Occupational Therapy -> Handwriting


Handwriting is a complex task used throughout the lifespan. Writing requires fine motor skills, visual motor skills, attention, sensory processing, efficient posture and set up of materials, visual memory, bilateral coordination, and visual processing skills. Occupational therapists address handwriting using direct teaching of the skill, intervention to address underlying deficits, adaptations or modifications of tools and activity demands, or alternative forms for written expression (i.e., voice to text into a computer).

Reference links

  • Handwriting: A Matter of Affairs 2
    Author: Iman M. M. Muwafaq Al-Ghabra, English Department, College of Education For Women, Baghdad University, Baghdad - Mangen and Velay (2010) state that in handwriting, visual attention strongly focuses on the movement of the hand, while in typing, the visual attention scatters between hitting the keyboard and watching the screen. Thus, tracing letters is important for children to improve their writing because they can focus only on drawing letters. Hence, handwriting is better for students than typing to gain more information; Alleyene confirms this (2011). In his article, Alleyne states that handwriting lets the information stick in the brain rather than typing; writing the piece of information is like imprinting it in the brain. In addition, FYI Health Writer (2011) states that since handwriting requires using motor skills which take some time to copy letters, this process helps children to develop their learning and cognition.
  • The Importance of Cursive Handwriting Over Typewriting For Learning In the Classroom: A High-Density EEG Study of 12-Year-Old Children and Young Adults 1
    Author: Eva Ose Askvik, F. R. (Ruud) Van Der Weel and Audrey L. H. Van Der Meer* - In a recent EEG study, Van der Meer and Van der Weel (2017) found that drawing by hand activated larger networks in the brain compared to typewriting and concluded that the involvement of fine hand movements in note-taking, as opposed to simply pressing a key on a keyboard, may be more beneficial for learning, especially when encoding new information.
  • The Impact of An Occupational Therapy–Based Handwriting Program For a Preschool Student 0
    Author: Breanna Taylor, Hailey Speight, Margaret McKinney, Elizabeth Carter, Lesly James, Denise Donica - Population: Pre K Results: Improvements in letter formation and posture. Learning the structure of each letter and how to increase fine motor abilities. Implication: A structured, occupational therapy led handwriting program with ongoing collaboration and coaching maximizes student performance Citation: Breanna Taylor, Hailey Speight, Margaret McKinney, Elizabeth Carter, Lesly James, Denise Donica; The Impact of an Occupational Therapy–Based Handwriting Program for a Preschool Student. Am J Occup Ther August 2020, Vol. 74(4_Supplement_1), 7411515453p1. doi: https://doi.org/10.5014/ajot.2020.74S1-PO9130
  • Handwriting Development, Competency, and Intervention 0
    Author: Feder, & Majnemer - Handwriting difficulties may be the result of intrinsic factors such as poor component skills, extrinsic considerations such as academic environment and biomechanics. Developmental Stages of Handwriting: Scribbling Imitating vertical strokes (age 2y) Imitating horizontal strokes (age 2y 6mo) Imitating circles (age 3y). Imitating and copying a cross (age 4y) Copying square (5) Copying triangle (5y 6mo) Quality Development: Quickly (grade 1 6–7y) and plateau (grade 2 7–8y). Automatic, organized, tool for idea development (grade 3 8-9y) Speed of writing is somewhat linear Handwriting measures: Letter formation, spacing, size, slant, and/or alignment, speed, Citation: Feder, & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine and Child Neurology, 49(4), 312–317. https://doi.org/10.1111/j.1469-8749.2007.00312.x
  • Handwriting 0
    Author: American Occupational Therapy Association - Handwriting is a complex process of managing written language by coordinating the eyes, arms, hands, pencil grip, letter formation, and body posture. The development of a child's handwriting can provide clues to developmental problems that could hinder a child's learning because teachers depend on written work to measure how well a child is learning. Occupational therapists can evaluate the underlying components that support a student's handwriting, such as muscle strength, endurance, coordination, and motor control, and parents can encourage activities at home to support good handwriting skills.
  • Occupational Therapy Practice Guidelines For Children and Youth Ages 5–21 Years 2
    Author: Cahill and Beisbier - Collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence. Activity- and Occupation-Based Interventions to Support Activities of Daily Living, Instrumental Activities of Daily Living, Play and Leisure, and Rest and Sleep -Parent, school, and community involvement should be supported throughout the course of intervention, and pediatric services should be provided in the natural context of the child’s or youth’s routine and environments. -Engagement in daily occupations should remain the central focus of goals and intervention. Practitioners should use manualized programs that have clear activity- and occupation-based strategies as opposed to those that are solely focused on performance skills or client factors. -Practitioners should collaborate with clients and caregivers to establish meaningful occupation-based and achievable goals and use intentional strategies to maintain a collaborative relationship throughout the therapy process. -Consistent caregiver training and instruction should be provided to promote carryover, and the power of the caregiver to effect change and support the child should be emphasized. -Practitioners should follow up with children, parents, and teachers and provide ongoing coaching and feedback on performance. They should provide opportunities for collaborative problem solving and model strategies for ongoing problem solving in the home and community as new challenges arise. -Skills-based interventions should incorporate peer, family member, and practitioner interaction. -Small-group service delivery methods provide an opportunity for increased motivation and modeling. -Practitioners should explore interactive technology interventions, especially with clients with ASD and ADHD. The use of technology can be coupled with skills training and other evidence-based interventions. -The evaluation and occupational profile should include consideration of the quality of rest and sleep. -Rest and sleep should be addressed to enhance health and well-being and increase performance and participation in meaningful occupations. Activity- and Occupation-Based Interventions to Improve Mental Health, Positive Behavior, and Social Participation -Activity- and occupation-based interventions should be implemented to address the mental health, positive behavior, and social participation of children and youth with or at risk for mental health concerns. -Practitioners should use group service delivery models when providing intervention to children and youth with or at risk for mental health concerns. -Sports activities should be used to develop social interaction skills. -Practitioners should incorporate meditation practices and blogging when attempting to foster positive feelings about self in children and youth. -Manualized yoga programs or less structured yoga games and poses should be used when addressing the mental health, positive behavior, and social participation of children and youth with or at risk for mental health concerns. Activity- and Occupation-Based Interventions to Improve Learning, Academic Achievement, and Successful Participation in School -Practitioners should incorporate peer support, such as peer tutoring and peer-mediated interventions, into occupational therapy interventions and provide services in typical school environments to promote social participation and academic performance. -Practitioners should emphasize the use of activity- and occupation-based approaches to improve learning, academic achievement, and successful participation in school. -Therapeutic practice should be favored over sensorimotor approaches for the development and remediation of handwriting and literacy skills and performance. -Weighted vests should be used with caution. Citation: Susan M. Cahill, Stephanie Beisbier; Occupational Therapy Practice Guidelines for Children and Youth Ages 5–21 Years. Am J Occup Ther July/August 2020, Vol. 74(4), 7404397010p1–7404397010p48. doi: https://doi.org/10.5014/ajot.2020.744001
  • Medicare Guidelines For Group Therapy 1
    Author: The American Speech-Language-Hearing Association (ASHA) - Medicare Benefit Policy Manual, Chapter 15 230-Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology A. Group Therapy Services. Contractors pay for outpatient physical therapy services (which includes outpatient speech-language pathology services) and outpatient occupational therapy services provided simultaneously to two or more individuals by a practitioner as group therapy services (97150). The individuals can be, but need not be, performing the same activity. The physician or therapist involved in group therapy services must be in constant attendance, but one-on-one patient contact is not required. The Medicare Benefit Policy Manual does not establish a specific restriction on the use of group therapy, particularly as it pertains to the size of the group. In the absence of such guidance, speech-language pathologists must refer to the LCD developed by their MAC to determine any such restrictions. LCDs may be accessed through the Medicare Coverage Database.
  • How An SLP and OT Collaborate Long-Distance - The ASHA Leader BLOG 1
    Author: Stephanie Sigal, MA, CCC-SLP, Michelle Bonang, OTR/L - As speech-language pathologists, we all experience stories of working as an interdisciplinary team. In this story, co-treatment brought us together and keeps us in touch today. Our relationship naturally affected us professionally, but personally as well. This story shares some of my adventures—I’m Stephanie Sigal, an SLP in Manhattan, with my friend and colleague Michelle Bonang, an occupational therapist in Vermont. Together, we teach each other invaluable skills.
  • Pre-Writing Skills/Strokes | Handwriting 1
    Author: Tools to Grow - Handwriting is a complex process of recording language by hand, often by using paper and a pen or pencil. The production of legible and efficient handwriting requires intact skills in the areas of postural control, eye hand coordination, visual perception, fine motor control, ocular control, and pencil grasp. A child’s handwriting abilities have significant influence on their academic performance.

Activity List(s)

Visual Schedule Cards

Goal Bank

  • Given minimal cuing, Dwain will copy 7/7 short phonemes on half inch lined paper with at least 90% accuracy for line placement and sizing as seen in 4/4 opportunities over a 7 week period. 2
  • In order to improve letter formation and handwriting, Peter will advocate for themself by requesting written assignments be turned in on red baseline and dashed midline with lines that are 5 /8 inch tall on 5 /5 scenarios by May 5, 2023 . 0
  • Given an initial directive, Alfonzo will utilize a dynamic tripod grasp and write upper and lower case letters of the alphabet with accurate letter formation, spacing, and line orientation with 90% accuracy as evaluated/determined by teacher/therapist observation and classroom samples over 5 weeks to demonstrate appropriate form when writing. 3