Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This scoping review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, reviews and critiques the efficacy of interventions used to remediate handwriting skills of adults poststroke. Data sources were OT SEARCH, PubMed Central, PubMed, PsycInfo, CINAHL, and MEDLINE. Search terms were CVA, stroke, adults, handwriting, fine motor, rehabilitation, and remediation. Nineteen studies were critiqued and organized by intervention type. Few studies address remediation of handwriting skills of adults poststroke. More research is needed.
Primary Author and Speaker: Beth Ekelman
Contributing Authors: Kaylee A. Buchenic, Sara E. Connelly, Mallory M. Deel, Morgan M. Haynik,Joseph Morrison, and Kelle Deboth
PURPOSE AND BACKGROUND: The purpose of this scoping review is to synthesize and critique the efficacy of interventions used to remediate handwriting skills of adults post-stroke. Handwriting is an occupation that is often compromised after stroke. Older adults rate the importance of handwriting very high (van Drempt et al., 2011). Most handwriting activities of older adults include note writing, puzzles, and writing lists. Handwriting also provides a means of social connection and communication (Simpson, 2015). Few studies address remediation of handwriting in individuals post-stroke.
DESIGN: A scoping review was completed using PRISMA extension for Scoping Reviews (2018). This protocol consists of a checklist of 20 essential reporting items and explanations of each item that should be included when completing a scoping review. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network (Tricco et al., 2018).
METHOD: Data Sources were OT SEARCH, PubMed Central, PubMed, PsycInfo, CINAHL, and Medline. Search terms used were: CVA, stroke, adults, handwriting, fine motor, rehabilitation, and remediation. Inclusion criteria: Studies that addressed rehabilitation of adults post-stroke, remediation or restoration of handwriting or fine motor control, Level I through IV evidence. Exclusion criteria: Studies that included pediatric population, adaptations rather than remediation, qualitative studies. We followed the PRISMA Flow Diagram format to list articles identified, screened, deemed eligible, and included in this scoping review (PRISMA, 2009). A data charting form was jointly developed by all reviewers to determine which variables to extract that corresponded with the research question. All reviewers independently charted the data, discussed the results, and continuously updated the data-charting form. Inconsistencies in charting were resolved by discussion with other reviewers. Level of evidence was determined using the Rating System for the Hierarchy of Evidence to Guide Clinical Interventions (Winona State University, 2020). Levels one through four were applicable for the analysis. Critical analysis was done using the McMaster University Quantitative Review Form (Law et al., 1998; McMaster University, 2014). We grouped the articles into tables by the types of interventions that were investigated and summarized the outcome measures, results and limitations. Results were synthesized.
RESULTS: 19 studies were deemed eligible and were organized by intervention type: electrical stimulation (n = 5), constraint induced therapy (n = 4), task oriented training (n = 3), mirror therapy (n = 2), emerging interventions (n = 5). Only one study specifically addressed remediating of handwriting skills of adults post-stroke using the task oriented approach. More research is required to determine outcome measures that accurately illustrate the effectiveness of the handwriting program. Other interventions focused on fine motor coordination remediation nonspecific to handwriting of adults post-stroke, although improvements in handwriting and decreased impairment level of the upper extremity had substantial effects on participants’ overall quality of life.
CONCLUSION: Few studies focus on examining the efficacy of interventions used to remediate handwriting skills of adults post-stroke. OTs must develop a formal handwriting assessment for adults post-stroke, design structured handwriting remediation programs for adults post-stroke, and assess the efficacy of handwriting programs.
References
McMaster University. (2014). Evidence-based practice research group. https://srs-mcmaster.ca/research/evidence-based-practice-research-group/#kKUoxuZy
PRISMA (2018). PRISMA for scoping reviews. http://www.prisma-statement.org/Extensions/ScopingReviews
van Drempt, N., McCluskey, A., & Lannin, N. A. (2011b). Handwriting in healthy people aged 65 years and over. Australian Occupational Therapy Journal, 58(4), 276–286. https://proxy.ulib.csuohio.edu:2096/10.1111/j.1440-1630.2011.00923.x
Winona State University. (2020). Evidence based practice toolkit. https://libguides.winona.edu/c.php?g=11614%26;p=61584
