Handwriting and Telehealth

Handwriting and Telehealth

By Katherine J. Collmer, OTR/L

On the Handwriting is Fun! Blog

Well, who knew a few weeks ago that we would be venturing into a new experience…just…like…that! And as Occupational Therapists, we would jump right in and get to it! I’ve had quite a few requests from readers about the strategies that I’ve used in my previous telehealth experiences. Of course, there’s tons of information in my two blogs on this topic (links below), but this new situation calls for immediate action. So, I’m venturing out there with some suggestions for setting up your therapy sessions. As professionals, you may be doing all of this already and really just need to have it reinforced that you’re doing fine!  I’m a person who jumps in with both feet and assumes that I will be successful. My first experience with telehealth in 2012 was “self-induced” and began as an adventure that proved to be very rewarding. Positive attitude! So here we go!

Handwriting is Handwriting, no matter where it is!

All of my suggestions are directly related to handwriting development.  I work very little on actual handwriting because our role as occupational therapists is to work on the underlying skills that provide the foundation for handwriting mastery. If the teacher is providing handwriting instruction, then this should be covered in the classroom remote learning sessions. The students in my sessions actually perform handwriting tasks, of course, but they are introduced at the end of my sessions and increase in frequency and length as the students progress toward mastery. The rest of the work they do doesn’t seem like handwriting for them, and in most cases, that is a good thing!  Some children are very compliant and do whatever is asked.  And for them, retaining the same sense of routine and normalcy that they experienced in your school therapy sessions may be just the right strategy. But some students will find this new experience stressful and awkward. In turn, they will not be inclined to participate in activities (such as handwriting) if they are also stressful and awkward for them. These ”other students” are the ones for which I am offering the idea that we “change it up!” It can benefit them if we are having fun and trying out strategies that may be different than those we have used in the therapy room.  Remote learning is very different than 1:1 and thereby requires different thinking.  Although this is the way I conduct all of my telehealth (and onsite) sessions, no matter the child’s diagnosis, I think it is especially helpful to think about them now.  So, let’s get started.


1.  I’ve found that THE most important aspect of this type of therapy is to connect with the parents or caregivers (herein called parents!) who will be (and SHOULD BE) sitting with the student as they participate in your therapy sessions.  This type of delivery demands that a second pair of hands are on site to help YOU provide the services.  In Part 2 of my blog about telehealth below, I stress that communication with the parents is key.  Talk to them. Phone or email but phone is best.

Find out how THEY feel about this new experience.

Determine their level of technological awareness. Ask them about their resources (printer, paper, crayons, writing tools, games) so that you will know which strategies they can participate in without further expense. Chat with them about their role in this and what you will need from them. Let them know how important they are in this experience.  My blog talks a lot about this. As school-based OTs, we don’t typically have the opportunity to get to know the parents and families like we can in a clinic setting.  So you may or may not have already met them.  If you have the opportunity to do the above, please try to.  It can make the experience much more rewarding for everyone concerned. It also gets the parents involved in the therapy in a way that they never would have been able to before.  

2.  Ask the parents about seating and table arrangements.  Discuss how they should try to make simple adaptations so that their children are sitting in an appropriate manner with the technological device in the appropriate place for viewing – both for them to see your work and vice versa.  Here’s a link to a blog you can share with them about seating:  http://blog.handwritingwithkatherine.com/5-reasons-handwriting-needs-good-seat/

3.  Insert lots (and I emphasize lots) of fun into the sessions. I know as OTs we do this already; but when it comes to this method of delivery, adding more is a good thing.  Remote learning is just that – remote – no personal connection or feeling. They will sit for all of the other remote learning they will be doing.  Stash your sit-down method of delivery into the middle of the session and work from their feet or from some type of movement for the first half.  Here are some ideas:

Start with a gross motor activity.

Stretching or running in place or some toe touching are great ideas.  Do it with them, of course.  If they don’t want to try it, feeling like it’s dumb to do it in front of the camera, then do chair pushups or arm stretching in the chair.  Chair yoga is fun, too.  Something to loosen up the stiff and formal feeling that you can get by just plopping down in a chair and beginning to work.  For those who may be in wheelchairs or cannot jump up and down, the chair exercises are excellent ways to get the blood flowing and can give them ideas of how to pump up their energy for the rest of their remote learning experiences.  Don’t forget:  the camera (on the computer or tablet, etc.) can be moved and positioned so that you can see them off to the side of the desk or table.

Next, take a look at vision activities (pun intended).  

It is still possible to use a pencil and have them perform eye movement activities to warm up the eyes.  If they have a small ball at home, have them toss it (lightly) into the air and look up and catch it.  They can play catch with the parent and you can watch to observe their movements. Blowing a cotton ball across the table toward a target (with or without a straw) is an inexpensive game that is easy for the parents to set up.

You can move from this into setting up a visual memory game by placing items on your desk and then having them list them verbally after you cover them.  If possible, have the parent perform this on the desk or table in front of the student. But either way, the eyes and brain are warming up together. Save the vision worksheets for later.

Move on to fine motor activities.  It is VERY important to warm up the hands, fingers, and wrists for handwriting remediation. If you can, it would be wonderful to get theraputty to the students so they can work on putty exercises.   If you cannot, see if the parents can come up with play dough or squishy balls.  Otherwise, engage the students in finger exercises.  There are plenty of downloadable handouts and visuals on Pinterest.  

Playing cards works on plenty of fine and visual motor skills. And most families have dice from their board games! There are some super activities that include both of these tools on the internet.

This is the time when I move into executive functioning and some handwriting. First, I’d find out which games the parents have on hand.  Even if you don’t have the game (which most likely you do!), you can use it for executive functioning warm ups and enhancement.  If you have it and have never used it with the students before, have them discuss the directions with you and set it up.  You can play even though you are not there.  Someone else can move your piece – you can text your next move to mom or dad. In a card game, the parent can show you the cards and you can text your move to them.  Make it fun for everyone!  Just don’t let the distance between you stifle your creative juices.  

At this point, it would be fun for the students to write down part of each direction for you on a list.  For example, simply “Set up the board.”  ”Pick a player piece.“  And so on.  This gets handwriting into the mix. But just brief spurts of it.  No long sentences or paragraphs.  This can be done with any game.

Later on, I add longer handwritten work, such as copying down mom’s favorite cookie recipe, or at least the ingredients. Perhaps they could write me a short note, address an envelope, and send it off to me!

If the parents can afford to order a small chalkboard

(link below as an example), then this is a wonderful way to practice letter formations, pressure, sizing, and alignment, and many facets of handwriting development.  Use a q-tip and water to form letters.  The q-tip is an excellent enhancement strategy for pencil grip. Chalk boards are SO much better then dry erase.  The tactile experience is by far more effective. Drawing on it (or on paper) is perfect at this juncture.  Drawing, in general, allows them to work on pencil grip using crayons or pens (no markers, please). You can focus on areas of handwriting (such as sizing or alignment) by having them draw boundaries on their paper within which they need to stay with their drawing.  There are tons of drawing ideas on Pinterest.

Don’t forget about vertical spaces!

Set up the activity behind you if you can and have the parents and students imitate your movements on a wall near them. The camera can move, remember!

Collect tons of free downloadable sites for parents. Select items from the sites that you can work on for handwriting practice toward the end of the session.  Ask the parent (if they have the resources) to print it off and then you can work on it together.  Or they can do it as part of their home program.  I have tons of them on my Pinterest site and I am sharing them all the time on my Handwriting With Katherine Facebook page.  If the parents cannot print items, then have a copy on your end and read it with the students and have them “fill in the blank” on their papers at home.  It’s easy to improvise with this. 

This is a great opportunity to pull in some literacy strategies and combine them with handwriting, letting everyone concerned know how important handwriting will continue to be in this new learning environment. Find out what homework or class work the student is working on that can be practiced in writing.  Let’s say spelling words or definitions.  Yes, they will say, “But we are typing them!”  Yes, they are.  But they can always use extra practice to learn them by writing them down – which has been proven to be the most successful way to learn something!

And lastly, begin slowly with all of this.  There’s no rush.  You will get your minutes in even if part of them are chatting with parents and students to calm them, discuss their feelings (which the students can write down if they want to), and discuss goals for telehealth.  This step is so important and can be forgotten because we’ve already worked with these students for months.  We forget sometimes that this is like having them walk in for the first time.  Have fun and enjoy.  It’s all new for everyone!

And don’t forget, there are plenty of fun ideas in my Handwriting is Fun! Blog archives! And please feel free to reach out to me with questions – or suggestions!!

As always, thank you for reading!


Previous Telehealth Blogs:

Link to Amazon Chalkboard: https://www.amazon.com/Plaid-Enterprises-Inc-Chalkboard-12679/dp/B01L3ZJFS8/ref=zg_bs_1069310_21?_encoding=UTF8&psc=1&refRID=Y63JBK7HQTCTXD69ADC8

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