Published on in Trisomy 21 Update
When you come in contact with an occupational therapist, you most likely will hear the term “visual motor integration.” What does this mean, and how does it translate into developmental milestones for your child?
Visual motor integration is the matching of a motor skill with a visual skill. When babies are born, one of the first things they develop is an ability to track toys or faces with their eyes, both horizontally and vertically. The first step in visual motor integration is when babies are able to swipe at items they see. Babies see an item that is dangling and, with minimal coordination and control, they will then swipe at the item. As babies develop, this becomes more refined, into the reaching and grasping of items throughout their environment. As children grow and develop, so do their visual motor integrative skills so they can catch a ball, draw letters and read books.
Like all elements of development, there are building blocks to visual motor integration. This is why it is so important to facilitate these skills early within infant development, to establish the building blocks and precursors for later skills such as reading, writing and playing sports.
When a baby is first developing, it is easy to just focus on the motor components of development, such as rolling, sitting, crawling and walking. However there are significant developments in vision that also take place within the first years that are important for further growth and development of skills.
Three components of vision
There are three key components of vision. Your child has her vision acuity tested at school or the doctor’s office. Acuity is the ability to see near and far, and if your child has difficulty, glasses may be prescribed. Acuity is a very important component of vision. However, there are two additional important components of vision not as readily understood.
It is important to also help your child develop visual efficiency, which is the effectiveness of the visual system to clearly, efficiently and comfortably allow an individual to gather visual information. This is done by accommodation (used for focusing on information), binocular vision (two eyes working together) and eye movements (can your child’s eyes move in all directions?).
The third component of vision to be aware of is information processing skills, a group of visual cognitive skills used for extracting and organizing visual information from the environment. Three types of visual information processing skills include:
- Visual spatial skills (such as how to navigate through an environment without looking “clumsy”)
- Visual analysis skills (understanding foreground vs. background and understanding where items are placed within the environment)
- Visual motor integration skills (matching motor component with visual component, such as catching a ball moving through the air)
Early skills to practice
All the components of vision are important to work on from the very early stages of development. One of the primary ways is combining vision and motor skills to assist your child with the ability to reach across his or her body to retrieve an item. When babies first begin to reach, all they are able to do is swipe at a toy. As they become stronger, babies begin to be able to grasp. From this point on, begin to challenge children to grasp items in all different areas with both hands; this will not only strengthen their bodies, but also strengthen their visual motor integrative skills.
Especially for children with Down syndrome — who tend to have difficulty reaching across their body and with trunk rotation because of hypotonia or floppiness and decreased strength — it’s important to begin working on these skills at an early age. Start when they are still lying on their backs, moving items so that they need to reach across their bodies to touch or grasp them. Continue when they can sit, with or without support. As they reach across, they begin to rotate their trunk. Reaching in all directions, especially across their body, also encourages rolling and transitioning into different positions as they gain the strength to do so.
Many children with Down syndrome tend to find other ways to complete developmental movements and tend to be very linear in their movements due to poor core strength. It is imperative to encourage hands to midline and midline crossing early in development to avoid the downfalls of linear movement, compensatory movements and avoidance of trunk rotation.
Next step skills
When your child is first learning to move, try encouraging him to pull off his socks while he is positioned on the floor, directing him to reach for each foot with the opposite hand. Place the sock half off to increase success. Another activity to facilitate midline crossing is to have him straddle your leg and reach across his body to retrieve objects.
When your child gets a little older and is more comfortable with upright sitting, encouraging reaching across her body while seated in a chair during mealtime is a repetitive task that can facilitate improved midline crossing. Sitting on a therapy ball and catching bubbles or reaching for engaging toys is also a great way to facilitate midline crossing and trunk rotation.
As your child continues to grow and develop, you can add games with a speed component. Velcro ball toss or other ball games are all good activities to promote midline crossing and visual motor integration. iPad games that require quick visual shifts and touch screen activation are also good tasks to engage your child. Drawing and writing — encouraging full letter formation or even just designs in a diagonal manner — going from top left to bottom right and vice versa can also encourage visual motor integrative skills.
Encourage your child by making him work for things. This will motivate him and encourage problem solving and development. Have fun!