Module To Improve Visuospatial Skills Among Individuals | MY FIT BRAIN

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module to improve visuospatial skills among individuals

Visuospatial ability can be understood as an individual’s ability to make identifications of visual and spatial relationships that exist among objects. Visuospatial ability comprises of one’s capacity to make accurate imaginations of objects, building holistic
shapes out of its small components and the ability to understand similarities and distinctions among objects. Visuospatial skills have a significant role to play in the day to day functioning and are crucial to effective living. In day to day life, we make ongoing analysis and identification of complex visual stimuli, without being aware of actually doing it.

From the simplest of tasks such as recognizing our toothbrush in the morning to complex tasks such as making estimates about if the car you are driving will pass through a particular lane; requires the use of visuospatial abilities. Therefore, despite this process being more or less automatic in nature, it serves very important adaptive functions and it is as important of a cognitive skill as the basic cognitive functions of memory and attention.

Visuospatial abilities are impaired in many of the neurodegenerative disorders such as Alzheimer’s, dementia, Parkinson’s; and schizophrenia to name a few. Impairment of this process leads to various deficits ranging from the failure to identify basic elements such as colors, lines, and orientation in various visual stimuli to more complex and comprehensive features such as identifying objects, familiar scenes or faces. The deficits can further take the more complex forms of visual neglect, Hemi-inattention or agnosia, and prosopagnosia. Such impairments may result from disconnection syndromes, wherein, the centers of basic visual sensory processing are disconnected from the association areas which are important for the
recognition of any sensory stimuli as being a specific object.

Block design test which is one of the core subtests of the Wechsler’s Adult Performance Intelligence Scale (WAPIS) is used to assess the visuospatial abilities in individuals. This test exposes the subject to different designs followed by which the subject
is required to replicate the designs. The time limit for designs 1-6 is 60 seconds and the time limit for designs 7-10 is 120 seconds. The test has ten different designs. The first design under the block design subtest of WAPIS is commenced after the
following instructions are given.

“Start with the first design for all the subjects”. (Take four blocks and say), “You have four, blocks some sides of which are fully red some are fully white and some are half red and half white. I am going to put them together to recreate a design given here. Watch me.” (Then arrange all the blocks into the pattern that is given in the manual. Leaving the model intact, give other four blocks to the subject and ask them to make one just like that). If the subject successfully completes the design within the time limit score 4 points proceed to design 2. However, if the subject fails to complete the task within the allotted time limit or arranges the blocks incorrectly, the blocks are picked up again and demonstrated a second time. The reversal of the design or inversion of the design is considered as an error. The subject is asked to make the design again. If, in the second trial of score of 2 points. The same procedure is followed for design 2 but not for 3 -10 where each reversal is scored as failures.

In design 2, the prior blocks from the first design are to be removed in order to create the second design. The subject is asked to observe for some time after which the blocks are mixed up and recreate the design once again. When the subject succeeds on the second trial, they are asked to proceed to design 3. In design 3, the subject is similarly asked to replicate the design made by the test administrator. They follow similar pattern to design 7. Thereafter, five blocks are taken out
to recreate the design, and instructions are given them to make the same design using 9 blocks. For design 10 the subject is not permitted to rotate the card to give the design a flat base. However, full credit is given if the design reproduced is rotated not more than 45 degrees.

The time taken by the subject to complete each design is recorded. If it is done correctly within the time limit then, bonuses are given for rapid performances in designs 7-10. The tasks are discontinued after three consecutive failed trials.
The scoring is done in the following manner: The designs 1-2 , the first trial 4 points each, second trial , 2 points each, designs 3-6 points each, design 7-10, 4 points each for the successful completion of each design. No credits are given for partially correct or incomplete design. The highest obtainable score is 48.

Interpretation is made based on the combined reports such as observation, scores obtained on the test and norms written in the manual. This test is used for understanding the visuospatial capabilities of the subject after which depending on the scorethe decision to give the retraining tasks will be made. Psychometric properties Reliability. The reliability of the tests was obtained by using Cronbach’s coefficient alpha

For digit symbol, test-retest reliability was used as it is a speed test and test conducted on the same participants once and then again 8 months later showed that the correlation between the two test scores was 0.94 for 15-19 group and 0.91 for 20-24 group. The reliability of block design ranged from 0.725 to 0.80 for all age groups. The reliability scores of this test are better than the scores obtained by Wechsler in his first edition. Validity.


To obtain validity three methods were employed in this study, a) Construct validity- the mean scores of people of different groups such as age, education, and economic status were analyzed. The mean total scores of each group were used and the difference between mean scores of these different groups was found to be significant at 0.01 level, b) Comparison of results with the original study- The results of the Indian adaptation were compared with Wechsler’s original test. This comparison revealed that the scores of reliabilities, correlation were similar. Norms. The scale can be used for people who are 16 years and above. It has been found to be appropriate for those above 74 years as well. The reliability coefficients are 0.93 for the
performance IQ average across all groups.

Visuospatial rehabilitation module (VHM)

The Visuospatial rehabilitation module is focussed on providing retraining for visuospatial perception and visuospatial construction. Visuospatial perception includes abilities that help one in orienting to the physical environment that one is staying in. It refers to the ability to interpret and process visual information about where objects are in space. It enables movements within one’s physical space, reach for objects as per one’s visual field, and to shift our gaze to different points of space. The brain regions involved in processing information about moving visual stimuli is the parieto-occipital region of the visual cortex. The infero-temporal region is responsible to process visual information about the form and color of the objects. Visuoconstruction ability relates to one’s ability to construct a figure through the given parts, units. Deblockedion of the module.


Once, the deficits are identified through the WAPIS, the clients will be recommended to participate in the visuospatial rehabilitation program. Our module focusses on improving the ability to imagine objects in space, make holistic shapes by grouping together smaller components or units and enable the clients to comprehend the differences and similarities between objects. The VHM module will be administered over a period of a month, where, three sessions will be held every week. Each session will last for a duration of approximately 60 minutes. Time taken to respond and complete the tasks at each level will be recorded.

The client can only progress to the second level once, they are able to complete the tasks in the previous level. The level of difficulty increases with each phase. This module can be used for clients ages 16 to 60 years. The module is generalizable to a larger population with visuospatial deficits including a normal population and individuals with different disabilities. Feedback will be provided to the clients after the completion of the module.

This module consists of three tasks and three levels (with the exception that visuospatial perception having four levels) that aims at developing the visuospatial construction, visuospatial perception and visuospatial recognition skills. Each level has two
sets (except visuospatial perception has only a set) and each set will be alternated during a week as per the schedule (that is different for visuospatial perception as it has one set)developed (Table 1).

Table 1. Displaying the schedules of the sessions per week for a month

Week Days Name of the Tasks

1
Monday

Set - A of Task 1 and 3
2 item from Task 2

Wednesday

Set - B of Task 1 and 3
2 item from Task 2

Friday

Set - A of Task 1 and 3
2 item from Task 2

2
Monday

Set - B of Task 1 and 3
2 item from Task 2

Wednesday

Set - A of Task 1 and 3
2 item from Task 2

Friday

Set - B of Task 1 and 3
2 item from Task 2

3
Monday

Set - A of Task 1 and 3
2 item from Task 2

Wednesday

Set - B of Task 1 and 3
2 item from Task 2

Friday

Set - A of Task 1 and 3
2 item from Task 2

4
Monday

Set - B of Task 1 and 3
2 item from Task 2

Wednesday

Set - A of Task 1 and 3
2 item from Task 2

Friday

Set – B of Task 1 and 3
2 item from Task 2

Task 1: Visuospatial construction.

The materials required are two boxes of magnetic sticks, stopwatch, and Lego blocks that can be used to construct the figure given during a particular level. The number of magnetic sticks provided will differ as per the picture. Pictures of square, triangle, rectangle, pentagon, trapezium, rhombus, and pentagon will be provided to the clients as per the set. The clients will be asked to construct the figures using the magnetic sticks similar to the pictures provided. In this task, three pictures of a set for each level will be shown. At first, the trial phase will be administered. The clients will be demonstrated in the first figure (eg. square in this case) with the help of the therapist. The remaining two items of the trial phase will be done by the client themselves. In the first week, the client will be given the set 1 of this task which has a total of 9 items. The third item of the level 3 will be used in both the set as it measures the speed to complete the task. The following instructions will be given: “You will be shown a picture of a figure and will be provided with magnetic sticks. With the help of those magnetic sticks, you have to replicate the figure as shown in the pictures. Each picture has a specific time limit. Try to complete as soon as you can. You will not be judged on any kind of wrong or correct answer. ” Time taken will be recorded for the items taken by each client in the record sheet. Each level has two sets of items and it will be used alternatively as per the schedule (except the visuospatial perception) as mentioned earlier. The task is demonstrated in a sequential order below:
Trial items.

1. 2.

3.

Level 1.
Three figures will be presented to the client and ask to replicate the figure in 5 minute. The extra time taken by the client will be recorded.
Set –A
1. 2.

3.

Set- B

1. 2. 3.

Level 2.
In this the participant will be given 12 magnetic sticks and has to make the following 3D figures in 10 minutes. The extra time taken by the client will be recorded.
Set A

1. 2. 3.

 Level 3.
In this level, the subject will be given Lego sets and will be shown the following cards. The client has to construct the object in 20 minutes. The extra time taken by the client will be
recorded.
1. The participant has to make a car. The parts will be provided with images of the car from different perspectives:

SET A SET B

2. Furniture:
SET A SET B

3. In this level will be that the participant has to stack as many Lego bricks to make the tallest tower in 1 minute.

To measure the progress:
To measure the progress or improvements of the visuospatial construction skills, the time taken to each item by the client will be recorded in both the sets. As the time taken will be reduced if the client is improving in this skill. Therefore, the decrease or increase of the time to complete the items in different sessions will be compared and analyzed to measure the progress or improvements.

Task 2: Visuospatial perception
The client has to solve any two questions from the following except the last level in each session. The questions progress from easy to very hard level. The client can only move to the next level only when the client has solved all the questions in previous level.

The client has to solve the test as per the time limits allotted for each level.
Level 1.
(Time taken by the client will be recorded).
1. Which of the objects in the options can be used to make the following figure?

A B C

2. Which of the following figure is identical to the first?

A B C D
3. Which of the following figure is identical to the first figure?

4. Which is the top view of this staircase?

A) B) C)

Level-2.
(Time taken by the client will be recorded)
1. How will the following object look from the top view?

A B C D

2. Which of the objects in the options will form the following figure?

3. Which of the objects in the options will form the following figure?

4. If this pyramid is cut at an angle as given below, how would it look like?

A B C

Level-3 (Time taken by the client will be recorded)
1. Which of the image will look like the following image?

 

A B C D

2. Which of the image will look like the following image?

A B C

3. The given solid is a part of the cube. From the options below, which solid would complete
the cube upon joining them?

Level-4.
(Time taken by the client will be recorded)
Which shape can be used using the following shapes?

Set-A

Set-B

Answer key:
Level 1: 1. (B) 2. (B) 3. (B) 4. (A)
Level 2: 1. (A) 2. (C) 3. (B) 4. (A)
Level 3: 1. (A) 2. (C) 3. (C)
Level 4: SET A- (B) SET B- (D)

Measuring the progress
To measure the progress or improvements of the visuospatial perception skills, the correct responses will be recorded. The correct responses will be compared over subsequent sessions and the progress will be monitored.

Task 3: Visuospatial recognition
The materials required are pictures. The response sheet recording the correct and the incorrect responses will be used. In this task, the client will be shown two pictures and asked to identify the differences in those pictures. Each level has two sets of pictures. The instructions will be provided asunder,
“You will be shown two pictures at a time. You have to spot the differences in each of the pictures. Try to be as quick as possible.”
Level 1.
(5 minutes. The extra time taken by the client will be recorded.)

Set A-

Set B-
Level 2.

(10 minutes. The extra time taken by the client will be recorded.)

Set -A

Set- B

Level 3.
(15 minutes. The extra time taken by the client will be recorded.)

Set A

Set B

Measuring the progress:
To measure the progress or improvements of the visuospatial recognition skills, the time taken to spot the differences by the client will be recorded in both the sets. The correct responses and time taken will be recorded. The correct responses within the time limit will be compared over subsequent sessions and the progress will be monitored.

Conclusion

The VHM module can be incorporated into rehabilitation programs of individuals with mild impairments in visuospatial skills. It can be used as an engaging task to improve visuospatial perception, constructional and recognition abilities for patients with
developmental disorders as well, apart from the general population. However, some of the tasks can get monotonous and considered boring for the older age group such as 45 years onwards. This might even lead to dropouts. Some of the visuospatial perception tasks can invite practice effects. The progress of the client will be checked after a duration of a month. Only, after that, further decisions to modify interventions or to terminate the sessions will be done. If the attrition rates would be observed, interventions to address the problem and increase the motivational responses of the clients will be done.

Nevertheless, the VHM module serves as a good starting point to aid individuals who are seeking to improve their visuospatial skills in order to help themselves become more integrated in their personal, occupational lives. The module will first be tested as a pilot intervention on a few individuals and based on the feedback of the improvements, the module will be further improvised.

 


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