Many people associate occupational therapy with handwriting because that is often what OT’s are working on with children in school, along with other school-age skills. At The Children’s Therapy Center, Inc., we often get calls from parents because their kids are having a hard time with learning how to write properly and legibly. Many are surprised at how we approach what seems like a simple direct ability. The reason is that there are so many fundamental skills that go into handwriting, and a problem in any one or more of those fundamentals will most likely affect the end product of handwriting. This blog will explain the different areas that may be contributing to a problem in handwriting.
An obvious place to start is to look at how the child is holding their writing utensil (pencil, crayon), but so much goes into just that action. Does he hold it correctly or does he hold it in a funky position that’s not efficient? The therapist will evaluate the child’s motor coordination and the underlying senses that feed into good handwriting such as proprioception (the sense that tells us if our joints are bent or straight, how heavy or light an object is). Sometimes we see that the child is squeezing the pencil with much more pressure than is necessary or is pressing too hard on the paper because they don’t properly sense the amount of pressure that is necessary. Try to imagine wearing two or three layers of gloves and still maintaining your grip as well as forming nice neat letters, and you will have a better idea of what poor proprioception and overall sensation can feel like. If poor proprioception is noted, then that area needs remediation. A previous blog can be found here that is all about Proprioception if you care to learn more detail.
Another area that often needs to be evaluated is the child’s visual perception. This is separate from visual acuity which is usually checked by your eye specialist, however a visit there may be warranted to be sure your child’s vision is considered. Visual perception deals with how the brain is interpreting what the eyes are seeing. This includes areas such as visual memory, spatial relations, visual attention and other areas. For example, if your child cannot keep a “picture” in her head of how a W looks, how can she be expected to write it properly? Good handwriting also involves using the right amount of space between letters and words, and this requires the child to be capable of noting how close and how far the letters are in relation to each other. If your child is unable to accurately interpret what she is seeing, it would be very difficult to write correctly and neatly, in a nutshell. You can learn more about Visual Perception in an earlier blog on this site.
Other areas that are often evaluated include the child’s muscle tone and motor planning. Low muscle tone is often the culprit when a child is not able to maintain a nice even grasp or if he tires out quickly when writing and doing other tasks. Motor planning involves being able to figure out and carry out a plan of action when approaching movement tasks, large and small. For example, to learn to skip, you must be able to figure out how to step and hop then do the same on the other leg all while moving forward. For some, it is that simple, but for our kids with difficulty in motor planning (also called dyspraxia), this is a complicated series of movements for them to interpret and sequence. It involves balance, quick changes from right to left, etc. With regards to handwriting, if you have difficulty with motor planning, imagine trying to form the letter K and doing it correctly between the lines of a paper. There is a lot of planning that goes into handwriting.
So, what do we do about it all? If your child simply has issues with handwriting, we work on it directly using any of a number of approaches, starting with where the child is at and gradually working through the basics (letter recognition, formation, using the lines properly, pencil grasp, etc.). We may incorporate specially designed paper to help her learn to keep her letters on the line and other specific handwriting skills. If your child is having issues with any of the foundational skills as noted above, we will work on those also. Sessions often begin with warmup activity then move to strength and coordination and handwriting towards the end. Sometimes handwriting or pre-handwriting tasks are interspersed throughout a session. There is no one way to approach therapy, and each child is treated and appreciated as an individual.
Some children resist handwriting, perhaps because they feel they have failed before, know they have a weakness there, and it’s just plain hard. The therapist works to gain trust and uses a “baby steps” approach to get the child to participate. We sometimes also run handwriting groups where children work in small groups on similar tasks. Usually in the summers, you can find individual handwriting sessions with one of our occupational therapists that has a lot of experience working in the school system. This is especially great for kids who need to keep up their skills during the summer vacation months.
Regarding pencil grasp, your child’s therapist may recommend trying any of a number of approaches such as using an adaptive pencil grip, a mechanical pencil, a pencil with a wider girth or other tool to help your child develop a better, more comfortable and efficient grasp. This is very specific to each child depending on their needs and abilities. There are so many options of pencil grips and other adaptive devices to choose from and all are not the same. Your therapist can try them with your child and recommend the ones that work best.
We have a saying at the clinic when someone calls because of their child’s handwriting: It’s never just handwriting. After seeing all that goes into writing, I’m sure you understand what that means now.
Nancy E.A. Weiss, MOT, OTR/L