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“The teacher is primarily responsible for handwriting instruction. The therapist’s role is to determine underlying postural, motor, sensory integrative, or perceptual deficits that might interfere with the development of legible handwriting” (Stephens and Pratt 1989).
Many children who are referred to Occupational Therapy from main stream schools have difficulties with handwriting. It is the Occupational Therapist’s task to assess the child’s handwriting and identify the underlying cause of the difficulties. Occupational Therapy is process-oriented, whilst education is product-oriented. When the teacher and the therapist work together, combining medical and educational knowledge, the results are often very positive in achieving legible handwriting.
The child’s stages of development and “readiness” for handwriting need to be taken into consideration. All research tends to agree that children should not be taught handwriting before they are ready as this can result in creating writing difficulties that are hard to reverse. Letter formation requires the integration of visual, motor, sensory and perceptual systems and it has been concluded that most kindergarten children who are typically developing should be ready for formal handwriting instruction in the latter half of the kindergarten school year (5-6 year olds – year 1).
When a child with handwriting difficulties is presented to the Occupational Therapist, the therapist will need to assess the level of functioning in the following areas:
Visual Motor Integration (neural function transferring what is seen into motor expression)
Fine Motor Skills (hand dominance, bilateral and motor co-ordination, in-hand manipulation, functional pencil grip, muscle tone, hand, arm and shoulder strength).
Visual Perception (discrimination between numbers, letters and words that are similar; spacing between letters; placing letters on the writing line and using margins correctly; identifying which letters have been formed completely; letter and number reversal).
Cognition (memory; language comprehension; specific learning difficulties e.g. spellings; problem solving and reasoning).
Possible sensory processing difficulties (that interfere with posture, attention, tactile, visual or proprioception having an effect on handwriting).
These may all impact on handwriting so it is important to determine and diagnose the underlying cause of the handwriting problem.
Correct equipment for handwriting is an important factor contributing to positive results. The child needs correct chair and table height for good posture. The type of pen/pencil used is also influential and using a correct pencil grip may aid speed and fluidity of writing.
There are many handwriting programmes to assist with difficulties and as occupational therapists work with the underlying cause of the problem and not necessarily the actual handwriting, it is important to choose the most suitable programme for the individual child. In this way therapists can work with teachers to address the problems that are causing the poor handwriting. The following programmes are the ones that I use and find most productive:
Handwriting Without Tears http://www.hwtears.com/
Speed Up (Lois Addy)
Teodorescu (Write From The Start)
Callirobics (handwriting exercises to music) http://www.callirobics.com/index.html
There are a number of activities that a child can do to help with handwriting difficulties. An Occupational Therapist will usually provide a programme of activities to be done daily along side the chosen handwriting programme that focuses mainly on letter formation and legibility. These activities tend be incorporated into the child’s daily routine in school, self care and play.
There is evidence to suggest that mild handwriting difficulties will be helped with good teaching and the maturation of the child. The more severe problems, however, tend to persist into adolescence and could continue into adulthood if the right intervention is not given. Occupational Therapists, Physiotherapists and specialist teachers will make a noticeable difference for most children with their professional intervention. Unfortunately there are a few children who may continue to have difficulties with handwriting despite professional intervention. A keyboard is often recommended as an essential alternative for these children