Handwriting for Occupational Therapists (OTs) – development, assessment, treatment

We recently had a handwriting lecture by a occupational therapist in private practice, Jennifer. We learned about the importance of handwriting, skills used in handwriting, how handwriting develops, how to evaluate it, and how to treat problems with handwriting. The following information is essentially a partial outline of her powerpoint.

Handwriting is rarely taught as a subject anymore, and many teachers don't feel they can teach it well. However, considering how much a child has to write during a typical day, problems with handwriting can cause a LOT of different school problems, including frustration, fatigue, low test scores, and more.

Handwriting is more complicated than it seems – it requires trunk/postural control, head stability for visual tracking, strength, hand control, visual perception, cognitive skills, etc.

Even things like the thumb web space, the ability to separate the two hands in terms of motor control, and well-developed palm arches, are important to handwriting. For example, one hand has to hold the paper while the other hand writes. The hand has to curve around the writing utensil properly.

Most agree that ages 4-6 are appropriate ages to begin handwriting instruction. Typically children go through a hierarchy of grasps..starting with a pronated hand (palm in a contorted position, facing outwards) and eventually moving into a more neutral position, with better finger control. Vertical and horizontal lines need to be mastered before diagonal lines.

During evaluation, it is important to not only look at handwriting skills. It is important to look at the context – the physical layout of the room/desk, the social context (lots of distractions by fellow students?), how much time the children are given, whether or not the children have to copy from the vertical surface of the board to the horizontal surface of the desk, and more!

There are lots of different handwriting assessments that can be used (as well as informal observation), such as the ETCH – Evaluation Tool of Children's Handwriting. These assessments can help further define the problem area – ie, is the handwriting issue a fine motor problem, a visual-perceptual problem, a cognitive problem, a trunk control problem, etc?

Treatment can vary based on the problem causing handwriting issues. It may be modifying the student's chair/desk, it might involve doing weight-bearing activities to improve proprioception, practicing fine motor activities, used paper with raised lines, or color-coded paper, using special grips…the possibilities go on and on.

Jennifer also showed us a large toolbox full of helpful items, such as very tiny pencils, an odd assortment of grips, fine motor squeezing/grasping/pinching activities, and “crayon nibbles”, which seemed pretty cool! She also said a kitchen store can be a great place for an occupational therapist, because typically such stores have things like strawberry hullers and tongs of different sizes, which can be used to help the child work on in-hand manipulation and strength. She even suggested getting a liquid laundry detergent cup, putting a sticker on it that clearly has an up/down (like a silly face), and then having the child manipulate the cap in circles between one hand.

It was a pretty interesting lecture and it really made me appreciate how complicated handwriting can be, for some children. So have some patience, try and get to the root of the problem,  and then get creative!

Nov 01, 2007 | Category: Occupational Therapy | Comments: 1

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