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Visual Motor Integration

Multi Matrix Vision Game  Above: one of our patients playing a game called Multi-Matrix. It trains eye-tracking, eye-hand coordination and visual motor integration. 

Summer is half way over, is your child ready for school in September? One of the fundamental skills for a child's development is called Visual Motor Integration.

Visual Motor Integration describes:

·         the ability to interpret visual information

·         the ability to direct coordinated movements

·         how one synergizes these two processes

In young children, visual motor integration is required in order to use a spoon or fork to feed independently, to throw and catch a ball, or to ride a bike. For older children, proper visual motor integration development is crucial for hand writing legibility, playing musical instruments and sports. It also correlates to reading and math ability. This is because in order to learn to read, the child must first learn how to decipher and organize visual information. For example, to differentiate between letters ‘b’ and ‘d’ and sight words such as ‘horse’ and ‘house.’ With regards to math, the child need to be able to spatially organize calculations, differentiate similar shapes such as diamond and square, and make accurate charts and graphs. 

VMISentence Copy

Figures above were produced by one of our 9 year old patient who was diagnosed with a deficit in visual motor integration. The first half of the page is pre-vision therapy, and second half is post-vision therapy.

The development of visual motor integration is a learned process, starting in infancy. Here is a table of visual motor milestones. Children who do not have good visually-guided motor skills will benefit from both vision therapy (visual perceptual assessment) and occupational therapy.




1 y 1m

Imitates adult by scribbling with crayon

1y 3m

Marks independently on paper with crayon

1y 4m

Scribbles spontaneously and freely with crayon

1y 9m

Scribbles without going off paper


Imitates drawing a vertical line

2y 1m

Uses paints and brush

2y 6m

Imitates drawing a horizontal line

2y 9m

Imitates drawing circular lines

2y 10m

Copies a vertical line


Copies a circle

3y 6m

Imitates drawing an oblique cross

3y 9m

Traces and stays on (most of the time) a 3”, pencil-thick, horizontal line


Draws a person with 3 different body parts

4y 1m

Copies a vertical-horizontal cross

4y 6m

Copies a square

4y 10m

Draws some simple, recognizable objects

4y 11m

Copies an X


Draws a face with mouth, nose, and eyes; copies first name although letters may be awkward, or reversed

5y 3m

Copies a triangle

5y 4m

Draws a person with 6 or more different parts

5y 6m

Copies an open square and circle together

5y 11m

 Draws a smooth line within an angled and curved path approximately ¼”wide

6y 1m

Prints all numerals 0-9 and all letters without copying



1. Daly CJ, Kelley GT, Krauss A. Relationship Between Visual-Motor Integration and Handwriting Skills of Children in Kindergarten: A Modified Replication Study. American Journal of Occupational Therapy. 2003; 57:459-462.

2. Kulp MT. Relationship between Visual Motor Integration Skill and Academic Performance in Kindergarten through Third Grade. Optometry and Vision Science. 1999; 76:159-163.

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