Date Presented 04/04/19
Effective use of the hands to engage in a variety of developmental occupations is critical for a child to be successful and independent. Understanding and choosing effective interventions to improve fine-motor skills and handwriting is imperative for pediatric OTs. This study used occupational performance and handwriting as both the intervention and the outcome, with both being found to be beneficial for skill development and sustained engagement in fine-motor activities.
Primary Author and Speaker: Camille Skubik-Peplaski
Additional Authors and Speakers: Jennifer Hight
Contributing Authors: Carol Rushing-Carr
PURPOSE: The purpose of this study was to compare the effects of occupation-based activities vs. handwriting interventions on a child’s ability to write.
RATIONALE/BACKGROUND: Effective use of the hands to engage in a variety of occupations is critical for a child's success in dressing, eating, playing, and ultimately writing. Hand use is based on complex interactions of many body systems including; musculoskeletal, postural mechanisms, cognition, visual motor, and perceptual motor (Case-Smith & Exner, 2015). Fine motor skills have been found to be a predictor of later academic achievement, and when combined with attention and general knowledge found to predict later success in reading, math and science (Grissmer, Grimm, Alyer, Murrah & Steele, 2010). Yet, Smits-Engelsman, Niemeijer and van Galen (2001) found that 10-34% of school-aged children do not master handwriting. Writing must become automatic to meet the demands of academic activities to learn (Berninger, Yates, Cartwright, et al. (1992). Successful handwriting is a critical developmental occupation for children’s academic success and promotion in school.
DESIGN: A quasi-experimental quantitative pretest, post-test with a follow-up test design was used to measure changes in handwriting and perceptual skills. Settings were outpatient pediatric clinics in two different Midwestern cities.
METHODS: There were 19 children ages 5-10 years old presenting with development delay conveniently placed in either an occupation-based activity group or a handwriting intervention group based on their residence location. Children received 6 sessions of intervention and one follow-up session. Outcome measures were Test of Visual Motor Skills, Test of Visual Perceptual Skills and The Print Tool. The first session began with assessments followed by a 15-minute preparatory session focusing on hand strength, coordination and core activation. Four intervention sessions followed utilizing the 15- minute preparatory tasks and then 60 minutes of either handwriting activities (specific handwriting activities) or fine motor activities (crafts, origami and manipulatives). During the sixth session, assessments were repeated. All received a home program with the follow-up assessment being completed 10 weeks later.
ANALYTICAL METHODS/ANALYSIS: Comparison of the group differences were carried out through a t-test analysis.
RESULTS: The study found that both groups made changes. The occupational-based intervention group demonstrating significant changes in perceptual motor skills (p- 0.0362<0.05) and the handwriting group displayed significant changes in visual perceptual skills (p- 0.0337<0.05). Handwriting changes included; improved letter recognition, letter production, improved prehension, sustained fine motor involvement and less frustration using their hands for occupational performance.
CONCLUSION: Understanding the effectiveness of interventions contributes to stronger client outcomes and success in occupational performance. If a child presents with visual motor deficits occupation-based interventions may be more beneficial and if visual perceptual skills are delayed providing handwriting interventions can be advantageous. All benefitted from intense fine motor interventions and at the 10-week follow-up assessment improvements were sustained.
IMPACT STATEMENT: Occupation-based interventions may improve visual motor skills and handwriting interventions could increase visual perceptual skills contributing to improved handwriting and occupational performance.
RELATES TO RESEARCH PRIORITIES: This study highlights the value of occupational therapy in developing handwriting skills, which are fundamental for children to successfully learn in school and transition throughout life.
References
Berninger, V., Yates, C., Cartwright, A., Rutberg, J., Remy, E., & Abbott, R. (1992). Lower-level developmental skills in beginning. Reading and Writing, 4(3), 257-280. doi: 10.1007/BF01027151
Case-Smith, J. & Exner, C. (2015). Early Intervention. In J. Case-Smith & J. O’Brien (Eds.). Occupational Therapy for Children and Adolescents, 7th ed. (p. 636-663). St. Louis: Mosby.
Grissmer, D., Grimm, K. J. Aiyer, S. M., Murrah, W. M. & Steele, J. S. (2010). Fine motor skills and early comprehension of the world: two new school readiness indicators. Developmental Psychology, 46(5), 1008-17. doi: 10.1037/a0020104.
Smits-Engelsman, B. C., Niemeijer, A. S. & van Galen, G. P. (2001) Fine motor deficiencies in children diagnosed as DCD based on poor grapho-motor ability. Hum Mov Sci, 20(1-2), 161-82. http://dx.doi.org/10.1016/S0167-9457(01)00033-1.
