Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Aims: This quantitative study compared effects of occupation-based versus handwriting interventions on handwriting. Methods: Twenty-seven participants, mean age 6.3, participated in a 3-week study. Initially, there was no significant difference between groups on handwriting. Results: Occupation-based interventions were more effective on handwriting and visual–perceptual skills. Handwriting interventions lead to a greater gain in perceptual–motor skills. Conclusion: Both interventions are beneficial.
Primary Author and Speaker: Camille Skubik-Peplaski
Additional Authors and Speakers: Jennifer Hight, Laura Bray, and Carol Rushing-Carr
PURPOSE: Handwriting is an arduous skill that many students experience negative performance and decreased engagement, therefore using a play-based occupation to increase a child's participation can enhance handwriting. Krohn (2014) found that therapists are using less occupation-based techniques, so the profession may be moving to a more top-down approach rather than a bottom-up method. As Trombly (1995) described, occupation-as-end refers to a bottom up approach, where client factors are purposefully targeted with occupation as the final goal. Occupation-as-means is a top-down approach with the occupation as the ‘therapeutic change agent' (p. 964). The purpose of this study was to investigate the effectiveness of an occupation-based approach as compared to the Handwriting Without Tears (HWT) curriculum in targeting handwriting outcomes.
DESIGN: This quantitative repeated measure cohort study used a parallel-group block design for simple allocation. Outcomes included Test of Motor Skills (TVMS), Test of Visual Perceptual Skills (TVPS) and The Print Tool. Study was approved by the institutional review board with assents and consents signed. The study was repeated over the summers of 2017, 2018, and 2019. Inclusion criteria were participants from 5-10 years old with developmental disabilities. Exclusion criteria was intellectual deficits that interfered with ability to follow directions.
METHODS: Participants completed pretests on first session, received 5 intervention sessions, administered the posttests, received home programs to be completed over the summer and then returned for a follow-up. Sessions for both groups included 10 minutes of preparatory activities. Fifty minutes of intervention and 15 minutes on home programs. All goals were focused on using either: origami, LEGO activities, coloring, crafts or HWT workbooks, HWT songs, coloring.
RESULTS: To examine the overall and between group differences a multivariate analysis of variance (MANOVA) was used to compare multiple dependent variable across the groups. A total of 27 participants (20 male, 7 female) with the mean age of 6.3 years participated, six that received interventions in the handwriting group (2018) were unable to complete the outcomes due to skill level. Mean and standard deviations for all 21 participants for pre/post and follow-up identified increases for both groups on the Print Tool, but the occupation-based groups had larger mean changes overall. On the TVMS both groups improved from pre to post testing and sustained gains from pretest by follow-up, but the handwriting group had larger gains overall. On the TVPS participants improved with larger mean changes for two of the three occupation-based groups and only small changes for the handwriting group from pre to post and it was not sustained at follow-up.
CONCLUSION AND OCCUPATIONAL THERAPY IMPLICATIONS: An occupation-based approach to address handwriting impairments was the most effective technique when a child presented with a visual perceptual impairment especially recognizing size, space, placement and orientation of shapes. If a child demonstrated a visual motor impairment, then using Handwriting Without Tears was more effective. Overall engaging in-hand manipulation and kinesthetic awareness as a preparation task was effective to improve handwriting skills. Handwriting is a foundational activity of daily living skill and having effective occupational therapy intervention approaches is critical for success in school occupational performance. This study highlights the critical role occupational therapists can have in enhancing the development of a child's literacy skills, specifically handwriting, through our artistry of crafting, occupation-based and client-centered interventions.
References
Krohn, C. (2014). Effectiveness of occupation based handwriting training for children with handwriting difficulties-a systematic review. Ergoscience, 9(3), 100-107, https://doi.org/10.2443/skv-s-2014-54020140302
Trombly, C.A. (November/December 1995). Occupation: Purposefulness and Meaningfulness as Therapeutic Mechanisms. 1995 Eleanor Clarke Slagle Lecture. American Journal of Occupational Therapy, 49(10), 960-972, Retrieved from http://ajot.aota.org/
