​quickly. This​ ​may be​ ​as​ ​brief​ ​as​ ​less​ ​than​ ​a​ ​minute​ ​or​ ​more​ ​typically​ ​5-15​ ​minutes.

There are several visual skills that are critical to good handwriting which may be underdeveloped in a child who is struggling in this area:

  • Visual Acuity:Uncorrected eyesight problems such as farsightedness, nearsightedness, and astigmatism can affect handwriting performance by causing blurred or distorted images
  • Focus Ability:Beyond seeing 20/20 when looking at the page, the eyes must maintain their focus to keep the print consistently clear and quickly refocus when looking from point to point. A reduced focus system can cause visual fatigue/headaches, words coming in and out of focus, and make copying from the board a difficult task
  • Peripheral Awareness: Lack of good peripheral vision can cause difficulty with writing in a straight line or crowding words at the margins
  • Eye Movement Skills: Lack of smooth and accurate tracking skills can lead to problems with spacing, omission of letters and words and slow writing speed
  • Eye Teaming Skills: Poorly developed eye teaming skills, such as convergence insufficiency (an inability to accurately and effortlessly coordinate the two eyes together when focusing on writing), can lead to double vision, overlapping of letters and extremely large or small printing

Visual perceptual skills relate to how our brain processes what is seen and are very important for success in written tasks. A few of the most essential ones are:

  • Visualization: Enables the student to remember what different words look like in order to reproduce them on the page
  • Spatial Concepts: Enhance the ability to know and plan how words will go together and be oriented on the page
  • Laterality and Directionality: Provide the ability to differentiate the direction of similarly-shaped letters such as “b, d, p, q”
  • Visual Discrimination: Allows students to easily see subtle differences between symbols and letters. This visual perceptual skill can be described as “paying attention to detail”
  • Visualization: The ability for students to create, organize, and compose ideas before starting their written work
  • Visual Recall: A visualization skill that promotes good spelling by providing the ability to create a mental image of a word based on past visual experience

Fine Motor, Visual Skills and Perceptual Abilities Need to be Integrated…

Visual Motor Integration

Visual​ ​motor​ ​integration is a complex combination of skills​ ​that​ ​allows​ ​us​ ​to​ perform complicated​ ​tasks​ ​by​ ​using​ ​our​ ​eyes​, ​hands​ and brain ​together. However, contrary to popular belief, it is not the same thing as eye-hand coordination. Eye-hand coordination refers to the eyes ability to guide the hands and does not usually involve visual perception per se. Examples include hitting a ball with a bat, catching a ball and tracing a path between two lines. In writing, it may cause difficulties with pencil control, such as trouble starting and stopping in the correct spot and over/under shooting. Keep in mind that fine motor delays can also cause this same issue. Visual motor integration utilizes eye-hand coordination, but includes the involvement of visual perceptual skills such as size perception, figure-ground awareness, sequential memory and visualization, just to name a few. Good writing skills heavily depend on a well-developed and fully integrated visual motor system. When there is an interruption or delay in this area it can make handwriting a very daunting task!

There is a Difference Between Eye-Hand Coordination and Visual Motor Integration…

How Visual Motor Integration Affects Writing

For students with visual motor integration deficiencies, coordinating their visual skills, perceptual skills and fine motor output is so challenging. They tend to have significant difficulty with tasks such as getting thoughts on paper and copying information from the board or a book. Because of this, learning occurs more slowly and overall performance is affected. A child may have trouble following instructions, completing worksheets and assignments and accurately writing answers on tests. They know the material being covered, but putting pencil to paper is not as easy for them as it is for their peers.

Other Signs of Visual-Motor Dysfunction Include:

  • Messy handwriting and sloppy drawing
  • Poor grades on written tests despite being able to give answers orally
  • Trouble gripping or repeatedly re-gripping a pencil
  • Difficulty coloring inside the lines or writing within lines
  • Misaligning numbers in columns for math problems
  • Excessive errors and erasing
  • Slow to complete written assignments
  • Frustration with pencil and paper activities
  • Difficulty copying from the board
  • General clumsiness or trouble with coordination
  • Poor performance in sports, such as hitting, catching, or kicking a ball

When a child is identified as having a visual motor integration problem through testing, it does not always mean that there is a deficit in the visual system. Their seeing ability (20/20), visual skills and visual perception may be intact. There may not be a problem with their motor control either. Strength, coordination and range of motion may be sufficient. Thus, the deficit is often in the mechanism that enables the visual and the motor systems to work together. In other words, the visual and motor systems are not communicating well with each other. Only in-depth testing of the motor skills by an occupational therapist and comprehensive visual skills testing by a developmental optometrist can reveal the core issues and pinpoint an appropriate treatment plan.

Handwriting Issues Can Be Related to Poor Visual Skills…

Visual Motor Integration

It is important that visual motor integration problems be diagnosed and treated as early as possible to minimize their impact on functional abilities such as handwriting. When a child is identified as having a visual motor integration problem through testing, it does not necessarily mean that there is a deficit in the visual system. Their seeing ability (20/20), visual skills and visual perception may be intact. Motor control may not be a problem either. Strength, coordination and range of motion may be sufficient. Thus, the deficit is often in the mechanism that enables the visual and the motor systems to work together. In other words, the visual and motor systems are not communicating well with each other. Primarily, a comprehensive eye exam including visual and perceptual skills testing by a developmental optometrist is recommended to either rule out or identify any delays in the visual system that are impacting handwriting performance. In addition, an in-depth motor skills assessment by an occupational therapist can help identify and treat weakness in gross and fine motor skills. It is important to note that any untreated visual conditions can stall or prevent progress with typical handwriting improvement programs provided by​ ​occupational​ ​therapy,​ ​physical therapy,​ ​or​ ​speech-language​ ​therapy. That is why early detection of visual problems known to negatively impact handwriting is key!

To Effectively Treat the Visual System, the Whole Eye-Brain-Body Connection Must be Addressed…

Vision Therapy

If​ ​you​ ​suspect​ ​your​ ​child​ ​may​ ​be​ ​struggling​ ​with​ ​a​ ​visual motor​ integration ​problem,​ ​the​ ​first​ ​step​ ​is​ ​to schedule​ ​a​ ​​functional​ ​vision​ ​exam​​ ​with​ ​an​ ​​optometrist​ ​trained​ ​in​ developmental​ ​vision​ ​care. ​The​ ​good​ ​news​ ​is,​ that once visual problems are diagnosed, ​an​ ​individualized​ ​​vision​ ​therapy​ ​program​​ ​can​ ​provide noticeable​ ​improvement​ ​in​ ​a​ ​relatively​ ​short​ ​period​ ​of​ ​time. At​ ​Invision​ ​Optometry,​ ​our​ ​Eyes​ ​+​ ​Brain​ ​+​ ​Body​ ​Approach​ ​in​ vision​ ​therapy​ ​results​ ​in​ ​improved visual​ ​motor​ ​speed,​ ​better​ ​legibility​ ​with​ written​ ​tasks,​ ​accelerated​ ​development​ ​of visual motor​ ​integration​ ​skills,​ ​and​ ​improved​ ​coordination​ ​and​ ​sports​ ​performance. Call our office to learn how we can help (619) 222-2020 ext. 205.


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