Just Focus on Handwriting

Deanna Macioce, MS, OTR/L

It is hard enough that not many people know what occupational therapists do, but when the parent of a child tells you not to work on core activities during sessions because “that is for physical therapy and his IEP states he has handwriting goals, so please work on handwriting,” you just want to bang your head against the wall.  Handwriting is so much more than the act of writing letters or words on a piece of paper.  For children who receive services, practice alone will not help them learn these skills.  The role of a therapist is to find out where the breakdown of skill mastery is, and then work on those components. 

Handwriting is mastered when a child has good core strength, bilateral coordination, hand strength, fine motor dexterity and visual motor skills, as well as appropriate self-regulation.  They need to have all the building blocks in order to master these skills well.

A strong core, including shoulder stability, allows children to have enough postural support to hold their bodies upright during writing tasks.  Proper position of the body, head and writing tools is key. Shoulder stability is important to lessen the movement of the whole arms during writing activities, and the stronger the shoulder, the more strength the elbow and wrist develop. These skills can be addressed during obstacle courses, using playground equipment, performing animal walks, and completing tasks in vertical.

Handwriting uses both sides of the body, therefore, having good bilateral hand skills is important.  Children who possess strong bilateral skills are able to cross midline with ease during writing tasks.  They can easily move from the left side of the paper to the right, form letters appropriately and use their non-dominant hand for stabilization.  Completing tasks such as playing with interlocking blocks, lacing beads and cards, and tearing paper can help achieve these skills. In regard to more gross motor coordination skills, using playground equipment, catching and throwing activities, as well performing games that include skills like jump roping, jumping jacks, and those hand clapping games we see on the playground are good.

Strong hands help children achieve an ideal grasp, while giving them enough endurance to perform handwriting tasks.  Children who have low tone hands, with not enough hand muscle development demonstrate difficulty maintaining a good triad grasp on writing tools. Therefore, playing with putty or playdough, using small objects for in-hand manipulation, and using squeeze balls are important to developing these greatly needed skills.

Visual motor skills are important for letter formation, sizing and spacing.  Children who have strong skills are able to copy and form letters with ease, as well as use the spacing appropriately on a page.  They are able to copy from both horizontal and vertical surfaces.  These skills can be strengthened through gross motor skill development of catching and tossing and throwing at a target.  For more refinement, coloring in small spaces, performing paper tasks such as mazes and dot-to-dots, and working in different visual planes.

Self-regulation and organization provides a child with the ability to sit, attend and focus on the task at hand.  With good regulation, children are able to take in all the information being presented to them, and then motor plan the completion of a task, such as handwriting. A well-developed sensory diet by the occupational therapist addressing the needed components, whether vestibular, proprioceptive, tactile, visual, or oral will help piece this area together.

It is plain to see that there are so many skills that make up the task of handwriting.  We are finding more and more children are entering school with these skills underdeveloped, making it a task for teachers and therapists to figure out the missing components, and for each child it is different. Therefore, if you are unsure of why a therapist is doing something during a treatment session, take the time to ask because what often looks like just “playing” to some has huge therapeutic benefits.  There is more foundation to just practicing a skill!