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Handwriting skills
 

Many children begin to scribble on paper shortly after they are able to grasp a writing tool, and if not supervised, they will eventually write on any available surface. As children mature their scribbling evolves into the handwriting skills specific to their culture.

Performance task
Age level
Scribbles on paper 10-12 months

Initiates horizontal, vertical and circular Marks on paper

2 years

Copies a horizontal line, vertical line and
Circle

3 years

Copies a cross, right oblique line, square Left diagonal line, left oblique cross, some letters and numbers and maybe able to write own name

4-5 years
Copies a triangle, prints own name, copies most upper and lower case letters
5-6 years

Pencil grasp development

Children commonly begin by holding the pencil with the whole hand - pronating the forearm and using the shoulder to move the pencil. Later, children use a more mature pencil grasp, holding the pencil between the distal phalanges of the thumb, index and middle fingers. At this later stage, the forearm is usually supinated and the intrinsic muscles of the hand move the pencil.

Handwriting readiness

The readiness factors needed for writing require the integrity of a number of sensori-motor systems. Letter formation requires the integration of the visual, motor, sensory and perceptual systems. Sufficient fine motor coordination is also needed to form letters accurately.

Six prerequisites that children must have before handwriting begins are:

  1. Small muscle development
  2. Eye-hand coordination
  3. ability to hold utensils or writing tools
  4. capacity to smoothly form basic strokes such as lines and circles
  5. letter perception, including the ability to recognize forms, notice likeness and differences, infer the movements necessary for the production of form and give accurate verbal descriptions of what is seen
  6. Orientation to printed language, which involves the visual analysis of letters and words along with right/left discrimination.

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Handwriting is complex perceptual-motor skill that is dependent upon the maturation and integration of a number of cognitive, perceptual, and motor skills, which is developed through instruction (Hamstra-Bletz and Blote, 1993; Maeland, 1992). It is an academic skill that allows individuals to express their thoughts and feelings and communicate with others. It is a complex process of handling language by pencil grip, letter formation, and body posture. Handwriting efficiency requires mastery of multiple skills, including vision, coordinating the eyes, arms, hands, memory, posture, and body control, as well as the task of holding a pencil and forming letters.

Schools depend on written work to measure what children are learning. Handwriting is a basic tool used in many phases of our daily life e.g. for taking notes, taking tests, and doing classroom work, homework. Poor handwriting can have a significant effect on school performance and children who lack some of these skills may miss learning opportunities and lack self-esteem.

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What are the signs and symptoms the children with handwriting difficulties present?

  1. Children may exhibit strong verbal but particularly poor writing skills.
  2. Random (or non-existent) punctuation.
  3. Spelling errors (sometimes same word spelled differently); reversals; phonic approximations; syllable omissions; errors in common suffixes.
  4. Clumsiness and disordering of syntax; an impression of illiteracy.
  5. Misinterpretation of questions and questionnaire items.
  6. Disordered numbering and written number reversals.
  7. Generally illegible writing (despite appropriate time and attention given the task).
  8. Inconsistencies: mixtures of print and cursive, upper and lower case, or irregular sizes, shapes, or slant of letters.
  9. Unfinished words or letters, omitted words.
  10. Inconsistent position on page with respect to lines and margins and inconsistent spaces between words and letters.
  11. Cramped or unusual grip, especially holding the writing instrument very close to the q paper, or holding thumb over two fingers and writing from the wrist.
  12. Talking to self while writing, or carefully watching the hand that is writing.
  13. Slow or labored copying or writing - even if it is neat and legible.

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The skill of handwriting is also referred to as a "Graphomotor" skill and includes visual-perceptual, orthographic coding, motor planning and execution, kinesthetic feedback and visual-motor coordination.

Visual-Perceptual Skills: Visual-perceptual skills involve the ability or capacity to accurately interpret or give meaning to what is seen. A number of specific skills fall into this category including visual discrimination (the ability to distinguish one visual pattern from another), and visual closure (the ability to perceive a whole pattern when shown only parts of that pattern). Adequate visual-perceptual skills are a necessary but not sufficient condition for legible written output.

Deficits in Visual-Perceptual Skills: A Child with visual-perceptual problems may have a history of reading problems because of difficulty with letter and word recognition. In addition, if he cannot visually discriminate the letter b from the letter d, he will be unable to reliably reproduce these letters upon demand. If the child has problems with visual closure, there may have difficulty with accurate letter formation and handwriting legibility may be poor. For example, they may print the letter ⁄o ⁄ with a space in the top, but perceive the letter as closed.

Orthographic Coding: It is the ability to represent a printed word in memory and then to access the whole word pattern, a single letter, or letter cluster in that representation.

Deficits in Orthographic Coding: A child who has trouble with orthographic coding will often forget how to form certain letters in the middle of a writing task. He may frequently retrace letters or exhibit false starts or hesitate as he writes. Observations of written output may show that he has formed the same letter several different ways. When asked, the child can usually report if he has difficulty remembering what letters look like. Children who cannot reliably make use of visual recall to form letters and words often prefer to print rather than write in cursive because print involves only twenty-six different visual letter patterns, whereas letters written in cursive have a seemingly endless number of visual patterns. Their spelling errors may be phonetic in nature.

Motor Planning and Execution (Praxis): Praxis is the ability to plan and execute motor actions or behavior. This definition includes difficulty with assigning the various muscles or muscle groups to their roles in the writing task. E.g., in order to hold a pencil effectively and produce legible handwriting at an acceptable rate, the fingers must hold the writing utensil in such a way that some fingers are responsible for stabilizing the pencil or pen and others are responsible for mobilizing it during writing.

Deficits in Motor Planning and Execution: Poor motor planning and execution is referred to as 'dyspraxia'. Children who suffer from fine motor dyspraxia show poor motor coordination. At times, they assign too many muscles to stabilizing the pencil or pen and too few muscles to mobilizing it. At other times, they assign too many muscles to mobilizing the writing utensil and too few muscles to stabilizing it. Thus, their pencil grips are often inefficient. They frequently perform poorly with other fine motor tasks that involve coordinated motor movements such as tying shoes or holding a fork correctly. Writing for them is a labor-intensive task. Fine motor dyspraxia is commonly associated with speech production problems because these children often have difficulty assigning the muscles in the mouth to specific speech sounds.

Kinesthetic Feedback: For legible handwriting produced at an acceptable rate feedback of the sensorimotor system, especially kinesthetic feedback, during the performance of motor actions is essential. Impulses from the body go to the brain and provide information about the location and movement of the body. The body then makes adjustments based on these impulses to alter its movement pattern until the desired pattern is achieved. Thus, it is kinesthetic feedback that facilitates a good match between the motor plan and motor execution.

Impaired Kinesthetic Feedback: Children with impaired kinesthetic feedback often develop a fist-like grip of the writing instrument. With this grip, they extend their thumb over the index and middle finger, limiting the mobility of the fingers. They may also press very hard on the paper with the writing utensil in an attempt to compensate for the lack of kinesthetic feedback. Further, they may look closely at the pencil or pen when writing thus attempting to guide the hand using visual feedback, which is a much slower process. This is why children with impaired kinesthetic feedback may produce legible handwriting at a greatly reduced pace. As they progress in school, however, the demands placed on written output are too great and legibility deteriorates. These children are often accused of writing neatly "when they want to". They may complain that their hand hurts when writing and they do not like to write. Performance in other fine motor skills may be adequate or good because many fine motor skills do not place such reliance on kinesthetic feedback.

Visual-Motor Coordination: Visual-motor coordination is the ability to match motor output with visual input. Although it is the non-visual or kinesthetic feedback that is crucial for handwriting, visual feedback is also important. Visual feedback provides gross monitoring of writing rather than the fine-tuned monitoring provided by non-visual feedback. This prevents us from writing on the desk, crossing over lines and staying within the margins.

Deficits in Visual-Motor Coordination. Children with visual-motor in-coordination function much differently than those with impaired kinesthetic feedback because of the different demands of certain motor tasks. Poor visual-motor integration may lead to problems with fine motor tasks that rely heavily on visual feedback. These include threading a needle, drawing, and painting, craftwork, building things with blocks, repairing things and using a mouse on a computer.

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Although handwriting instruction is mostly the responsibility of teachers, an Occupational therapist plays an important role in determining the underlying postural, motor, sensory-integrative, and perceptual deficits (Stevens and Pratt 1989, 321) that may be causing the bad writing. The Occupational therapist also analyzes writing readiness skills, and the sensory-motor, cognitive, psychosocial, and environmental factors that interfere with the development of legible handwriting. The Occupational therapist provides intervention wherever appropriate (Schlussel 1998) by devising exercises to develop necessary skills, providing teachers with strategies to improve classroom performance, and by suggesting supporting home activities (AOT 1998). An Occupational therapist will look for prewriting skills, which must be developed before penmanship instruction can begin (Beery 1982b, 1989; Klien 1990). Occupational therapists look into the small details associated with the components involved in handwriting (as described above) and design an intervention plan to tackle those specific issues.

On the home front, sports, games, and everyday activities help children improve many of the skills involved in handwriting. To improve motor control, require the use of silverware with proper grip. Any activities involving hand-eye coordination are helpful- cutting, crafting, cooking, baking, etc. To improve visual memory, teach card games, marbles and jacks, and engage in hand sports- using large then smaller balls. Use dictation or a computer for homework assignments when a child's poor muscle strength and low endurance cannot sustain written work despite high intelligence. Encourage letter writing to family and friends (AOT 1998).

When evaluating the actual task of children's handwriting, following 4 areas are considered:

  1. Domains of handwriting - copying (near and far point), manuscript to cursive transition, ability to integrate auditory directions and a motoric response (dictation).
  2. Legibility components - letter formation, letter alignment, spacing, size and slant
  3. Writing speed - the number of letters written per minute
  4. Ergonomic factors - writing posture, upper-extremity, stability, mobility and pencil grasp pattern.

During handwriting assessment; sensorimotor, cognitive and psychosocial components also should be evaluated.

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Occupational therapy frames of reference that apply to designing handwriting intervention programs include:

  1. Neurodevelopment
  2. Sensory integration
  3. Biomechanical
  4. Behavioral
  5. Acquisitional

Neurodevelopment frame of reference

  • Focuses on an individuals ability to execute normal postural responses and movement patterns
  • Decreased, increased or fluctuating muscle tone, inadequate writing and equilibrium responses along with poor proximal stability may interfere with successful performance in fine-motor activities (E.g. Handwriting)
  • Postural and limb preparation activities are an important component of a comprehensive handwriting program for children with mild Neuro-muscular impairment.
  • Postural preparation to modulate muscle tone may involve activities to increase, decrease or balance muscle tone
  • Children with poor handwriting frequently exhibit poor proximal stability. To encourage co-contraction through the neck, shoulders, elbows and wrists; games like animal walk can be given during therapy.
  • Within the school setting proximal stability may also be improved through every day routines such as cleaning blackboards and table tops, pushing heavy external doors open, or pushing and moving classroom furniture etc.
  • Alternative positions during writing activities can enhance proximal stability during writing. The prone position requires weight bearing on the forearms for writing which increase proximal joint stability and dissociation of the hand and digits from the forearm.
  • Prewriting, handwriting and manipulative activities on vertical surfaces can assist children to develop more wrist extension stability to facilitate balanced use of the intrinsic musculature of the hand.
  • Activities requiring in-hand manipulation skills maybe appropriate for children with deficits in handwriting.

Sensory Integration frame of reference

  • By providing various sensory opportunities the child's nervous system may integrate information more efficiently to produce a satisfactory motor output. E.g. legible letters in a timely manner.
  • The parameters for this frame of reference include controlling sensory in out through selected activities to enhance the integration of sensory systems at the sub-cortical level. E.g. Standing in front of a chalkboard with the body in full extension and parallel to the writing surface may promote more internal stability of the trunk, increase the child's arousal, provide more proprioceptive input throughout the arm and shoulder and allow the hands to move independently or dissociate from the arm.

Biomechanical frame of reference

Focuses on the ergonomic factors of sitting posture, paper position, pencil grasp, writing instruments and type of paper in training the handwriting skills.

Sitting posture

  • The student should be seated with the feet firmly planted on the floor providing support for weight shifting and postural adjustment while writing.
  • The table surface should be 2 inches above the flexed elbows when seated in the chair. This position enables the child to experience both symmetry and stability while performing written work.

Paper position

  • The paper should be slanted on the desktop so that it is parallel to the forearm of the writing hand when the child's forearms are resting on the desk with hands clasped. This angle of the paper enables the student to see hi/her written work and avoids smearing of writing.
  • The writing instrument should be held below the baseline and the non-preferred hand should hold the writing paper.

Behavioural frame of reference

  • The basic premise is that measurable adaptive behaviours can be learned through interaction with a reinforcing instrument
  • Using this frame of reference, the occupational therapist can also employ activities to enhance children's social competence while participating in a handwriting intervention group.

Acquisitional frame of reference

The scope and sequence of handwriting program should focus on a structured progression of introducing and teaching letter and numeral forms. Letters with common formational features are introduced as a family such as the lower case letter like e,i,t and l. After a child masters these letters they can immediately be used to write the words eat, tile and little.

The focus is to sequentially introduce new letters and use them with mastered letters, excluding letters the child is forming incorrectly or the ones unknown to the child because this only reinforces unwelcome perceptual motor patterns.

Combining newly acquired letters with already mastered letters reinforces learning and expands writing practice from repetition of letter to the formation of words and sentences. This immediate reinforcement of writing words is more powerful and meaningful for the child than repeatedly writing strings of letters.

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Handwriting readiness can be developed by activities to improve children's fine motor control and isolated finger movements, such as;

  1. Rolling 1/4 - 1/8 inch balls of clay or therapy-putty between the tip of the thumb and tips of the index and middle fingers.
  2. Picking up small objects with tweezers
  3. Pinching and sealing a zip lock bag using the thumb opposing each finger while maintaining an open web space.
  4. Twisting open a small tube of tooth paste with the thumb, index and middle fingers while holding the tube with the ulnar digits.
  5. Moving a key from the palm to the finger tips of one hand.
To promote prewriting skills in children the following activities may be tried;

  1. Drawing lines and copying shapes using shaving cream, sand trays or finger paints.
  2. Drawing lines and shapes to complete a picture story on chalk boards.
  3. Drawing pictures of people, houses, trees, cars or animals with visual and verbal cues from the practitioner
  4. Completing simple dot-to-dot pictures and mazes.

Activities to enhance right-left discrimination includes

  1. Playing/maneuvering through obstacles and focusing on the concept of twining right or left
  2. Connecting dots at the chalkboard with left to right strokes.
 

Improving children's orientation to printed language may be achieved through the following activities;

  1. Labeling children's drawings based on the child's description
  2. Having children make their own books on specific topics such as favorite foods, special places etc.
  3. Labeling common objects in the therapy room.

When planning any handwriting intervention program, the following aspects should be included;

  1. Preparing children's bodies for handwriting
  2. Providing sequenced handwriting instruction
  3. Using various multisensory writing tools, mediums and positions for writing
  4. Recommending that children use practical techniques and approaches for functional handwriting
  5. Offering methods for children to have success, reinforcement and social competence with in the handwriting program.

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