Visual Motor Integration

These instructions are for Children's Hospital of Philadelphia (CHOP) patients to strengthen their visual motor skills.

Important information:

• Visual motor integration is the ability of the eyes and hands to work together in smooth, efficient patterns.

• Visual motor skills are important because they allow us to perform daily activities such as putting on a shirt, fastening buttons, and tying our shoes. Visual motor skills also allow us to hit a baseball with a bat, write, and draw pictures.

• Visual motor skills start to develop in early infancy and continue to advance through high school and beyond. The activities we engage in, and how often we practice them, can have a direct impact on how strong our visual motor skills become.

• Children who have challenges with visual motor skills may have difficulty learning in a classroom, which can often lead to frustration and avoidance of schoolwork. They may have a hard time with:

  • Organizing school materials and class assignments

  • Understanding math concepts

  • Reading

  • Writing (forming letters properly and with appropriate size, using consistent spaces between letters and between words, or writing on a line)

• The good news is that visual motor skills can be improved with practice.

Patient instructions:

Strengthen muscles

Having a strong body, especially arms and hands, helps to improve the ability to write, draw, eat with a spoon and fork, and more. Here are some ideas to build strength:

• Walk like a bear, crab or frog.

• Wheelbarrow walk: support your child at their hips, knees or ankles to adjust the difficulty.

• Swimming

• Lay on stomach for coloring, playing a board game and reading.

• Strengthen hands by coloring, Play-Doh activities, and building with Lego sets.

• Draw or color on a vertical surface such as an easel or paper taped to a wall.

Strengthen visual perceptual skills

• Seek-and-find books

• "Find the differences" pictures

• Word searches

• I spy games

• Color-by-number coloring books

• Connect-the-dots worksheets

• Simple or complex mazes

Practice hand-eye coordination skills

• Targeting: throw and catch a ball or dribble. Use a small ball for older children and a larger ball for smaller children.

• Drawing: younger children can practice making shapes. Older children can copy a design.

• Tracing: put a piece of tracing, tissue or parchment paper over a line drawing and trace the lines.

• Dot-to-dot worksheets

• Mazes (practice keeping the pencil on the "road" and not hitting the walls)

Activities to promote visual motor integration skill development

Infants and toddlers: 6 months to 3 years

• Container play: provide baskets, bowls, containers, and objects of various sizes to encourage taking objects out of containers and putting objects into containers.

• Shape sorters: range from a simple circle, square or triangle for younger children to more complex shapes for older children.

• Simple puzzles with large chunky pieces and simple shapes.

• Practice using a spoon and a fork by encouraging your child to hold them l and practice bringing them to their mouth, bang them on a tray, or dip them in food. Start at 7-9 months or when your child is reaching out for a spoon.

• Stacking toys like ring stackers, stacking cups and nesting blocks.

Preschool: 3 to 5 years

• Pegboards: place pegs and create shapes.

• Duplo bricks: stack and be creative.

• String beads on a shoelace. Start with large beads and a thick lace. Advance to smaller beads and a thinner lace. Older children can copy a pattern such as red, blue, red, blue.

• Color with markers and crayons. Start by having your child copy a vertical line, horizontal line, circle and cross. Then advance to diagonal lines to form an X, a square and a triangle. These foundational pre-writing forms should be mastered by the age of 5 so that your child can learn how to write letters.

• Build designs with blocks. Make a game of "can you make your tower look like mine?"

• Practice cutting. Start by snipping along the edge of a paper. Then practice snipping forward to cut paper in half. Advance to cutting straight lines and then curved lines. Use thick lines to make it easier and thin lines make it harder.

• Play-Doh activities for hand strength and bilateral coordination.

• Simple jig saw puzzles with 4-12 pieces.

School Age: 5 to 12 years

• Draw letters. Encourage your child to start from the top of the letter instead of the bottom.

• Mazes, beginning with simple mazes and moving to complex. Encourage controlling the pencil so that it stays in between the lines and does not hit the "walls."

• Spot the difference or seek-and-find pictures

• Dot-to-dot worksheets

• Color-by-number worksheets

• Tracing activities

• Cutting, begin with circles and squares and move on to more complex shapes like stars.

• Play games like Connect 4, Battleship, Pictureka, Spot It, Q-bitz, Memory, Perfection, Make-n- Break.

• Jigsaw puzzles

• Design copying or learn-to-draw activity pages with step-by-step instructions

• Word searches

• Letter cancellation activities. (Find all the A's and cross them out, find all the B's and circle them, find all the C's and put a box around them.)

• Play checkers or chess.

• Origami or paper airplane folding

• Make bracelets with embroidery thread, plastic string or rubber bands, such as Rainbow loom.

Adolescents: 12 years and up

• Word searches

• Sudoku puzzles

• Following drawing tutorials (written or on YouTube)

• Adult coloring pages

• Play checkers or chess

• Make bracelets with embroidery thread or Rainbow Loom bands

• Knit or crochet

• Advanced jigsaw puzzles

Additional resources:

• www.eyecanlearn.com (Online activities for visual skill development including practicing eye tracking, visual perceptual skills and others)

• Your therapy source (Search under visual motor activities for articles related to visual motor integration)

• The OT tool box, visual motor integration

• Therapy street for kids, hand eye coordination

• OT mom, visual motor integration

Reviewed on January 23, 2023, by Jennifer Strebel, OTR/L