Beth Pfeiffer, Beverly Moskowitz, Andrew Paoletti, Eugene Brusilovskiy, Sheryl Eckberg Zylstra, Tammy Murray; Developmental Test of Visual–Motor Integration (VMI): An Effective Outcome Measure for Handwriting Interventions for Kindergarten, First-Grade, and Second-Grade Students?. Am J Occup Ther 2015;69(4):6904350010. https://doi.org/10.5014/ajot.2015.015826
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© 2021 American Occupational Therapy Association
We determined whether a widely used assessment of visual–motor skills, the Beery–Buktenica Developmental Test of Visual–Motor Integration (VMI), is appropriate for use as an outcome measure for handwriting interventions. A two-group pretest–posttest design was used with 207 kindergarten, first-grade, and second-grade students. Two well-established handwriting measures and the VMI were administered pre- and postintervention. The intervention group participated in the Size Matters Handwriting Program for 40 sessions, and the control group received standard instruction. Paired and independent-samples t tests were used to analyze group differences. The intervention group demonstrated significant improvements on the handwriting measures, with change scores having mostly large effect sizes. We found no significant difference in change scores on the VMI, t(202) = 1.19, p = .23. Results of this study suggest that the VMI may not detect changes in handwriting related to occupational therapy intervention.
visuomotor integration seems to be an important variable to a child’s handwriting skill, particularly when copying or transposing from printing material to cursive or manuscript writing. In copying, the child must visualize the letter form and shape, assign a meaning to the form, and then manipulate a writing tool to reproduce the same letter. (p. 734)
The results of this study add to the current research suggesting that the VMI may not be an effective outcome measure for handwriting interventions (Howe et al., 2013; McGarrigle & Nelson, 2006).
If the VMI had been the only posttest measure used in this study to examine the outcomes of the intervention, the results would have suggested that the children did not demonstrate progress, although handwriting measures including the THS–R and MHA demonstrated significant handwriting improvements.
It is important to ensure that measurement tools are appropriate for, and sensitive to, the construct being measured, which in turn must be the construct that the intervention is addressing.
Although visual–motor integration is consistently correlated with handwriting, the VMI was never intended to assess handwriting ability, nor was it designed to screen specifically for handwriting dysfunction (Chang & Yu, 2009; Goyen & Duff, 2005).
The literature has consistently supported some level of correlation between VMI scores and handwriting, lending some support to the continued use of the VMI as a tool to measure the component skills of visual–motor integration and to help determine which children could benefit from further assessment and treatment. However, because correlations in this review were small to moderate, additional forms of assessment are suggested, including handwriting, fine motor, and environmental assessments, as well as clinical observations, when making determinations regarding treatment and progress.
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