Feasibility of a home-based program to improve handwriting after stroke: a pilot study

Abstract

facilities, health-related websites and in a seniors' newspaper. Eligibility criteria included having sustained a stroke at least three months previously, having self-reported difficulties with, and goals related to, handwriting, being able to hold a pen, and having sufficient cognitive and communication skills to complete a daily home program.A four-week, home-based handwriting training program was delivered by an occupational therapist. The intervention applied principles of task-specific motor training, involving intensive practice of meaningful handwriting tasks related to participant goals. Whole handwriting tasks were practised, as well as problematic handwriting task components. An occupational therapist provided supervised practice and coaching, giving feedback on task performance and using shaping to achieve the right level of challenge. Two 1-hour therapy sessions were provided per week. Another three hours per week of independent, unsupervised practice was prescribed to increase practice intensity. Participants were taught cognitive strategies to analyse their handwriting performance and problem-solve ways to improve specific handwriting features.Handwriting performance was measured at baseline, after the training program (at four weeks) and four weeks later. The primary outcome measure was the modified Evaluation Tool of Children's Handwriting-Words (mETCH-W), a subtest of the Handwriting Assessment Battery (HAB). Secondary outcome measures included other subtests of the HAB, the modified Four Point Scale, and the modified Disability of the Arm, Shoulder and Hand (DASH) Scale. Legibility was scored by a blinded rater.Feasibility of recruitment, intervention and outcome measures was evaluated using descriptive statistics, including means, standard deviations and proportions. Utility of the outcome measures was also evaluated by comparing participant score at baseline, postintervention and follow-up. Mean or median change scores were then calculated between these three time points and reported with a 95% confidence interval or interquartile range.Results: Seven adults with stroke were recruited over 18 months (eligibility fraction 43% of those screened, and enrolment fraction 78% of those eligible). There were no dropouts. Mean time post stroke was 2.6 years (range: 3 months to 7 years). Mean age was 71 years (range: 50 to 87 years). Mean disability measured using the Modified Rankin Scale was 2.3 (range 1 to 4). Although recruitment was slow, the intervention was feasible. Participants completed a mean of 7.9 hours of occupational therapy supervised handwriting practice (range: 7.6 to 8.3 hours) and 10 hours of independent practice (range: 6 to 14 hours). Participants were able to

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