Visual-Motor Integration (VMI) Is Also Relevant for Computer, Smartphone, and Tablet Use by Adults: Introducing the Brief Box Clicking Test.

Abstract

Importance: Visual-motor integration (VMI) is typically examined in children to promote handwriting, but it may also be relevant for adults' capacity for technology use.

Objective: To examine the reliability and validity of speed of completion of the box clicking test, a web-based test of VMI.

Design: Participants in the Understanding America Study completed online surveys on a regular basis, including a very brief (less than 30 s) self-administered box clicking test. For validity testing, we examined whether box clicking speed was associated with constructs relevant to visual-perceptual skills and motor coordination, the skills underlying VMI. Test-retest reliability was examined by computation of intraclass correlation coefficients.

Participants: A total of 11,114 adults.

Measures: Measures included the completion time for the box clicking task and measures relevant to visual perception (e.g., perceptual speed) and motor coordination (e.g., self-reported functional limitation).

Results: Results suggested that the box clicking test was a VMI task. Slower test performance was associated with lower visual-perceptual speed and a greater likelihood of reporting difficulties with dressing, a motor coordination relevant task. Box clicking tests taken within at least 2 yr of one another had moderate test-retest stability, but future studies are needed to examine test-retest reliabilities over brief (e.g., 2-wk) time intervals.

Conclusions and relevance: The box clicking test may serve both as a tool for research and to clinically observe whether clients have VMI difficulties that interfere with computer, smartphone, or tablet use. Plain-Language Summary: Use of devices such as smartphones and computers is increasingly becoming integral for daily functioning. Visual-motor integration (VMI) has often been addressed by occupational therapists to support handwriting of children, but it may also be important for technology use by adults. Prior literature supports the relevance of VMI to technology use, and adults with various chronic conditions have been found to have decrements in VMI. We tested the psychometric properties of a brief box clicking test of VMI that could be used to examine VMI underlying technology use among adults. Overall, results suggested that the box clicking test was a VMI task. Just as speed of gait has been used as an index of functional mobility, speed on the box clicking task seemed serviceable as an index of VMI ability. The box clicking test may also be used for clinical observation of whether VMI interferes with technology use.