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Chapter 3

Handwriting

One of the most common skills OTs work on in a school setting is handwriting. Problems with handwriting can occur in the general population as well as with children with special needs. While OTs are not handwriting teachers, we are able to assist students with the underlying difficulties that make up the task of writing. Handwriting does not simply involve the formation of letters and numbers, it also involves difficulty with the following: using the correct pressure on the pencil, the ability to grasp the pencil properly, cursive, staying within the lines of the paper, and spacing between words. Children need to develop handwriting skills as they progress through school and life but before the actual writing process begins, there are pre- writing skills that the student needs to learn and master.

What Are Some Warm Up Exercises for Writing?

There are many fun ways to warm up as a group prior to handwriting.

• Jumping jacks can be done in place.

• Various yoga poses are appropriate for the classroom.

• Call out a letter and ask students to try and form that letter using their bodies (similar to the YMCA dance).

• Do chair push-ups. With feet placed on the floor and both hands on sides of the seat, lift your body up slowly and hold for a few seconds. Slowly lower yourself back down. Don’t help with your feet!

• Finger push-ups can be done at the desk. Place fingertips together. Bend and then straighten the fingers. Make sure the fingertips are always touching each other.

• Table push-ups can be done at the desk. Ensure feet are flat on the floor. Place the hands and forearms on the desk. Ask the student to lower his upper trunk down toward the desk and then use arms to push back into a seated position.

• Assign each student a small portion of putty or dough and place small items such as beads into the putty. Ask students to find them. Roll putty into a hot dog and use fingers to pinch the roll into smaller pieces. Form letters with the putty.

• Make circles with arms at shoulders, wrists, and thumbs. Start small and gradually increase the size of the circle. Reverse.

• Draw large figure eights with each arm ten times. The importance of the figure eight is that it requires students to cross their body’s midline. This skill is an important one and can be adapted in many ways. Draw or tape a figure eight racetrack on the floor. Ask child to sit in the middle and roll cars along the entire track with the right arm. Repeat with left arm. Use a large sheet of craft or poster paper and place on student’s desk. Draw a “lazy 8 lying down.”

• Ask students to give themselves a big hug for a job well done.

What Are the Skills Needed before Writing?

Often times, OTs work with children on their handwriting skills before they are expected to form letters. These skills are called “pre- writing” skills. Handwriting is a complex process because there are several areas of our body and brain that are used when writing. The cognitive (brain) abilities include: attention, visual-perceptual skills, interest in handwriting, and sequencing (first, then, last). The sensory motor-body awareness includes: posture and body control, motor planning, knowing right from left, crossing the body midline, and using both hands together. Handwriting also includes the ability to hold the pencil, scribble or mark on the paper, copy shapes, make “strokes” in all directions (vertical, horizontal, circular, and diagonal). As the student advances in school, copying from the board and from books makes the task more difficult as the skills required place more demands on the muscles of the hand, the eyes, and the attention required.

What Is Crossing the Midline?

A midline is an imaginary line in the middle of the body. When we are babies, we learn to bring our hands together and reach for toys with our hands while sitting on the floor. The ability for your student to cross her midline is extremely important for developing motor skills. It goes hand-in-hand with bilateral integration. As we develop, one of our hands becomes the dominant one and the other is the helper. If we do not develop a dominant hand, we do not refine the skills of either hand for writing, dressing, eating, and scissoring. When we read a page, our eyes must scan across the entire page. During writing, a student should be able to draw a horizontal line across the entire page with one hand and not switch hands in the middle. Many children prefer to use their right hand for activities on the right side of their body and their left hand for things on the left side of their body.

Many of my students demonstrate the lack of ability to cross their midline. Here’s an example: A student in pre-school is observed during snack time. The juice box is on the left side of his placemat and the graham crackers are on the right side of the placemat. You observe that he uses his left hand only to pick up the juice box and his right hand only to pick up and eat the crackers. He does not change how he’s reaching for items during the entire snack time. You encourage him to try to pick up the juice box with his right hand and you notice distress when he tries. You may need to provide encouragement for your student to cross his hands across his body. Have fun with the activities listed below and be sure to ask your student not to move his body (trunk) side to side, but instead have his arms move to cross the imaginary line across the center of his body.

• Use a large poster board or butcher paper and encourage the student to stand at the middle of her desk and take turns using each arm to fill the opposite half with shapes and colors.

• Ask students to lay prone (tummy down) on a carpeted area and complete their written work or complete a game or puzzle. This will require them to cross over the board to move and arrange the pieces.

• Students can pass a beach ball back and forth. Put on some music, move chairs next to each other, and make a chain of friends and pass the ball in one direction. Switch directions when you stop the music. This can even be done while students are standing at their desks.

• Sit back to back and pass a ball around your body to each other. My students love doing this to fun, bouncy music.

• Scrub down a chalk board or use a sponge to clean large windows together. Hold the sponge or brush with both hands.

• Work on paper/pencil activities such as matching the doggie to his bone. Draw the doggie on the left side of the paper and the bone on the right side of the paper. Make sure your student doesn’t move the paper while drawing the line, but instead moves his pencil across the paper. You can draw anything you want that may go together and interests your student. Mazes, word searches, and tracing are other paper/pencil activities you can try.

• Using a large whiteboard or chalk board, draw a figure eight lying on its side (like the infinity sign). Draw a rainbow with many colors. Have your student stand in the middle of the shape and trace the shape back and forth. Encourage him to cross his arm across his body while completing the activity.

• Use colorful pieces of fabric to write numbers or letters in the air and across their bodies.

What Is Bilateral Integration?

Bilateral means both sides and integration means working together. Bilateral integration is when both sides of the body work together to complete a task. Often, the hands are completing different tasks to accomplish a common goal. There is awareness of sides, right and left. Generally, one side is dominant and the other is used as a stabilizer. When a student has difficulty in this area, she may avoid crossing her midline. This means that she may not be able to coordinate her hands together to complete a task. She may have difficulty with scissoring since it requires one hand to cut while the other stabilizes the paper. A student with poor bilateral integration may also have trouble with lacing shoes, jumping jacks, bicycle riding, and threading beads. Sometimes a student may appear “clumsy” and may have a great deal of frustration. Many of my clients have difficulty cutting meats with a fork and knife. This task requires both hands to work together.

Children with bilateral integration difficulty should be given motivating tasks that are specifically planned to be fun. Encourage wording such as “use both hands” or “use your helper hand.”

• Cut worksheets into halves or quarters and ask students to crawl around the room to find the pieces.

• Set up a bakery center and use the hands together to roll, pat, and create pastries out of real or play dough.

• Complete jumping jacks, skip, or do “scissors” by crossing legs over each other when lying on the back.

• Scooter activities in the gym use the entire body.

• Shuffle cards and play card games which require the student to hold the cards in one hand and pick up with the other.

• Provide containers of different sizes to practice opening and closing, place a treat in each one for a fun surprise!

• String beads of different shapes and sizes.

• Use different veggies to stamp onto paper. The dominant hand is the primary one, but the helper hand is needed to stabilize the paper and ink container.

• Squeeze sponges of different shapes. Use colored water for more fun.

• Play hide and seek with various shaped items in putty or dough.

• Tearing paper is a fun activity. Use paper to make a craft.

• Origami uses both hands and is fun.

• Set up a t-ball area at recess or gym and encourage use of both arms to swing at the ball.

• Work on classroom exercises prior to longer lessons. Encourage students to clasp fingers on both hands and move arms across the body in circles—big and small; diagonally; etc. Move to music for relaxation. (Neck rolls are an extra way to relax!)

What Is Vision?

Vision is the ability to see with our eyes. However, we need to make sense of what we’ve seen. We don’t usually consider that our eyes must work together to focus: they must move to see what’s around us; help us to see objects near and far; and they must be able to determine details of what we are looking at. When we have processed all of those things, we can then use our hands together with the information from our eyes to complete a task. Most children have an evaluation of their eyesight performed by an ophthalmologist to rule out problems with vision or have a screening at school. The doctor will use charts with either pictures or letters, examine the eyes with various ophthalmic instruments, and complete tests to look at the structures of the eye. It is at this time glasses may be recommended. Additionally, when a child has headaches, developmental delays, and difficulty in school; I always recommend a functional vision assessment by a developmental (sometimes called a behavioral) optometrist. There can be difficulties not only with visual acuity, but also in the processing of the information we receive via our eyes.

See “Visual Supports” section for more details and for visual accommodations.

What Is Hand-Eye Coordination?

Hand-eye coordination is when the visual system and brain give information to the hands to complete movements necessary to successfully complete tasks such as painting, writing, and catching a ball. Additionally, this skill is used in gross motor movements. When a student plays baseball, he must be able to see the ball coming toward him to either hit or catch it. The eyes and body need to work together so functional activities can be done. It is important to remember that the eyes, hands, and arms make constant small adjustments to ensure that the activity is done successfully. Here are some activities that you can do to work on hand-eye coordination:

• Hang a Koosh or tennis ball from a string on a small hook either in the garage, ceiling, or a doorjamb and have your student use arms individually and then together to hit the ball.

• Encourage your student to lie on his back as you hold the ball on the string. Ask him to hit the ball with the arm(s) you name (left, right, and together).

• While lying on his back, your student can toss the ball up into the air. Therapy catalogues or even discount stores offer balls with many different textures and colors for more variety. Beach balls are slower moving and larger for beginners.

• Build a small tower with blocks and then knock it down for fun!

• Sit on the ground facing each other and roll balls of various sizes to each other.

• Copy shapes or trace them using differently sized puzzle pieces or blocks.

• Pour water with different sized cups.

• Play balloon volleyball.