by Katherine J. Collmer, M.Ed., OTR/L
on the Handwriting is Fun! Blog
Research results indicate that “the number of children who experience handwriting difficulties can be upwards of 27% in the primary grades (Volman, van Schendel, & Jongmans, 2006, as cited in Collmer, 2016, xiii). Experts have identified a current trend that may result in handwriting difficulties and an inefficient pencil grasp: presenting toddlers and preschool children with pencils and pencil activities before their motor muscles are ready for this complex fine motor task. (Collmer, 2016, p. 28) Proper development of the muscles of the hand, both intrinsic and extrinsic, assist the writer in maintaining his grasp without pain or fatigue, with grip strength correlating with handwriting legibility in typically developing children. (Collmer, 2016, p. 29) As occupational therapists, we play a key role in alerting educational staff about the hazards of pushing children into forming inefficient handwriting habits. However, what do we do when we are presented with a student who has been struggling with his handwriting skills for quite some time; and who now, at the age of 9, is attempting to keep up with his peers in handwritten assignments? Where do we begin?
I recently received a note from a seasoned occupational therapist who was striving to provide the best services to her young client. She wrote:
“I have recently begun working with a student who is 9 years 4 months old. He is quite inefficient in the classroom due to the speed at which he completes his classwork. This is concerning to the team as he approaches 4th grade. His OT Evaluation revealed that he continues to use a static tripod grasp for all of the handwriting tasks. I am curious about your experience with the static to dynamic transition for handwriting. I am wondering if you have any thoughts on why some children do not transition to a dynamic grasp. My assumption in this scenario is the lack of transition is related to poor postural control. For some reason, this one is just throwing me off a bit more than others to see an nearly nine and a half year old doing writing assignments from his shoulder.”
I did agree with this therapist that a common reason for a static tripod grasp is poor postural support. Taking that assumption a step further, inefficient posture can also be an adaptation for the underlying reasons for his inefficient pencil grasp. Poor shoulder, arm, wrist, hand, and finger muscles may cause the writer to grip the pencil tightly, brace his arm and elbow against his body, and produce movements from the shoulder instead of fluidly moving his hand and arm across the page. I was excited about helping this therapist and her young man and I dove right in with a suggestion or two. Since I had not seen this student’s grasp, I provided a strategy that I felt would help in most cases, discussing it as a step-by-step process from which I’d typically work. Of course, we’d work on more than one strategy in the list at a time, with those presented close together complementing each other. Both she and I thought it would be a nice idea to share it with you, too!
Step-by-Step: Proximal to Distal
At this age, I turn to a very basic assessment that looks at shoulder, arm, wrist, and finger strength. If it is determined that the grasping problems result from strength issues, then I begin there. Experience has shown me that most times it will be! At the start, I tend to do very little handwriting practice or paying much attention to changing the child’s grip during handwriting tasks, as most likely that is like trying to get blood from a stone. Often, there’s been lots of practice and there’s been tons of hours spent on tips and tricks to change his grasping pattern with little success. The frustration meter at this point has been pegged out for everyone concerned. I’ve found the most success comes from working strictly with strengthening activities designed to address the child’s particular areas of concern.
- I’d begin by concentrating on palmar arches and separation of the two sides of the hand. There are plenty of exercises and activities that concentrate on these skills and can be adapted to his developmental level, helping him to open his web space and attain flexibility in his fine motor movements. It’s important to be sure that he can perform thumb opposition efficiently, as well. If not, include activities for that in this step. This sets the stage for the following strategies.
- At the same time, I would work on shoulder stability with upper body exercises or yoga activities. Select activities that allow you to monitor progress with repetitions or quality of production, such as the plank, wall pushups, and indoor volleyball between you and him. Work on drawing, sketching a map, or visual perceptual copying tasks on a vertical surface (such as a wall or window or chalk board – no dry erase please!), working with his wrist extended to 20 degrees and about 10 degrees of ulnar deviation. You won’t have to be as vigilant on correcting his positioning if he is working on these types of vertical surfaces since they will most often position his wrist and arm correctly by default!
- When he begins to experience some progress with No. 1 above, I’d include some bilateral fine motor activities such as molding clay or those that include cutting or putting things together. This will begin to include his wrist and fingers of his dominant hand with help from his non-dominant. Be sure he is resting his arms and hands on the table at first. If he is performing everything “in the air,” chances are he’s using his shoulders to brace himself and he is less likely to move his hands and arms fluidly across the table (even in small bits) during the task, which is the goal in handwriting tasks. Be sure that during these tasks, you are reminding him of the postural “must do’s” that you have been working on so far – back slightly bent toward the table so that he can see his work, elbows on the table, knees in front, feet flat on the floor. I have to confess, I’m not as strict with every part of this as I used to be. If the posture is working for the task and the child is not experiencing discomfort due to it, then I let it go and move on to the other things I’m working on. If the posture is hindering the task, I have the student remind me what he needs to fix. It helps to have a sign on the wall or a note on the desk that he can refer to during the activity.
- Along with this, I’d begin to include core exercises in his routine (No. 2) above. Alternating toe touches, modified sit ups, or yoga poses such as rocking the boat are great ways to add abdominal muscle work that is quantifiable and allows the student to monitor his progress. (There are quite a few examples of exercises in the downloads included with my book.)
- After some more progress is achieved with 1 and 3 above, which will be demonstrated by less dependence on his shoulder for movement and increased flexibility in his arm and wrist, I’d add fine motor exercises – not tasks or activities. Strictly the same types of exercises that we would do with adults in a rehabilitation setting. (I’ve included a handout for putty exercises in my downloads for my book.) They are simple to demonstrate and easy for him and his parents to follow at home….and they work. I am leaving this until he has some upper body improvement because, as you know, development is proximal to distal. Once we can get him to stabilize his shoulder and begin to move his arm in tandem with his hand, then he can begin to include fine motor movements to tie it all together. The exercises are static, however, and do not involve much arm movement. I try to mix the exercises in with some of the other activities above to add movement. For instance, I might have the student perform one upper body exercise and then move over to the table for a fine motor, sequencing like that until both sets of exercises are completed. Or I like to have them play a dice game where each number is attached to an upper body or fine motor exercise. The student checks off which ones he’s completed and we roll the dice until they’ve all been done. This way, the arm is working as well as the fingers. It works to enhance flexibility. You can also have the student perform the exercises standing up when his fine motor skills begin to get stronger. This allows him to move his arms without support. But be sure he’s not using his shoulder to stabilize too much!
- When the above strategies are moving close to his final goals for those skills, I’d move on to adding about 5-10 minutes at the end of the session to work on activities that include handwriting – slowly at first. I begin with a reminder of the appropriate ways that the shoulder, arm, wrist, hand, and fingers work together toward efficient handwriting skills. Handwriting program workbooks often have great visuals to remind students of the placement of these parts. (I know Universal Publishing’s books have great ones.) I keep a checklist on the desk where the student can self monitor his positioning. We work with tasks such as copying spelling or vocabulary words from the board in therapy to take home for study. Even if this is a repeat of what he’s done in class, the task completion is being monitored by you and the student can actively practice his self monitoring techniques for use at home or in the classroom. I like to have them write down directions to their home or the park or movie theater, make a list of items that they will need for their next camping trip or for what they want for lunch, or draw a picture and write a short, short description of what is happening in it. It depends on what the child likes to do for fun.
Be sure to continue to include upper body exercises in his program to keep the muscles toned and ready for fine-motor work. Most children love to continue with the putty exercises, too. And that’s good because the fingers continue to need work at this point. If he tires of them, there are others on line that he can try that use other materials or exercise tools. It’s up to you and him.
- Finally, when all of this is working, I shift from exercises to activities that concentrate on handwriting mastery. We remain on vertical surfaces at first, moving to the table bit-by-bit as the student demonstrates transference of the skills he developed in the exercises and small tasks to specific handwriting activities. If the quality of my student’s letter formation and alignment are good, then I’d work on speed and accuracy. (Otherwise, I’d begin with those basics.) I have some speed and accuracy activities in my downloads for my book; but I put a really effective one on my blog that’s not in there. Here’s the link:
I would work very slowly with students such as this guy. I know sometimes that frustrates teachers and parents who want to see results right away for grading purposes. However, slow but sure wins the race! Posture is a problem for them. But most of the time, their posture is poor because they are using their shoulder to stabilize their arm; and their wrists, hands, and fingers are too weak to form and maintain an appropriate grasp. It is important to remember, too, that a functional grasp is not necessarily a pretty one. If the grasp isn’t the traditional dynamic tripod grasp but his fingers aren’t white with pressure and he isn’t complaining about pain or fatigue in the hand, then it just might be an appropriate grasp. In this case, to address speed and accuracy I would assess his shoulder and back muscles to determine their need for strengthening. Just for fun, I’ve included a blog I wrote on functional grasping patterns. If you have purchased my book, you may recognize parts of it, as some of the information is included in there:
I am pretty consistent in the method of my delivery, moving from gross motor, to vision skills, to fine motor, then function in my sessions, as I’m sure you all do. I didn’t include any vision in the above, but these skills could easily be addressed in both types of exercises.
I really enjoyed working with this therapist and am looking forward to hearing her feedback about her student’s progress toward handwriting mastery!
As always, thank you so much for reading and sharing my work!
The Handwriting is Fun! Blog is published and is the property of Handwriting With Katherine.
Katherine J. Collmer, M.Ed., OTR/L, is a pediatric occupational therapist who specializes in the assessment and remediation of handwriting skills. In her current book, Handwriting Development Assessment and Remediation: A Practice Model for Occupational Therapists, she shares a comprehensive guide and consistent tool for addressing handwriting development needs. She can be contacted via her website, Handwriting With Katherine.
- Collmer, K. Handwriting Development Assessment and Remediation: A Practice Model for Occupational Therapists. 2016 ed. Waymart, PA: Universal Publishing, 2016. Print.
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