Handwriting: technology and best practice

1. Handwriting: technology and best practice Robyn Thompson, MS, OTR/L Krisanne Lewis MOT, OTR/L

2. Handwriting is important • Handwriting is predicative of length and quality of composition (1) • Handwriting instruction correlated with improved reading (5) • Composition length and complexity improves with handwriting automaticity (1, 7) • Sensori-motor experience (writing, seeing, hearing, speaking) is crucial for the development of functional specialization of the brain for letters & leads to improved letter recognition (25)

3. Pencil grasp • Grasp has no effect on legibility or speed (16, 19, 24) • Grip force (mean and axial) is greater for lateral grasps, but thumb position and grip force has no effect on legibility or speed (14) • Static grip force correlates with lower legibility and form scores (17)

4. Intervention for pencil grasp • Get vertical! • Grips? • Activities involving opposition • Tongs/chopsticks • Pegs • Work on in-hand manipulation skills • Placing a nut on a bolt • Placing pennies in a piggy bank

5. Assessment • Beery VMI (ages 2-100) • Test of Handwriting skills (ages 5 through 18-11) • Minnesota Handwriting Assessment (1st and 2nd graders) • ETCH (grades 1-6) • Portions of BOT-2

6. Which method? • Handwriting Without Tears, Zaner-Bloser, Loops and Other Groups, D’Nealian, Callirobics, Write Start • No significant difference between programs (20) • Co-taught handwriting program resulted in increased legibility and fluency (13) • Systematic instruction is more important than the program!

7. What works • Have children name the letters as they write to assist with orthographic-motor integration (7) • Blocked practice is important for formation and automaticity (9, 10) • Introduce one challenge at a time after mastery (8, 11) • Include functional tasks (8) • Use a variety of media (8) • Verbal and visual modeling for letter formation (12) • Handwriting “clubs” or groups (15) • In autism-training targeting formation and FM control most successful (18)

8. What works, cont… • Therapeutic listening programs & sensory diet (VMI, ETCH, Sensory Profile scores improved) (21) • Ball chairs (23) • Aligning OT with classroom instruction methods to avoid introducing unintended variables

9. What to teach first • Formation • Line orientation • Size • Spacing • Pressure

10. Formation • Multi-sensory approach • Letter stories, rhymes, songs, etc. • Tactile boards, sandpaper, shaving cream, sand/sugar trays, dry erase crayons, chalk, wiggle pens, finger paint • Color changing markers, gel bags, rainbow writing • Have students form letters with eyes closed • Handwriting Without Tears “wet-dry-try” • “body” writing

11. Line Orientation Refer to lines by name (top, middle, bottom) Be consistent with paper usage Trace lines with finger, then with marker/highlighter Wikkistix on bottom line Trace line with glue (raised line paper) Begin with vertical line, then move to circles, then letters Begin without drop letters?

12. Size Teach “tall”, “small”, (“drop”) letters in groups Practice identifying size variance using objects, people Sky/grass/dirt as VC Worksheet where students fill in tall, small, drop letters Words with only small or only tall letters Mixed words: highlight small or tall letters

13. Spacing Student points out spaces between pre-written words Practice spacing between people, objects Use pennies, spacers, etc. Highlight spaces

14. Pressure Practice pressure on student’s arm/hand Practice pressure on play-doh Write on shelf liner, carpet, etc. Feel the lines on the back of the paper Weighted pencil

15. What doesn’t work • Focusing on visual motor integration, sensori-motor function, or fine motor control in isolation (8,15) • Waiting (22) • Starting kids out with cursive? (teach manuscript first) • Starting too early • Trying to change pencil grasp after about 2nd grade • When intervention doesn’t work, when to focus on accommodations?

16. Keyboarding? • Struggles with handwriting = struggles with keyboarding (2) • Poor keyboarding skills have a negative impact on composition speed (3) • Keyboarding should be considered only after all other strategies have been tried (4)

17. Strategies to support Students in Handwriting Efforts • Consider Sensory Arousal Levels: • What Low Tech Strategies can support children? • Sensory Modulation Disorders: • Overresponsivity, • Underresponsivity, • Sensory Craving • Identified through: Sensory Profile, Sensory Processing Measure, SIPT, observation

18. Consider How a Balanced Sensory System can Support Handwriting Efforts What AT strategies can be used to support Sensory Modulation? Retrived From: www.earlylinks.com.au

19. Low Tech StrategiesSensory Overresponsiveness • Sensory Backpack • Pressurized belts, socks, vests, weighted blankets • Jacket placed over back of chair with arms through sleeves for more input • Jacket over chair with sleeves tied around shoulders • “Time In” Spaces • Headphones, noise cancellation, Music-based Interventions, white noise machines or CDs • Visual schedules, timed timer (Bialer & Miller, 2011)

20. Low Tech StrategiesSensory Overresponsiveness • Chewy type foods • Chair pushups, wall wedges • Fragrance arm bands • Fidget Toys: Koosh balls, silly putty bendable figures • Slow linear swinging • Rocker or glider chair (Bialer & Miller, 2011)

21. Low Tech StrategiesUnderresponsivity • Play games that alternate between fast and slow pace- “Simon Says” with Metronome • Brighten up room with more lighting • Use fluorescent colors to brighten up clothes, toys, rooms • Play with vibrating toys (Bialer & Miller, 2011)

22. Low Tech StrategiesUnderresponsivity • Wheelbarrow walks • Sit on stools, crates, balls to help create more optimal state of arousal • Crunch snacks, pretzels, vegetable sticks • Offer hot, sour, sweet, spicy gum (Bialer & Miller, 2011)

23. Low Tech StrategiesSensory Cravers • Games that use vestibular stimulation that start and stop • Create signs that cue, start, stop and slow • Use timers for start/stop • Goal directed heavy work activities before sitting down for work • Wheel-barrow walking • Compression garments • Crunchy, chewy, and sucking type foods (Bialer & Miller, 2011)

24. Low Tech StrategiesSensory Cravers • Listening programs with calming sound frequencies • Functional, goal directed fidget toys • Visual schedules to plan out movement and sit down tasks • Calming scents, aroma bracelet • Vary Chair Positions: Sit in chair with seat back facing front (straddle chair), kneel on chair with seat back facing front • Sit on rolled up jacket instead of sit-n-move cushion (Bialer & Miller, 2011)

25. Sensory Back Pack • Create a backpack so that a child has items to support their sensory system and learning needs “on the go”

26. Sensory Back Pack • Sensory Overresponsivity: • Familiar Items (Hot Wheels Car, My Little Pony, train, book) • Smooth Items (rock, putty, fidget toys) • Soft, Squishy Items (Koosh ball, stress ball, putty) (Bialer & Miller, 2011)

27. Aroma Wrist Band Use Essential Oils to help Regulate Arousal Levels Alerting: Mint, Pine, Menthol, Eucalyptus Calming: Lavender, Vanilla, Coconut (Bialer & Miller, 2011)

28. Sensory Back Pack • Sensory Underresponsivity • Jangly, odd shaped items • Sticky, smelleable items • “Pokey” items (Bialer & Miller, 2011)

29. Sensory Back Pack • Sensory Craving • Heavy objects or items with moving parts that are interactive • Small hand weights • Gadgety games • Drawing-type games to keep kids busy • Hand-held computer games (Bialer & Miller, 2011)

30. Now That My Sensory System is Regulated…what’s Next? • Continuum of Assistive Technology Supports for Handwriting: • No Tech • Low Tech • High Tech

31. No Tech • Use highlighters to frame sections of a worksheet • Writing on every other line to increase legibility • Reduce far point or near point copy work   • Allow single word or short answers   • Extra time on assignments   • Double grade papers for content and presentation https://sites.google.com/a/plainvilleschools.org/assistive-technology/home/writing---mechanics

32. Low Tech • Pencils and pens of various widths • Pencil grips and adapted pencil holders • Pencils and pens with different grips • Pens or pencils that provide a light as the student writes • Weighted pens and pencils • Laminated alphabet to guide handwriting • Full page handwriting guides or sentence windows to help stay within a designated writing space https://sites.google.com/a/plainvilleschools.org/assistive-technology/home/writing---mechanics

33. Low Tech • Slant boards • Special paper (raised lines, colored lines, extra space between lines, graph paper) • Highlighters (permanent or erasable) • Correction tape • Correction fluid pens • Use WikkiStix to help keep writing within a designated space • Personal dry erase board • Non-slip writing surface

34. Low Tech • Electric eraser • Tape recorders (or iPods with microphone attachment) for recording selected content lectures • Scribe • Record answers in software such as Garage Band, or use iPods with microphone attachment https://sites.google.com/a/plainvilleschools.org/assistive-technology/home/writing---mechanics

35. High Tech • Portable word processors such as AlphaSmart, iPad • Accessibility options in computer control panels to adjust repeat rates, mouse speed, assist with double click or click and drag • Control panel changes to enlarge the cursor or change display options • Document templates to set background color, font, bold text, text size and spacing features • Screen magnifiers or magnification through computer zoom features • Adapted mouse, track balls, track pads

36. High Tech • Alternate keyboards • On-screen keyboarding • Worksheets scanned into text files • Talking word processors • Word prediction • Outline/graphic organizing software • Interactive writing software https://sites.google.com/a/plainvilleschools.org/assistive-technology/home/writing---mechanics

37. High Tech • Drawing software • Typing programs to teach touch typing or increase keyboard familiarity • Allow alternate methods for reporting and making presentations (PowerPoint, Animation software) • Voice recognition software https://sites.google.com/a/plainvilleschools.org/assistive-technology/home/writing---mechanics

38. Community Resources • Utah Center for Assistive Technology The Utah Center for Assistive Technology
Judy Ann Buffmire Building
1595 West 500 South
Salt Lake City, Utah 84104
Phone: (801) 887-9380
Fax: (801) 887-9382 http://ucat.usor.utah.gov/contact-us/ Kevin Christensen, OTR/L

39. Baker, S., Gersten, R., & Graham, S. (2003). Teaching expressive writing to children with learning disabilities: Research based applications and examples. Journal of Learning Disabilities, 36, 109-123. • Connelly, V., Gee, D., & Walsh, E. (2007). A comparison of keyboarded and handwritten compositions and the relationship with transcription speed. British Journal of Educational Psychology, 77, 479-492. • Preminger, F., Weiss, P., & Weintraub, N. (2004). Predicting occupational performance: handwriting versus keyboarding. American Journal of Occupational Therapy, 58, 193-201. • Handley-More, D., Deitz, J., Billingsley, F., & Coggins, T. (2003). Facilitating written work using computer word processing and word prediction. American Journal of Occupational Therapy, 57, 139-151.

40. Berninger, V., Rutberg, J., Abbott, R., Garcia, N., Anderson-Youngstrom, M., Brooks, A., et al. (2006). Tier 1 and tier 2 early intervention for handwriting and composing. Journal of School Psychology, I44, 3-30. • Berninger, V., & Fuller, F. (1992). Gender differences in orthographic, verbal, and compositional fluency: Implications for assessing writing disabilities in primary grade children. Journal of School Psychology, 30, 363-382. • Edwards, L., (2003). Writing instruction in kindergarten: Examining an emerging area of research for children with writing and reading difficulties. Journal of Learning Disabilities, 36, 136-148. • Denton, P., Cope, S., & Moser, C. (2006). The effects of sensorimotor-based intervention versus therappeutic practice on improving handwriting performance in 6-11 year-old children. American Journal of Occupational Therapy, 60, 16-27.

41. Poole, J. (1991). Application of motor principles in occupational therapy. American Journal of Occupational Therapy, 45, 531-537. • Christensen, C. (2005). The role of orthographic-motor integration in the production of creative and well-structured written text for students in secondary school. Educational Psychology, 25, 441-453. • Guadagnoli, M., & Lee, T. (2004). Challenge point: A framework for conceptualizing the effects of various practice conditions in motor learning. Journal of Motor Behavior, 36, 212-224. • Graham, S., & Weintraub, N. (1996). A review of handwriting research: Progress and prospects from 1980 to 1994. Educational Psychology Review, 8, 7-87.

42. Case-Smith, J., Holland, T., & White, S. (2013). Effectiveness of a co-taught handwriting program for 1st grade students. Physical and Occupational Therapy in Pediatrics, Apr 23. • Schwellnus, H., Carnahan, H., Kushki, A., Polatejko, H., Missiuna, C., & Chau, T. (2013). Writing forces associated with four pencil grasp patterns in grade 4 children. American Journal of Occupational Therapy, 67 (2), 218-227. • Howe, T., Roston, K., Sheu, C., & Hinojosa, J. (2013). Assessing handwriting intervention effectiveness in elementary school students: a two group controlled study. American Journal of Occupational Therapy, 67 (1), 19-26. • Schwellnus, H., Carnahan, H., Kushki, A., Polatejko, H., Missiuna, C., & Chau, T. (2012). Effect of pencil grasp on the speed and legibility of handwriting in children. American Journal of Occupational Therapy, 66(6), 718-726.

43. Falk, T., Tam, C., Schwellnus, H., & Chau, T. (2010). Grip force variability and its effects on children’s handwriting legibility, form, and strokes. Journal of Biomechanical Engineering, 132 (11). • Fuentes, C., Mostofsky, S., & Bastian, A. (2009). Children with autism show specific handwriting impairments. Neurology, 73(19), 1532-1537. • Kavak, S., & Bumin, G. (2009). The effects of pencil grip, posture, and different desk designs on handwriting performance in children with hemiplegic cerebral palsy. Jornal de Pediatria, 85(4), 346-352. • Shimel, K., Candler, C., & Neville-Smith, M. (2009). Comparison of cursive handwriting instruction programs among students without identified problems. Physical and Occupational Therapy in Pediatrics, 29(2), 170-181.

44. Hall, L., Case-Smith, J. (2007). The effects of sound-based intervention on children with sensory processing disorders and visual motor delays. American Journal of Occupational Therapy, 61(2), 209-215. • Feder, K., & Majnamer, A. (2007). Handwriting development, competency, and intervention. Developmental medicine and child neurology, 49(4), 312-317. • Schilling, D., Washington, K., Billingsley, F., & Deitz, J. (2003). Classroom seating for children with attention deficit hyperactivity disorder: therapy balls versus chairs. American Journal of Occupational Therapy, 57(5), 534-541. • Koziatek, S., & Powell, N (2003). Pencil grips, legibility, and speed of fourth-graders’ writing in cursive. American Journal of Occupational Therapy, 57(3), 284-288.

45. 25. James, K. (2010). Sensori-Motor experience leads to changes in visual processing in the developing brain. Developmental Science, 13 (2), 279-288.

46. Baker, S., Gersten, R., & Graham, S. (2003). Teaching expressive writing to children with learning disabilities: Research based applications and examples. Journal of Learning Disabilities, 36, 109-123. • Connelly, V., Gee, D., & Walsh, E. (2007). A comparison of keyboarded and handwritten compositions and the relationship with transcription speed. British Journal of Educational Psychology, 77, 479-492. • Preminger, F., Weiss, P., & Weintraub, N. (2004). Predicting occupational performance: handwriting versus keyboarding. American Journal of Occupational Therapy, 58, 193-201. • Handley-More, D., Deitz, J., Billingsley, F., & Coggins, T. (2003). Facilitating written work using computer word processing and word prediction. American Journal of Occupational Therapy, 57, 139-151.

47. Berninger, V., Rutberg, J., Abbott, R., Garcia, N., Anderson-Youngstrom, M., Brooks, A., et al. (2006). Tier 1 and tier 2 early intervention for handwriting and composing. Journal of School Psychology, I44, 3-30. • Berninger, V., & Fuller, F. (1992). Gender differences in orthographic, verbal, and compositional fluency: Implications for assessing writing disabilities in primary grade children. Journal of School Psychology, 30, 363-382. • Edwards, L., (2003). Writing instruction in kindergarten: Examining an emerging area of research for children with writing and reading difficulties. Journal of Learning Disabilities, 36, 136-148. • Denton, P., Cope, S., & Moser, C. (2006). The effects of sensorimotor-based intervention versus therappeutic practice on improving handwriting performance in 6-11 year-old children. American Journal of Occupational Therapy, 60, 16-27.

48. Poole, J. (1991). Application of motor principles in occupational therapy. American Journal of Occupational Therapy, 45, 531-537. • Christensen, C. (2005). The role of orthographic-motor integration in the production of creative and well-structured written text for students in secondary school. Educational Psychology, 25, 441-453. • Guadagnoli, M., & Lee, T. (2004). Challenge point: A framework for conceptualizing the effects of various practice conditions in motor learning. Journal of Motor Behavior, 36, 212-224. • Graham, S., & Weintraub, N. (1996). A review of handwriting research: Progress and prospects from 1980 to 1994. Educational Psychology Review, 8, 7-87.

49. Case-Smith, J., Holland, T., & White, S. (2013). Effectiveness of a co-taught handwriting program for 1st grade students. Physical and Occupational Therapy in Pediatrics, Apr 23. • Schwellnus, H., Carnahan, H., Kushki, A., Polatejko, H., Missiuna, C., & Chau, T. (2013). Writing forces associated with four pencil grasp patterns in grade 4 children. American Journal of Occupational Therapy, 67 (2), 218-227. • Howe, T., Roston, K., Sheu, C., & Hinojosa, J. (2013). Assessing handwriting intervention effectiveness in elementary school students: a two group controlled study. American Journal of Occupational Therapy, 67 (1), 19-26. • Schwellnus, H., Carnahan, H., Kushki, A., Polatejko, H., Missiuna, C., & Chau, T. (2012). Effect of pencil grasp on the speed and legibility of handwriting in children. American Journal of Occupational Therapy, 66(6), 718-726.

50. Falk, T., Tam, C., Schwellnus, H., & Chau, T. (2010). Grip force variability and its effects on children’s handwriting legibility, form, and strokes. Journal of Biomechanical Engineering, 132 (11). • Fuentes, C., Mostofsky, S., & Bastian, A. (2009). Children with autism show specific handwriting impairments. Neurology, 73(19), 1532-1537. • Kavak, S., & Bumin, G. (2009). The effects of pencil grip, posture, and different desk designs on handwriting performance in children with hemiplegic cerebral palsy. Jornal de Pediatria, 85(4), 346-352. • Shimel, K., Candler, C., & Neville-Smith, M. (2009). Comparison of cursive handwriting instruction programs among students without identified problems. Physical and Occupational Therapy in Pediatrics, 29(2), 170-181.