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-UE support: positioning important for proximal stability in order to have distal control -Fluid ROM in UEs is needed for natural nonresistant fine motor abilities -Stabilize the wrist for finger control -Open web spaces between fingers -Increase and stabilize the arches of the hand -Separate the motor functions of the two sides of hand: Stabilizing side and skilled side

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Hand development for pencil control

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- In-hand manipulation: translation, shift, simple and complex rotation -Distal isolation -Bilateral integration skills

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Hand development for pencil control

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-visual-motor skills -visual-perception: figure ground, spatial relations, visual closure, visual discrimination, visual form constancy -Motor planning (praxis)

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Other skills needed for handwriting

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-lower scores on school work -slow completion of written work -difficulty finishing assignments on time -difficulty taking and reading their own notes -failing to learn other higher-order writing processes (planning and grammar) -avoidance of writing -omitting details of what they know -submitting shorter or incomplete written responses

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Handwriting struggle risks for students

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find out why the student is struggling within their occupation as a student

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Role of OT in Pregraphics & Handwriting

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what areas of handwriting is the student struggling with and what is causing the interference with handwriting production (pregraphics)

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OT Evaluation

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-VMI assessment for handwriting predictability -Test of Handwriting skills & Evaluation Tool of Children's Handwriting (ETCH) -May design a therapy program around working on underlying deficits, handwriting itself or both -May see students on a consultation service or direct service

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OT Evaluation & Assessments

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-Do NOT put a pencil in a child's hand that is not ready to receive a pencil -Use fat crayons, paints, chalks -No reason to use a pencil prior to kindergarten -Grasp patterns are evolving -Visual-motor skills developing -Graphic abilities evolving

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Pregraphics

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information discussed on hand development slides, also the child needs to know letters and have the ability to copy basic shapes

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Handwriting readiness

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-UE support -wrist and hand development -visual control -bilateral integration -spatial analysis -kinesthesia

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Benbow six developmental classifications that contribute to greater adeptness in operating a pencil

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-Clinic setting: handwriting assessment to determine if handwriting is below average and needs intervention -School setting: referred for "poor handwriting", no handwriting assessment needed -Observation of child engaging in handwriting tasks-speed, legibility (functional assessment) -Obtain information from parents/teachers handwriting strengths/weaknesses -Formal observation of specific components (fine motor, in hand manipulation, distal isolation, hand structure, strength, formal speed) -Further assessments to determine if there are other factors affecting handwriting (VMI, TVPS, QNST, SPM) -Make recommendations based on findings: direct services, consultation services, accommodations/modifications/AT, keyboarding, cursive handwriting

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Handwriting Evaluation

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in-hand manipulation, hand strengthening, grasp patterns

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FM activities (interventions)

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playground routine, crawling, jungle gyms

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GM activities (interventions)

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visual closure puzzle, diagonal puzzles, home program

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Visual-perceptual activities

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focus with black underlay, decrease distractions, tactile desensitization, use multi-sensory approach for learning letters

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Sensory strategies

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slant board, stable positioning

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Reflexive pattern integration

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tracing, hand/eye activities

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visual motor activities

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90-90-90, paper position

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positioning/stability

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building letters, verbal cues, kinesthetic learning, pencil grip, drop and pick up pencil

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motor planning for learning letters or holding pencil

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computers, pencil grips, slant boards, special paper

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Assistive technology (high tech/low tech)

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-Handwriting without Tears -Loops and Other Groups -Zaner Blosser -D'Dealian

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Handwriting programs

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5-6 years

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At what age do children copy a triangle and print their own name?

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Ninth grade

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At what age do children demonstrate adult speed in writing?

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Combining the components to write

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Which of the following is an example of visual motor integration required for handwriting?

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They use vision to guide their hands.

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How do children first learn to write their letters?

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Lateral pincer

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Which of the following is not considered a mature pencil grip for handwriting?

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Gathering data on a child's writing compared with classroom standards

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What is the first step when evaluating a child's handwriting?

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Composition

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Which domain of handwriting is considered the most complex?

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Ability to read it

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What is the most important aspect of legibility?

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Make spaces with a rubber stamp.

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Which solution may help Kylee, a 7-year-old girl who has difficulty spacing her words?

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It allows for faster and more automatic writing.

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What are the advantages of cursive writing?

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-Mechanical process -Perceptual -Acquisition of language -Spelling and phonology

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Pre-literacy writing development of young children

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Controlled scribbles Discrete lines, dots, or symbols Straight-line or circular uppercase letters Uppercase letters Lowercase letters, numerals, and words

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Prewriting and Handwriting development

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Scribbles on paper

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10-13 months Development of Prewriting

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Imitates horizontal, vertical, and circular marks

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2 years Development of Prewriting

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Copies vertical and horizontal lines and circles

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3 years Development of Prewriting

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Copies cross, right oblique line, diagonal left oblique cross, some letters and numerals; may write own name

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4-5 years Development of Prewriting

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Copies triangle, prints own name, copies most lower and uppercase letters

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5-6 years Development of Prewriting

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Fluency develops in 3rd or 4th grade Adult speed by 9th grade Linked to eye-hand coordination Perceptual motor Cognition Language Vision

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Writing Development in School-aged Children

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Small muscle development Eye-hand coordination Hold writing tools Form basic strokes Letter perception Right-left discrimination

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Handwriting Readiness

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Visual Motor Sensory Perceptual Motor planning Eye-hand coordination In-hand manipulation Kinesthesia

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Handwriting Readiness Factors

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Whole-hand primitive grip Transitional pencil grip—flexed fingers, pronated forearm Mature pencil grip

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Pencil Grip Progression

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-Identify which writing tasks are most problematic -Behaviors -Level of independence -Attention—distractions -Environment—where child sits, teacher -Curriculum

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Direct Observation

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Domains of handwriting Legibility Writing speed Ergonomic factors

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Measuring Handwriting Performance

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Writing alphabet Copying Near-point copying Far-point coping Manuscript-to-cursive Writing dictated words Composition

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Domains of Handwriting

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Letter formation Alignment Spacing Size Slant Readability

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Legibility

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Formula: Total number of readable words = 4 = 50% Total number of written words 8

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Legibility Formula

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Number of words per minute Consider within context of classroom, assignment, child

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Writing Speed

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Posture Upper extremity stability Mobility Pencil grip

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Ergonomic Factors

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Children's Handwriting Evaluation Scale (CHES) CHES-manuscript Denver Handwriting Analysis Minnesota Handwriting Test Evaluation Tool of Children's Handwriting Test of Handwriting Skills The Print Tool

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Handwriting Assessments

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D'Nealian CASL First Grade Handwriting/spelling Program Handwriting without Tears Graphomotor intervention Zaner-Bloser

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Handwriting Programs

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-Postural and arm preparation -Muscle tone -Proximal stability and strength

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Handwriting Intervention: Neurodevelopmental

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Practice Repetition Feedback Reinforcement

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Intervention: Acquisitional

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-Proprioceptive, tactile, visual, auditory, olfactory, and gustatory -Incorporate a variety of senses into the intervention

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Intervention: Sensorimotor

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Sitting posture Paper position Pencil grip Writing tools

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Intervention: Biomechanical

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Self-control Coping Social behaviors

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Intervention: Psychosocial

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Intervention focuses on writing within the context of literacy.

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What is the occupational therapist's role in regard to writing and literacy?

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Fourth grade

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By what grade do children develop fluency in writing?

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Legibility

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What is the therapist evaluating when he/she observes a child producing improper letterforms, poor leading in and leading out of letters, inadequate rounding of letters, and incomplete closure of letters?

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Spacing on paper

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Which handwriting problem may be addressed by providing the child with grid paper or requesting the child write on every other line of the paper?

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use of grid paper; write on every other line of the paper; and draw colored lines to mark (e.g., green is left; red is right).

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Some potential solutions for handwriting problems of spacing on paper include the following:

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