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BACKGROUND: Visual-motor integration (VMI) test was introduced into China in the 1970s and 1990s and widely used for evaluation and identification of problems in intellectual development and learning ability in children due to its good applicability without limitations by language and cultural background.OBJECTIVE: To assess the value of developmental test of VMI in children with hearing handicap, and evaluate its practical feasibility in largescale screening of intelligence problems in these children by comparing its reliability and validity with the norms of children in Shaanxi Province and the USA.DESIGN: A controlled correlation and multiple stepwise regression analysis with randomized cluster sampling.SETTING: Neurological Department of the First Hospital Affiliated to Medical College of Xi' an Jiaotong University.PARTICIPANTS: From January 1998 to December 2000, 638 children under 18 years of age with hearing handicaps were chosen from 6 schools of deaf-mutes in Xi'an City, Xianyang City, Chang'an County, Huxian County,and Lintong County in Shaanxi Province. Another 43 children with hearing handicap including 23 male and 20 female children aged (11.62±1.98) years were selected randomly for EEG and brain electrical activity mapping (BEAM) examination, who had a mean development quotient of VMI of 86.60±15.68. The children were divided by the development quotient into two groups, namely those with development quotient ＜ 86.6 (n=20) and those with development quotient ≥ 86.6 (n=23). METHODS: ① The VMI test was performed in accordance with the Fourth edition of VMI Manual by Beery K.E. The test was terminated when the testee failed to correctly copy three consecutive geometrical figures without time limit. The scale score varied from 0 to 27. ② The reliability test included split-half reliability test in which the items were split into two parts according to odd-even number, re-test reliability that tested the same group of children again in two months and inter-examiner reliability in which two examiners were asked to grade the same test paper.③ The validity test included structural and correlation validity test. Three well-revised and already established norms of scales in China, including Hiskey- Nebraska test of learning aptitude (H-NTLA), performance scale of Wechsler intelligent scale for children (PS-WISC) and Combined Raven's test (CRT), have been chosen as the structure validity criteria. The performance IQ of PS-WISC, learning quotient of H-NTLA, percentile rank of CRT and standard score of VMI were taken respectively for each test in this study.Academic achievements and teachers' and parent's rating were used as the validity correlation criteria. During the administration procedure, a card describing the requirements in detail were presented to the deaf children with reading capacity, while for those too young to read, the teacher was asked to help translate the requirements using standard sign language, but no any hints or clues in relation with the test contents were given. ④ The test did not start until the subjects fully understood the requirement (7314/F/W DYD-300A).EEG recording was performed with the leads deposited according to the international standard 10/20 lead system. Routine EEG had been recorded at least 30 minutes for visual assessment, and stable and representative waves for 120 seconds free of biases or inferences were recorded using unipolar lead from the subjects at rest with the eyes closed and stored in computer.Experienced EEG experts were asked to select the most representative waves of 20 seconds in a double-blind manner to compute the absolute power spectrum of the brain wave.MAIN OUTCOME MEASURES: Reliability and validity of VMI test,relationship between VMI ability and cerebral electrophysiological changes.RESULTS: Totally 638 children under 18 years old with hearing handicap were involved, of whom 72 were eliminated because of lack of data, congenital disease or central nervous system diseases. Finally 566 cases were available for analysis, including 346 male and 220 female children with an average age of (12±3) years. ① The reliability of VMI reached an average of 0.92, varying from 0.63 to 0.99 in each group. The equivalent age corresponding to the scores of the VMI test norm established for the 566 healthy deaf children was lower by an average of (1.79±0.9) years than the equivalent age in the norms of the normal children in Shaanxi Province delayed and USA. ② The standard score of VMI test showed the highest correlation coefficient of 0.661 0 with the learning quotient of H-NTLA, while the correlation with PS-WISC and CRT were 0.357 6 and 0.517 4, respectively.③ Children with higher VMI score showed more powerful absolute spectrum among frequency rangesδ,θ,αl and total power spectrum in the central, parietal and occipital regions of the left hemisphere, respectively.CONCLUSION: VMI test can efficiently reflect the development status of visual-motor integration or intelligence of the school-age deaf children and represent the level of central EEG activity.
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Objective To provide an effective instrument assessed the ability of children's visual-motor integration in China.Methods 1*!798 children aged 3 to 18 years old were randomly sampled from Xi'an city and were tested with VMI-4R test.The reliability and validity were then analyzed.Results The norms of aged-equivalent,percentile,and standard scores were established.Split-half reliability,coefficient KR20,test-rerest reliability,and interscorer reliability ranged from 0.90 to 0.96(P＜0.01).There are moderately-highly correlation between VMI-4R with WISC-R,WPPSI-R,CRT,FQS,Drawing-A-Man test respectively.Conclusion VMI-4R has good reliability and stable construction.It can effectively reflect the level of visual-motor integration.It is worth while to use widely as instrument for intelligence screenging and development assessing.