Assessment

Robyn S. Hess, Rik Carl D'Amato, in Comprehensive Clinical Psychology, 1998

4.09.4.3

Sensory-motor Integration

An additional component of our motoric functioning is the ability to integrate what is received by
the senses with what is produced through action. For example, an individual may be able to perceive
letters correctly and have adequate fine motor control, but still have difficulty correctly copying
material presented in visual form. Numerous paper-and-pencil tests have been developed to assess
motor function as it relates to visual-motor integration. Two of the most popular measures for this
purpose are the Bender Visual-Motor Gestalt (Bender, 1938) and the Developmental Test of Visual-
Motor Integration (VMI; Beery, 1989).

The Visual-Motor Gestalt Test (Bender, 1938) is an individually administered test containing nine
geometric figures which the client copies on to a blank sheet of paper. While historically this test
was seen as a general measure of organicity, it is more appropriately used as a measure of visual-
motor skills. Standard scores are provided in the developmental scoring system for children ages 5–0
to 11ndash;11, although it is frequently used with adults as well. Most commonly known as the
“Bender,” this measure is perhaps the best known and most widely used visual-motor assessment
procedure available today (Bender, 1938; Reynolds & Kamphaus, 1990). As a component of a
comprehensive assessment battery, performance on the Bender has long been thought to reveal
visual-motor difficulties that may be associated with cerebral impairment (Sattler, 1992).
Traditionally used to assess an individual's constructional praxic skills, the Bender provides an
evaluation of motor integration employed in the execution of complex learned movements (Hartlage
& Golden, 1990). The information generated through this process may then be compared with levels
of performance across other measures of functioning.

Alternate uses of the Bender include its administration as a memory test as well as a copying test.
This dual administration process can be employed to assess different mental functions (short-term
visual memory and visual perception) which utilize the same modalities in perception and task
execution (Sattler, 1992). An additional technique available when interpreting the Bender
performance is to have individuals compare the figure which they produced with the corresponding
stimulus design. If the client is unable to recognize obvious differences between the two designs, a
perceptual deficit may be involved. Likewise, if the client is able to detect a difference between the
two figures, but is unable to make them alike, motor involvement may be influencing performance
(Hartlage & Golden, 1990). In the personality area, performance on the Bender may also be used to
develop hypotheses regarding impaired performance due to poor planning, impulsivity, or
compulsivity. Extremely large or small figures, heavily reinforced lines, and second attempts are
examples of the item reproduction difficulties which are thought to indicate emotional concerns on
the part of the individual.

The VMI is an individual or group administered test that involves copying a sequence of 24,
increasingly complex, geometric figures. The test requires a relatively short administration time and
is designed primarily for ages 4 to 13. The VMI offers several advantages as a tool for assessment
and is widely used in psychological evaluation and research. The most common use of the VMI, now
in its third edition, seems to be in assisting with the diagnosis of children who are suspected of
having learning problems due to visual-motor difficulties. The VMI is also frequently employed when
investigating the reliability and validity of other tests of visual-motor integration, such as the Bender,
self drawing tasks, progressive matrices, and neuropsychological tests (Goldstein, Smith, & Waldrep,
1986; Palisano & Dichter, 1989). Because the VMI does not require a verbal response, it has also
been used to assess visual-motor processes among non-English-speaking children (Brand, 1991; Frey
& Pinelli, 1991).

4.09.4.3.1 Motor: implications for intervention

Motor problems and sensory-motor integration difficulties can impair a client's ability to write or to
learn new skills requiring motor coordination, and generally can have a negative impact on daily
functioning. In the classroom setting, possible suggestions for accommodating these difficulties
might include modifying instructions to compensate for motor difficulties (e.g., allowing pointing to
the correct choice rather than writing, allowing students to tape record notes or copy them from
others). In a rehabilitation setting, the client may need to learn alternative methods for writing such
as using word processing programs on a computer or, if serious difficulties exist, using voice-
activated programs. Consultation with an occupational therapist or a physical therapist will be
extremely helpful in treatment planning when motor difficulties are evident.