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Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine
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Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine
Navigating the special education process in the school system can be tricky and confusing. And the maze of testing that it results in can be daunting for the parents as well as the child. Marie Toole, MS, OTR/L, shares insight into the Occupational Therapy evaluation process. She also offers a link to her blog, The Special Education Process: How it works.
Occupational Therapy Evaluations in the School: How do they work?
by Marie Toole, MS, OTR/L
on the School Tools From Your Pediatric Occupational Therapist Blog
Last month I wrote about the special education process and what you as a parent could expect. There was lots of information about timelines, permissions, and the kinds of evaluations that may occur. This month I want to tackle the occupational therapy evaluation in particular. When I evaluate a student, I am looking at him through the eyes of a school-based pediatric occupational therapist (OT). Let’s just clarify what a school-based OT can and will need to do to fully explore all options to best plan for your child’s educational needs.
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Occupational Therapy Evaluations in the School: How do they work?
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Photo credit: renaln
Each year, as I work with students in elementary school, I continue to worry about their needs being the result of inadequate pre-handwriting skill training. In short, that really simply means how well they learned to use their hands in play activities and kinesthetic learning. Children learn to use their hands as tools to help them learn and grow from the moment they are born. However, sometimes in this accelerated learning environment the we seem to be in now, children are being asked to attempt to learn skills that are far beyond their developmental capabilities. With this in mind, I offer again my work to draw attention to the learning brain of the child.
Kinesthetic Learning and Pre-Handwriting Skills
by Katherine J. Collmer, M.Ed., OTR/L
Jean Piaget introduced the world to the learning brain of the child. Through his systematic study of cognitive development, he discovered that children simply do not learn in the same way as adults. According to his theory of cognitive child development, “children are born with a very basic mental structure … on which all subsequent learning and knowledge is based.”
To read the entire article, click here.
Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine
Molly Shannon, OTR/L, ATP, shares her expertise on upcycling Assistive Technology equipment to provide students and families with inexpensive methods for increasing independence in the school and at home in her two-part series.
Use It or Lose It! Upcycling Assistive Technology (AT)
by Molly Shannon, OTR/L, ATP,
on the ATandOT Blog
In this blog post we will explore imaginative assistive technology (AT) upcycling ideas that you can employ for unused or under-utilized AT and provide fun, functional engagement for students and persons with various disabilities. In other words, we will emphasize “what’s old is new again,” sometimes with a twist. First, let’s discuss the important distinction between the terms recycling and upcycling, as well as ways in which AT recycling is promoted on a national basis through a variety of programs and initiatives.
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Use It or Lose It! Upcycling Assistive Technology (AT)
National Handwriting Day is celebrated each year on January 23, John Hancock’s birthday (according to the Gregorian calendar), an American Revolutionary leader and first signer of the U.S. Declaration of Independence. The Writing Instrument Manufacturers Association started this holiday in 1977 to acknowledge the history and influence of penmanship. And we carry on this tradition today to increase awareness of the literacy benefits of mastering handwriting skills.
One of the most overlooked skills in the assessment of handwriting problems is the visual component. Vision (which is comprised of 17 skills, only one of which is eyesight) can hinder a child’s educational progress by robbing him or her of the opportunity to form accurate perceptions of himself, the environment around him, and letter and numbers. These misperceptions can lead to reading and writing challenges as well as problems with sports and activities of daily living.
With vision in mind, I am re-sharing this post that explains the vital need for having a child’s vision assessed and the important role vision has in learning. And that includes handwriting.
In”sight” Into Handwriting Struggles
Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine
Stacy Turke, OTR/L, shares her enlightening experience when her student creates a new therapy idea right before her eyes!
Can We Try It Like This? Or, What happened to this school OT when she lost control of a therapy session…
by Stacy M. Turke
on the On the Road with @stacyturke OTR blog
Last year I had a student who helped me grow as a therapist.
Okay…truth be told, all my students do that, daily, because from our interactions I learn what works, what doesn’t, what to repeat, and what to toss into the ‘great idea, poor outcome’ pile. This particular student came to me on this particular day as he always did, full of energy, chatty, and happy to see what was beyond the door in the therapy environment. “What we doing today?” he asked with his usual eagerness. I adore this aspect of his personality.
Click here to read the rest of the blog.
When an OT loses control of the session!
Handwriting and the non-dominant hand
by Katherine J. Collmer, M.Ed., OTR/L
Frank R. Wilson, in his renowned discussion of the evolution of the hand, poses the suggestion that bimanual tasks result in the development of a visual vocabulary. He defines a “visual vocabulary” as one that is established as a result of a mysterious, nonverbal language. This language can be witnessed in the arts, from jewelry making to writing, as each creator uses “internalized rules for combining materials and structural elements” to produce unique patterns of work. These works of art take on a meaning for both the designer and viewer and become the personal stamp of the creator. (1) In this sense, handwriting can be defined as a nonverbal language that results from the production of lines and shapes that are placed within spatial constraints according to predetermined directional and alignment rules. They become words and sentences that take on a meaning that the writer conjures up in our minds to share thoughts, feelings, information, and knowledge. Although Wilson describes handwriting as a task commonly considered to be a unilateral hand skill, (1) one that is considered by researchers to require only the “specific coordination between the finger and wrist movements” of one hand, (2) it appears that handwriting under the label of a visual vocabulary would then be considered a bimanual task.
The production of a visual vocabulary, in the arts and handwriting, depends on the ability of the hands to form a complementary partnership in their role as a vehicle for expression. This partnership consists of a dominant and non-dominant hand that become one unit in the completion of bimanual tasks. Brain lateralization and the intercommunication between the two sides of the brain have been considered the foundational requisites that facilitate the establishment of a dominant hand and determine handedness in humans. However, the establishment of hand dominance remains a confusing and baffling human trait that scientists admit there is little known about its history or neurologic foundations. The study of the evolution of handedness has taken anthropologists back to an examination of how the hands were used by our Stone Age predecessors to wield stones as hammers to create tools for building or cooking or to design weapons intended to kill game or to act as protection against predators. Their studies revealed that the tool users would have divided the tasks of hammering or throwing into two distinct parts, utilizing one hand to steady the object to be hammered or to balance 
the body against gravity in throwing and the other hand to perform the precise movements necessary to direct the stone toward a target with accuracy. This division of labor has been labeled as the dominant and non-dominant hand movements.
Hand dominance has been suggested to have been a “critical survival advantage” to hunters and gatherers as they engaged precision tasks within their competitive environments. (1) Given that precision tasks demand practice for mastery, their consistent use of one hand to perform and perfect an accurate aim-and-throw movement may have organized the brain-hand pathways and established a hand dominance. Again, the baffling question remains: Why did these early humans select the right versus the left hand for precision tasks? While scientists have yet to uncover the answer to this conundrum, they have turned with equal wonder at the mystery of the perceived underdevelopment of the non-dominant hand. Some ask the question, “Did it stagnate? Was it ‘dumbed down’ somehow, in order to guarantee the emergence of a manual performance asymmetry?” Or was the non-dominant upper limb intended to become specialized in a different way? (1) This latter view of the non-dominant hand suggests that the two hands are complementary, forming a whole that is dependent on the accurate production of the specified movements of both sides. This is an enlightening perspective on the role of the non-dominant hand, for sure.
Dominant and non-dominant hands were once referred to as the “good” and “bad” hands, with the non-dominant hand being labeled as the “somewhat disabled one.” (1) The right hand was viewed as the “good” hand despite the occurrence of left-handedness in some children. Left-handedness, in fact, was considered to be a deficit and children were strongly encouraged, sometimes forced, to ignore their tendency to use their left hand and to switch 
instead to their right hand for writing and drawing. The argument and prejudice against left-handedness was promoted by the confusing fact that an overwhelming number of people were right-hand dominant. In the end, regardless which hand became dominant, the non-dominant hand was believed to be an unequal force in the production of bimanual tasks. It was considered to be inferior to the more precise hand. As researchers began to investigate more closely the interaction of the hands in bimanual skills, they questioned this idea and considered instead the likelihood that they were interdependent. Bimanual tasks, by definition, involve the use of both hands. While some bimanual tasks can be accomplished with the use of one hand (as evidenced by the rehabilitation efforts of persons who have suffered from a stroke), most often the speed, fluidity, and accuracy of their production are compromised by the lack of a supporting hand. In general, then, bimanual tasks demand the use of both hands for efficiency, as is seen in activities such as playing a musical instrument, golfing, tying our shoes, cutting our food, and handwriting.
Wilson describes handwriting as a task commonly considered to be unilateral hand skill, (1) one that is considered by researchers to require only the “specific coordination between the finger and wrist movements.” (2) However, in light of the research that considers the two hands as partners in a task, an analysis of the the non-dominant hand in handwriting has revealed it to play “a complementary, though largely covert, role by continuously repositioning the paper in anticipation of pen movements.” (3, qtd in 1) In 1987, French psychologist Yves Guiard studied the complementary hand movements in handwriting relative to the idea that the physical characteristics of the movements of each hand, as well as the sensory control mechanisms that supported those movements, were significantly different. He proposed that their scaled movements were spatially and temporally divided into two categories. In Guiard’s theory, the scale of the dominant hand’s movements is considered to be “micrometric,” or produced within a smaller space with slower speeds relative to the supporting hand. Its performance is rehearsed and mostly internally driven or pre-programmed, directed by the development of motor patterns and the automatic reproduction of those patterns. (1) In contrast the movements of the non-
Photo: Property of Handwriting With Katherine
dominant hand in its role as the paper positioner are “macrometric.” They are conducted to facilitate improvised adjustments using faster speeds within a larger context. They are externally driven, being directed by the writing hand to set the spatial boundaries within which it can perform its skilled movements. In effect, the non-dominant hand is supporting the precise movements of the dominant one by providing a stabilizing environment that allows for frequent alterations that are responsive to the movements of the skilled hand. This perspective of the non-dominant hand elevates its significance in the production of handwritten work. The actions of the supporting hand require controlled motor movements that can transition within a diverse range of “improvised hold and move sequences” that do not follow strict rules for patterns or rhythm. These movements require sensory control mechanisms that can detect, analyze, and integrate visual perceptual information, such as spatial boundaries or paper angles, relative to the movements of the dominant hand. The supporting role of the non-dominant hand demands flexibility to “conform its movements both to the behavior of an external object and to the actions of the other hand, to ensure that the object and the handheld tool will intercept at the intended time and place.” (1) Guiard discovered that these alterations are anticipated and initiated before the movements of the skilled hand take place, leading to his proposition that “there is a logical division of labor between the two hands that appears to govern the entire range of human bimanual activities.” (1)
The precise, rehearsed, and preprogrammed facets of handwriting rely on the supportive role of the less-precise hand to guide the dominant one in producing the “collection of identical hash marks” (1) that create an individual penmanship style and comprise the visual vocabulary that delivers each writer’s personal message. The supporting role of the non-dominant hand places handwriting among our most creative bimanual tasks. In this light, an assessment of handwriting development skills would warrant an evaluation of the behaviors demonstrated by the supporting hand and rehabilitative efforts designed to develop it to its highest skill level.
Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine
Hand Dominance – a key factor in handwriting success
by Katherine J. Collmer, M.Ed., OTR/L
Hand dominance is a key factor in handwriting mastery. Handwriting is a complex functional task that demands the hand to work efficiently with a tool. This is accomplished through the hand’s intricate link with the brain. Handwriting is considered to be the highest form of unilateral hand dexterity skill attained by the general population. (1) The establishment of hand dominance provides the child with a skilled hand for efficient pencil control to facilitate the learning of letter formations and line alignment as well as a stabilizing hand to monitor paper placement.
What is hand dominance or handedness?
Hand dominance is the term used to describe the hand a child is observed using spontaneously during skilled activities such as brushing his teeth, using scissors, or handwriting tasks. It is the hand a child naturally prefers to use because it performs skilled tasks more efficiently, leaving the other hand to act as a stabilizer. For example, a child who is right-hand dominant, or right-handed, will use his right hand to manipulate the scissors and his left hand to stabilize the paper during a cutting task. The development of hand preference is a sign that the brain is maturating and that brain lateralization is occurring. Initial development of a preferred hand occurs from about the age of 4 months to the age of three to four, shifting from a reach that is convenient (such as using the right hand to pick up objects on the right side) to one that crosses the body’s midline. Hand preference for the completion of unilateral tasks becomes more evident during this time with further bilateral differentiation occurring between 5 and 7 years. Although children may continue to switch preferred hands at this stage for use with different fine-motor skilled activities, a fully established hand dominance presents itself between the ages of 6 and 9.
What are the behaviors associated with an Unestablished Hand Dominance?
Hand dominance is a foundational skill that promotes using the hands together efficiently during activities that involve more complex motor plans, motor accuracy, and greater skill. These tasks include tying shoes, buttoning a coat, playing with interconnecting blocks, or handwriting. Crossing
Image by © Royalty-Free/Corbis
the midline and bilateral coordination are contributing foundational skills for the establishment of hand dominance and equally important in the performance of skilled tasks. Difficulties in either of these skills can result in unilateral hand preference (using the right hand for performance on the right side and vice versa), difficulty with symmetrical bilateral hand skills such as catching a ball or holding an object with two hands, or competing dominance where the child switches hands during a fine-motor task. It is also important to note that if a child who demonstrates a clear preference for one hand is observed switching between his dominant and non-dominant hand during skilled activities, muscle fatigue could be the underlying cause rather than difficulty with any of the above skills.
How can you determine the Establishment of Hand Dominance?
There are several ways to determine a child’s preferred hand and to determine the establishment of hand dominance.
Activities that Promote the Development and Establishment of Hand Dominance.
After collecting observational data that reflects the child’s level of hand dominance, determine the hand that he appears to prefer. Direct him to use that hand in activities that will reinforce it as the dominant hand. If the child does not yet appear to have a preferred hand, begin with the foundational activities below to encourage the development of a dominant hand. Progress to the activities that follow to enhance the underlying skills that promote the development and establishment of hand dominance.
Foundational Activities:
Enhancement Activities:
Gross motor games. Position balls or bean bags on the side of a child’s preferred hand and have him toss them at a target placed at his midline or on the opposite side of his body. This activity promotes the development of hand dominance, as well as balance, bilateral coordination, visual attention, and crossing the midline skills. Games of throw and catch (for example, baseball or bowling) and basketball (dribbling and throwing) also promote these skills.
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Fine motor activities. The activities below promote the use of a dominant hand as well as the development of visual attention, crossing the midline, and bilateral coordination skills.
Academic activities.
Children who have not established a dominant hand may also be working with inefficient body image and spatial awareness skills. It is important to observe the child in a diverse array of activities and provide a variety of opportunities to engage in bilateral tasks in order to determine the underlying developmental skill needs.
Katherine J. Collmer, M.Ed., OTR/L, owner, 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.
Disclaimer: The information shared on the Handwriting With Katherine website, blog, Facebook page, Twitter page, Pinterest page; in the Universal Publishing Handwriting Teachers’ Guides; on any guest blog posts or any other social media is for general informational purposes only and should not be relied upon as a substitute for sound professional medical advice or evaluation and care from your physician/medical team or any other qualified health care providers. Therefore, the author of these links/posts take no responsibility for any liability, loss, or risk taken by individuals as a result of applying the ideas or resources.
References:
Children who experience difficulty with the mastery of handwriting skills are often struggling with crossing their body midline. During the performance of handwriting tasks, the arm, hand, and eyes travel from the writer’s left side to his right, crossing the body’s center many times. Letter formations also rely upon the writer’s ability to cross from left to right to cross a “t” or produce an “x.” A developmental skill need that limits the fluid movement across midline prevents a child from mastering the basic facets of handwriting mastery.
Crossing the midline is a bilateral skill demonstrated by the ability to spontaneously move one hand, foot, or eye into the space of the other hand, foot, or eye. This happens when we sit cross-legged on the floor, scratch our elbow, read or write from left to right, draw a horizontal line from one side of the paper to the other, or connect intersecting lines to draw a cross without switching hands. Crossing the midline is a coordinated movement that is developed as a child experiences activities that include cross-lateral motions, such as reaching across the body to retrieve a toy. These movements help to build pathways in the brain that facilitate the development of various motor and cognitive skills involved in completing self-care tasks, participating in sports, reading, and writing.
Crossing the midline is an integral skill related to bilateral coordination. Bilateral coordination is defined as the ability to use both sides of the body together in a coordinated, controlled, and organized manner during tasks that require the use of one hand to stabilize and the other to perform simultaneously. These activities include crawling or climbing stairs, catching or throwing a ball, manipulating clothing fasteners, tying shoes, stringing beads, cutting, and handwriting. In addition to the foundational skills of eye-hand coordination and muscular strength, the development of bilateral coordination is dependent upon an accurate body awareness. This perceptual skill represents the ability to know where the body and its parts are positioned in space without using vision allowing for the spontaneous and efficient completion of tasks. The development of bilateral coordination indicates that both sides of the brain are communicating effectively in the sharing of information. The development of a “helper” and a “worker” hand to facilitate bilateral movements is a sign that the brain is maturating and that brain lateralization is occurring. The lateralization process is strongly correlated with the ability to cross midline.
Brain lateralization is defined by the ongoing process that is thought to begin in the prenatal period and continue throughout early childhood. The 
cerebrum consists of two hemispheres (or halves) that specialize in different functions which control different areas of the body. The left hemisphere controls the right side of the body and contains the centers for the understanding and use of language (listening, reading, speaking, and writing), memory for spoken and written language, analysis of information in detail, and motor control of the right side of the body. The right hemisphere controls the motor movements of the left side of the body and contains the centers for processing visual-spatial information, comprehending and remembering things you see and do, and using pieces of information to form a complete picture. The two halves are connected by a band of fibers called the corpus callosum which plays an important role in integrating their respective functions. Lateralization becomes specialized to serve particular functions and involves a preference for using one hand or side of the body more than another. Hand dominance is a result of brain lateralization. (1, p. 176-7)
Children who have difficulty with these skills may display decreased coordination and motor control, tend to avoid crossing their midline by using alternate hands for performing tasks on each side of their body, and have difficulty establishing hand dominance. These children may appear to be ambidextrous because they use both hands alternately during and among tasks. However, they may actually be doing that because they have two unskilled hands. In addition, children who experience problems with crossing the midline can have difficulty with higher level skills such as reading and writing as they both involve left-to-right eye and hand movements. This may be observed as stopping in the middle of the page to blink or rub their eyes, losing their place frequently during close work tasks, being unable to master letter formations that include diagonal lines, or stopping in the middle of the page to switch hands during handwriting assignments. For children who have an inaccurate sense of body awareness, they may appear clumsy and cautious with movement especially when it involves having their feet of the ground. They may seek or avoid deep sensory input or have difficulty coordinating both sides of their body to complete bilateral activities of daily living. These behaviors also can result from inefficient eye-hand coordination and muscular strength.
The activities listed below are some examples of easy-to-implement tasks or games that will enhance the underlying skills that promote the development of crossing the midline skills.
For younger children:
child. This activity promotes visual attention, bilateral coordination, midline crossing, and upper extremity muscle strengthening skills.
Large movement activities performed on the floor on a large piece of paper or on a sidewalk can encourage crossing the midline. Have the child trace large crosses or figure 8’s (drawn on their side) using different colors of chalk to create rainbow tracings, drive a toy car through a figure eight driveway, or complete a large simple maze with chalk or colored pencils. These activities promote visual attention, bilateral coordination, and crossing the midline skills as well as upper extremity muscle strengthening with crawling and movement on all four’s. The use of chalk provides tactile input to promote handedness and writing/drawing tool control.
For older children: While some of the activities listed below were also listed for younger children, they can be enhanced for the older ones by increasing the challenges with time or speed elements or the inclusion of academic tasks.
balance, body awareness, bilateral coordination, and visual attention skills.
Crossing the midline skills are developmental and should appear by the age of 3-4 years. This article is meant to provide information about its development and the symptoms that indicate a need in this area. If you find that your child has not achieved this milestone by the age of 4, it would be wise to consult with his or her pediatrician to determine if there is an actual need that would benefit from intervention.
Katherine J. Collmer, M.Ed., OTR/L, owner, Handwriting With Katherine