Prevalence of handwriting difficulties among school-age children:
10%-34%
Diagnostic groups that often have handwriting difficulties: (6)
- Developmental Coordination Disorder (DCD)
- ADHD
- Learning Disabilities
- ASD
- Sensory Processing Disorder
- Downs Syndrome / other genetic disorders
How does handwriting influence written production?
“If writers have to devote a large amounts of working memory to the control of lower level processes such as handwriting, they may have little working memory capacity left for higher level processes such as the generation of ideas, vocabulary selection, monitoring the progress of mental plans and revising text against these plans.”
Components of handwriting: (9)
- Vision
- Visual Perception
- Gross Motor/Proximal Stability
- Fine Motor Control
- Cognition/Language
- Attention/Arousal
- Discrimination (touch, vision, proprioception)
- Motor Planning
- Behavior/Motivation
general handwriting assessment procedures: (5)
- Review the child’s school record
- Talk with primary teacher / parents re: concerns
- Conduct classroom observation including notebook/workbook review
- Complete standardized ass’s of hw and other component skills (fine motor, visual perceptual)
- Synthesize/Analyze results, develop tx goals.
What should you consider as part of their school record review? (6 things)
- IEP?
- Medical or psych. dx or learning disabilities?
- Recent vision and hearing tests?
- Accommodations/modifications?
- Other services or test results?
- Any standardized test scores (e.g. 3rd gr state test for writing, 1-2nd gr tests for reading)
Eight aspects of handwriting to observe:
- Accuracy of formation (legibility)
- Line intersection
- Baseline accuracy
- Spacing between letters words
- Alignment on page (also math problems)
- Errors of omission or skipping lines
- Mixed Cases
- Reversals/Directionality
Observations during handwriting: (8 things)
- Posture/Positioning
- Pencil Grasp/Handedness
- Approach to forming basic lines / shapes (L-R, T-B)
- Copying (near/far point)
- Forming from memory
- Pressure (too hard/too soft, consistency)
- Speed, Endurance
- Sequencing, Organization, Approach
Functional pencil grips:
Dynamic tripod
dynamic quadrupod
lateral tripod
adapted tripod
lateral quadrupod
Not optimal pencil grips:
thumb wrapped around pencil
index finger high up on pencil
fingers not curved
Five elements of good posture for handwriting:
- Trunk aligned against back of chair
- Head aligned w trunk (optimal for visual scanning)
- Feet planted on floor; ankles, knees, hips ~90°
- Forearms stabilized on desk (elbows may be slightly off desk)
- Wrist in a neutral position.
Analysis of results and tx planning:
Identify goals related to functional performance (e.g. improve formation, legibility, speed)?
Determine underlying components to be addressed (fine motor, posture, visual perceptual, attention/behavior)?
Choose strategies that will work best for the child, teacher, family…
Handwriting programs
Handwriting Without Tears - multi-sensory techniques and consistent patterns for letter formation; includes print, numbers, cursive
Loops and Other Groups - cursive only; focuses on kinesthetic movement and verbal cues for letter formation
Trics for Written Communication - Focus on mechanical and organizational deficits; remedial and compensatory strategies.
How is pencil grip related to hw legibility or speed?
Pencil Grip not related to handwriting legibility or speed (Burton & Dancisak, 2000; Dennis & Swinth, 2001; Parush et al., 1998; Kavak & Burmin, 2009).
How is hw eficiency related to body positioning, pencil positioning and consistency of pencil grip?
High correlations among handwriting efficiency and body positioning, pencil positioning, and consistency of pencil grip (Rosenblum, Goldstand, & Parush, 2006)
What is the relationship between in-hand manupulation ability (esp. rotation and translation) and 1st graders with either good or poor handwriting.
In hand manipulation (especially rotation and translation) were significantly different between first graders with good and poor handwriting (Cornhill & Case-Smith, 1996)
Postural prep and strengthening:
Postural prep for fine-motor activities:
- Bounce, jump, and other gross motor play activities help develop trunk musculature.
- Sit on therapy ball/T stool for different pelvic tilt, movement, alertness.
- Chair calisthenics too.
Strengthening proximal musculature can help:
- reduce factors associated with fatigue
- improve distal control
- improve posture for fine motor and perceptual motor tasks
hand skills/strengths to develop:
- arches
- hand musculature
- In-hand manipulation
- Disassociation
For distal finger control:
- Penny/coin banks
- Pushpins
- Pegboard/lite brite
- Lacing boards and sewing
- Dress up with fasteners
- Games
For separation of the two sides of the hand:
- Squirt bottles
- Bubble scissors
- Spinning top
- Finger spelling
- Roll clay/putty between thumb and fingers
- Clothespins/pushpins
- Open small containers with one hand
- Play with tongs, tweezers
- Squirrel objects into hand
- Crawling with objects in hand
For forearm strength:
- Opening doors, opening screw on lids
- Wind toys/keys
- Turn over blocks, cards
- Spinning tops
- Songs with palm up/palm down mvmts.
- Scooping/dumping rice, water, sand play
Adaptive techniques/tools:
- Adapt grip
- Change length or width of pencil
- Change ouput (pencil, mechanical pencil, marker)
Name four goals you could design intervention for:
- Strengthen eye-musculature
- Teach strategies or compensatory mechanisms
- Change visual behavior (e.g. organization of approach)
- Improve ocular-vestibular or other sensory-integrative functions
What does visual motor dysfunction look like?
- Poor fixation
- Poor eye-head-body dissociation
- Decreased accuracy
- Increased Jumpiness
- Discomfort or fatigue associated with eye movement
