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Clinician Packet
Clinician Reference

Visual Motor Integration Clinician Packet

A practical clinical reference for pediatric OTs addressing visual motor integration — covering the developmental progression, assessment considerations, sample goals, grading strategies, caregiver coaching, and documentation language.

What's inside
VMI developmental progression across four levels
Sample goal bank — short-term & long-term for all 4 levels
Grading & activity modification strategies
Caregiver coaching prompts & teach-back cues
Documentation language & progress note phrases
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Visual Motor Integration · Clinician Packet
Developmental Progression

The Four Levels at a Glance

Emerging

Understands basic maze logic. Matches simple shapes. Follows wide paths. Copies 2-colour AB patterns. Typically ages 3–4.

Developing

Navigates tighter corridors. Follows 8–10 dot sequences. Copies 3-colour ABC patterns. Notices subtle differences. Typically ages 4–5.

Consistent

Stays within narrow corridors accurately. Copies multi-line designs. Extends patterns. Self-monitors errors. Typically ages 5–6.

Advanced

Handles complex multi-step designs. Plans before acting. Manages spatial rotation and mirror tasks. Self-corrects independently. Typically ages 6–7+.

Clinical note: VMI is distinct from visual perception and fine motor skill alone — it requires the integration of both. A child may have intact visual perception (can identify shapes) but poor VMI (cannot copy them accurately). Always assess the components separately before attributing difficulty to any one area.
Prerequisite Skills

What to Assess First

Visual perceptual skills

  • Figure-ground discrimination
  • Visual closure (completing incomplete shapes)
  • Form constancy (recognising shapes in different sizes/orientations)
  • Visual sequential memory (recalling a sequence of shapes)
  • Spatial relations (understanding position in space)

Fine motor foundation

  • Functional pencil grasp (any consistent grip)
  • Wrist stability during drawing
  • Adequate hand strength for sustained grip
  • Smooth, controlled pencil strokes
  • Eye-hand coordination during mark-making
Goal Bank

Sample Short-Term & Long-Term Goals

Emerging — Level 1
STG 1
Child will complete a wide-corridor maze (corridor ≥1 inch) from start to finish with no more than 2 wall contacts, in 3 of 4 trials.
STG 2
Child will match identical shapes from a field of 4 (same shape and colour) with no more than 1 error per row, in 3 of 4 trials.
LTG
Child will copy a 4-item AB pattern (2 colours, 1 shape type) from a model with correct colour and sequence, in 4 of 5 opportunities with no more than 1 verbal cue.
Developing — Level 2
STG 1
Child will complete a tighter-corridor maze (corridor ½ inch) from start to finish with no more than 3 wall contacts, in 3 of 4 trials.
STG 2
Child will connect a 10-dot sequence in correct numerical order with no more than 1 error or skip, in 3 of 4 trials.
LTG
Child will copy a 4-item ABC pattern (3 colours, 2 shape types) from a model with correct colour, shape, and sequence, in 4 of 5 opportunities with no cues.
Consistent — Level 3
STG 1
Child will copy a 3-line geometric design from a nearby model with recognisable proportions and orientation, in 3 of 4 trials.
STG 2
Child will correctly identify and draw the next item in a 4-element repeating pattern with no more than 1 cue, in 3 of 4 trials.
LTG
Child will complete a narrow-corridor maze (corridor ¼ inch) and copy a 3-line design from a model in the same session, with no more than 1 verbal cue total, in 4 of 5 opportunities.
Advanced — Level 4
STG 1
Child will scan a complex visual task before beginning and identify at least 1 planning decision (e.g. which direction to go first), in 3 of 4 trials.
STG 2
Child will copy a 5+ element design from a model with proportional accuracy and self-correct at least 1 error without prompting, in 3 of 4 trials.
LTG
Child will independently complete complex VMI tasks (multi-turn mazes, multi-element design copying, pattern extension) with no more than 1 setup cue, demonstrating self-monitoring throughout, in 4 of 5 opportunities.
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Visual Motor Integration · Clinician Packet
Grading & Modification

How to Grade Up or Down

Variable Grade Down (easier) Grade Up (harder)
Maze corridor width Wide corridors (1 inch+) — lots of room for error Narrow corridors (¼ inch) — demands high precision
Dot-to-dot sequence 5–6 dots, simple shape — short sequence, easy to track 15+ dots, complex shape — long sequence, high working memory demand
Pattern complexity AB pattern (2 items) — minimal memory load ABCDE pattern (5 items) + extension question — maximum load
Model distance Model directly beside the copy space — look and reproduce immediately Model on a whiteboard across the room — requires visual memory
Design complexity 1–2 line design — single visual element to reproduce 5+ element multi-component scene — spatial planning required
Self-monitoring demand Therapist checks accuracy after each step Child checks own work against model independently throughout
Time pressure No time limit — child sets their own pace Timed task — adds processing speed and efficiency demand
Cognitive load One task at a time — maze OR copying, not both Combined task — maze then copy the shape from memory
Caregiver Coaching

What to Teach Families

The three things that matter most

  • Look before you draw — scan the whole task first
  • Eyes lead, hand follows — visual attention should be just ahead of the pencil
  • Check your work — compare to the model after completing each step

Teach-back cues to share with parents

  • "Look at the whole maze before you start drawing"
  • "Eyes find the path first, then pencil follows"
  • "Count the dots before you connect them"
  • "Look at the model, then look at yours — do they match?"
  • "Slow down when it gets tricky — rushing makes more mistakes"

Home practice tips

  • Mazes in activity books work just as well as worksheets
  • Pattern blocks and bead sequencing build the same skill off-paper
  • Dot-to-dot colouring books are great for motivated children
  • 5–10 minutes daily is more effective than one long weekly session
  • Let them check their own work — build the habit early

Red flags to watch for

  • Cannot complete a simple maze by age 4½
  • Significant gap between visual perception scores and VMI scores on standardised assessment
  • Avoidance of all drawing, copying, or connecting tasks
  • No improvement across 6–8 sessions at the same level
  • Difficulty generalising to real-world tasks (art, handwriting, puzzles)
Documentation Language

Sample Phrases for Progress Notes & Reports

Describing current performance

"Child demonstrates emerging visual motor integration skills, completing wide-corridor mazes with frequent wall contact and copying simple AB patterns with inconsistent colour accuracy."

Documenting a session

"Addressed VMI using structured maze and pattern copying activities. Child completed maze with 2 wall contacts (improved from 5 last session) and copied a 4-item ABC pattern with 1 colour error and no sequence errors."

Noting progress toward goal

"Making progress toward STG: child now completes a wide-corridor maze independently with no more than 2 wall contacts in 3 of 4 trials, compared to requiring hand-over-hand guidance at baseline."

Justifying continued services

"VMI skills remain below age expectation and impact participation in classroom handwriting, art, and visual tasks. Skilled OT is required to address the integration of visual perception and fine motor execution."

Caregiver education note

"Caregiver educated on home VMI practice strategies including maze books, pattern blocks, and dot-to-dot activities. Caregiver demonstrated 'look before you draw' and 'check your work' cues and identified 2 home activities to try this week."

Discharge or transition language

"Child has met VMI goals at the Consistent level, copying multi-line designs with recognisable accuracy and completing narrow-corridor mazes with minimal wall contact. Home program provided; family to monitor for generalisation to classroom visual tasks."
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