Developmental Test of Visual-Motor Integration (VMI): An Effective Outcome Measure for Handwriting Interventions for Kindergarten, First-Grade, and Second-Grade Students?

Precision in Progress: Unraveling the Clinimetric Properties of Beery-Buktenica Developmental Test of Visual-Motor Integration in Children With Cerebral Palsy Across Diverse Motor Severities

BACKGROUND

In the realm of pediatric cerebral palsy (CP), visual motor challenges often overshadow a child's developmental journey. This study delves into the responsiveness and crucial benchmarks, specifically the minimal clinically important difference (MCID), of the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) among children with varying motor severities.

METHOD

Eighty-eight children with CP (50 males, 38 females; aged three to 12 years) with Gross Motor Function Classification System (GMFCS) levels I to III were recruited from the rehabilitation department of Chang Gung Memorial Hospital in Taiwan. Each participant received the Beery VMI tests at baseline and at one-year follow-up. The standardized response mean (SRM) was calculated to determine the responsiveness of Beery VMI, and a distribution-based approach was used to estimate MCID.

RESULTS

The Beery VMI exhibited remarkable responsiveness across GMFCS levels I to III (SRM = 0.98-2.36). MCIDs for Beery VMI varied across severities, with ranges of 2.93 to 4.41 (0.2 S.D.), 7.31 to 11.49 (0.5 S.D.), and 11.70 to 18.38 (0.8 S.D.). Notably, in the visual perception subset, MCIDs were 3.93 to 4.03 (0.2 S.D.), 9.83 to 10.07 (0.5 S.D.), and 15.73 to 16.11 (0.8 S.D.). In the supplemental motor coordination subtest, MCIDs spanned 1.67 to 4.87 (0.2 S.D.), 4.18 to 12.17 (0.5 S.D.), and 6.68 to 19.47 (0.8 S.D.).

CONCLUSIONS

Beery VMI demonstrates robust responsiveness in children with CP. Motor-severity-tailored MCIDs offer a guide for clinicians and researchers, hinting at treatment efficacy. Particularly, lower change scores in VMI and motor coordination subtests may signal effective interventions for moderate motor disability over mild cases.

Exploratory Investigation of Handwriting Disorders in School-Aged Children from First to Fifth Grade

Handwriting disorders (HDs) are prevalent in school-aged children, with significant interference with academic performances. The current study offers a transdisciplinary approach with the use of normed and standardized clinical assessments of neuropsychomotor, neuropsychological and oculomotor functions. The aim is to provide objective data for a better understanding of the nature and the etiology of HDs. Data from these clinical assessments were analyzed for 27 school-aged children with HD (first to fifth grade). The results underline a high heterogeneity of the children presenting HDs, with many co-occurrences often unknown. However, it was possible to highlight three levels of HDs based on BHK scores: mild HD not detected by the BHK test (26% of children), moderate HD (33%) and dysgraphia (41% of children). The mild nature of the HDs not detected by the BHK test appears to occur at a relatively low frequency of the associated disorders identified during clinical evaluations. On the contrary, dysgraphia appears to be associated with a high frequency of co-occurring disorders identified in the clinical assessment, with a predominance of oculomotor disorders (55% of children), leading to visual-perceptual difficulties and a high level of handwriting deterioration. Finally, children with moderate HD have fewer co-occurrences than children with dysgraphia, but have more difficulties than children with mild HD. This highlights the importance of differentiating between different degrees of HDs that do not respond to the same semiologies. Our findings support the interest in performing a transdisciplinary and standardized clinical examination with developmental standards (neuropsychomotor, neuropsychological and oculomotor) in children with HD. Indeed, HDs can therefore be associated with a multitude of disorders of different natures ranging from poor coordination of the graphomotor gesture to a more general and more complex impairment affecting perceptual-motor, cognitive and/or psycho-affective functions.

Screening Tools: They're So Quick! What's the Issue?

Screening tools are needed in occupational therapy practice to determine which clients require formal evaluation. Because screening tools also tell us who does not require formal evaluation, they are key to improved clinical efficiency. Screening tools are brief, easy to administer, and often freely available. These qualities also lead to misuse of screening tools, including using them to measure progress over time or to serve as a confirmatory assessment on which to base treatment planning. We present additional common missteps of screening tool use, including a lack of consideration for a tool's psychometric properties, and exemplars of these common misuses in adult and pediatric practice. Finally, we offer solutions to address these concerns.

No evidence of a minimal clinically important difference for the Beery-Buktenica Developmental Test of Visual-Motor Integration in children with autism spectrum disorder

The Beery Visual-Motor Integration (VMI) battery of tests are some of the most commonly used assessments in pediatric occupational therapy, often used to measure change over time. However, the minimal clinically important difference (MCID) has not been estimated for interpreting change scores. We estimated the MCID for the Beery VMI battery of tests in children with autism spectrum disorder (ASD). Four occupational therapists collected data in a public elementary school on 64 children with ASD. The Beery VMI battery was administered to children with ASD twice, approximately 11 months apart. To estimate MCID values, Beery VMI battery scores were anchored to 15-point Likert questions measuring occupational therapists’ ratings of functional change over three domains: fine motor skills, handwriting, and activities of daily living (ADLs). Using this anchor-based method, we were unable to estimate MCID values for the Beery VMI battery. Children’s Beery VMI battery scores did not change significantly over the course of the school year, and there was only one weak correlation between VMI battery change scores and therapists’ ratings of change. The inability to estimate Beery VMI battery MCID values for children with ASD adds further support for research cautioning the use of the Beery VMI as an outcome measure.

Association Between Preschoolers' Specific Fine (But Not Gross) Motor Skills and Later Academic Competencies: Educational Implications

Motor development is an inseparable component of cognitive development. So, to develop the mind, it is necessary to work the body. Therefore, Early Childhood Education curricula and the scientific literature emphasize the need to promote the development of motor skills during the 1st years of life. These skills are necessary for learning and subsequent academic performance. However, studies frequently offer only a partial view of these relationships. Few works have analyzed the specific relationships between different components of preschool gross and fine motor skills and subsequent performance on different academic competencies. Further, they present discrepant results. The aim of this study was to determinate which specific components of gross and fine motor skills assessed in Spanish students during the final year of Early Childhood Education (5 to 6-year-olds) were associated with different academic competencies assessed in the following academic year, when the students were in their 1st year of Primary Education. The final sample consisted of 38 Spanish students, aged 5. A mixed methods approach was used. It consisted of systematic observation to assess specific components of gross and fine motor skills when children were in the Early Childhood Education period, and selective methodology to evaluate their academic competencies (specifically in literacy and mathematics and overall), 1 year later, once in Primary Education. Multiple linear regression models were constructed using the computing language R to examine the association between motor skills and academic competencies. The results indicated that only the components of fine motor skills showed associations with academic competencies. The pattern of association varied when literacy and mathematics competencies were specifically and individually assessed and when overall academic competency was considered. The two assessed fine motor skills (Coordination and Integration) were associated with literacy competency (β = 0.344, p = 0.025; β = 0.349, p = 0.024, respectively) and overall academic competency (β = 0.267, p = 0.065; β = 0.493, p = 0.001, respectively). However, only Integration was associated with mathematics competency (β = 0.476, p = 0.002). The "Discussion" section focuses on the educational implications of these results and future research. It highlights the importance of early assessment of fine motor skills to identify students likely to present inadequate subsequent academic performance and the need to apply instruction and interventions tailored to the specific needs of each child.

Systematic Review and Meta-Analyses: Motor Skill Interventions to Improve Fine Motor Development in Children Aged Birth to 6 Years

OBJECTIVE

The objective of this study was to systematically review the evidence of motor skill intervention programs on typically developing children's fine motor development aged birth to 6 years.

METHODS

Six electronic databases were searched with no date restrictions. Inclusion criteria were any school-, community-, or home-based intervention targeting the development of fine motor skills of children aged birth to 6 years; randomized controlled trials using quasiexperimental, experimental, or single group prepost designs with a minimum sample size of 15 participants per group; and statistical analyses of fine motor skill development at both preintervention and postintervention or addressing the intervention effects on fine motor skill development. Data were extracted on design, participants, intervention components, methodological quality, and efficacy.

RESULTS

Twenty-five of the total 31 studies reported positive intervention effects on fine motor skills. The meta-analyses included 19 studies and revealed moderate effect sizes of motor skill programs on fine motor, visual motor, and manual dexterity outcomes. There were substantial differences between intervention settings, facilitators, length, and content with most studies implemented in school settings and facilitated by teachers.

CONCLUSION

Fine motor skill development in the early years is an extensive upcoming field of interest for many international researchers. This review study presents evidence on the positive effects of intervention programs that aim to enhance fine motor skills for young children. The findings are promising but need to be interpreted with caution because of the high risk of bias in many of the studies.

Visual-Motor Integration in Children With Mild Intellectual Disability: A Meta-Analysis

Visual-motor integration (VMI) skills, defined as the coordination of fine motor and visual perceptual abilities, are a very good indicator of a child's overall level of functioning. Research has clearly established that children with intellectual disability (ID) have deficits in VMI skills. This article presents a meta-analytic review of 10 research studies involving 652 children with mild ID for which a VMI skills assessment was also available. We measured the standardized mean difference (Hedges' g) between scores on VMI tests of these children with mild ID and either typically developing children's VMI test scores in these studies or normative mean values on VMI tests used by the studies. While mild ID is defined in part by intelligence scores that are two to three standard deviations below those of typically developing children, the standardized mean difference of VMI differences between typically developing children and children with mild ID in this meta-analysis was 1.75 (95% CI [1.11, 2.38]). Thus, the intellectual and adaptive skill deficits of children with mild ID may be greater (perhaps especially due to their abstract and conceptual reasoning deficits) than their relative VMI deficits. We discuss the possible meaning of this relative VMI strength among children with mild ID and suggest that their stronger VMI skills may be a target for intensive academic interventions as a means of attenuating problems in adaptive functioning.

The Computerized Perceptual Motor Skills Assessment: A new visual perceptual motor skills evaluation tool for children in early elementary grades

Visual perceptual motor skills have been proposed as underlying courses of handwriting difficulties. However, there is no evaluation tool currently available to assess these skills comprehensively and to serve as a sensitive measure. The purpose of this study was to validate the Computerized Perceptual Motor Skills Assessment (CPMSA), a newly developed evaluation tool for children in early elementary grades. Its test-retest reliability, concurrent validity, discriminant validity, and responsiveness were examined in 43 typically developing children and 26 children with handwriting difficulty. The CPMSA demonstrated excellent reliability across all subtests with intra-class correlation coefficients (ICCs)≥0.80. Significant moderate correlations between the domains of the CPMSA and corresponding gold standards including Beery VMI, the TVPS-3, and the eye-hand coordination subtest of the DTVP-2 demonstrated good concurrent validity. In addition, the CPMSA showed evidence of discriminant validity in samples of children with and without handwriting difficulty. This article provides evidence in support of the CPMSA. The CPMSA is a reliable, valid, and promising measure of visual perceptual motor skills for children in early elementary grades. Directions for future study and improvements to the assessment are discussed.