Failure to attain handwriting competency during the schoolage years often has far-reaching negative effects on both academic success and self-esteem. This complex occupational task has many underlying component skills that may interfere with handwriting performance. Fine motor control, bilateral and visual-motor integration, motor planning, inhand manipulation, proprioception, visual perception, sustained attention, and sensory awareness of the fingers are some of the component skills identified. Poor handwriting may be related to intrinsic factors, which refer to the child's actual handwriting capabilities, or extrinsic factors which are related to environmental or biomechanical components, or both. It is important that handwriting performance be evaluated using a valid, reliable, standardized tool combined with informal classroom observation and teacher consultation. Studies of handwriting remediation suggest that intervention is effective. There is evidence to indicate that handwriting difficulties do not resolve without intervention and affect between 10 and 30% of school-aged children. Despite the widespread use of computers, legible handwriting remains an important life skill that deserves greater attention from educators and health practitioners. 'People present themselves to the world through their handwriting and are inevitably judged by it. From our earliest school days, success and failure are often measured in terms of neat handwriting.' 1 Why is handwriting important?The development of writing ability is not only important in building a child's self-esteem, but is considered an essential ingredient for success in school. 1,2 Children spend 31 to 60% of their school day performing handwriting and other fine motor tasks, 3 and difficulty in this area can interfere with academic achievement. Illegible handwriting can create a barrier to accomplishing other higher-order skills such as spelling and story composition. 4 Despite the use of computers, handwriting remains an important developmental skill for a child to master. 1 In our society, handwriting is both a means of communication and a necessary life skill, as in writing a letter or telephone message, completing an application form, or writing a cheque. Handwriting 'is still the most immediate form of graphic communication'. 1
The objective of this survey was to describe assessment and treatment approaches commonly used by occupational therapists for children exhibiting handwriting and related fine motor difficulties. Secondarily, the application of weights as a treatment modality was also explored. Fifty experienced paediatric occupational therapists from Ontario (46%), Quebec (22%) and six other Canadian provinces, were surveyed by telephone. The majority of therapists indicated that they evaluated gross/fine motor and perceptual skills, motor planning, quality of movement and sensory functioning for this population, while psychosocial and environmental factors were often not formally evaluated. Evaluations most commonly utilized included the Beery, Bruininks-Oseretsky and Gardner Tests. Standardized handwriting assessments were rarely employed. All used an eclectic treatment approach with sensorimotor most frequently selected (90%). Work setting and years of experience did not influence the treatment approach favoured.
Effective occupational therapy for improving handwriting must include adequate handwriting practice.
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