Improving Handwriting Through Kinaesthetic Sensitivity Practice

Interrelationships of Touch and Proprioception with Motor Impairments in Individuals with Cerebral Palsy: A Systematic Review

Considering that somatosensory impairments may impact motor performance in individuals with cerebral palsy (CP), a better understanding of these relations is relevant to planning interventions. To synthesize research evidence to date on the interrelationships between the somatosensory functions of touch and proprioception with motor functions in persons with CP, we systematically searched Embase, CINAHL, PsycINFO, and Medline databases for studies relating these variables that were published in English from the inception of these databases to November 2020. We targeted the following content categories in our literature search: (a) cerebral palsy; (b) sensory functions; (c) tactile functions; (d) proprioception functions; and (e) motor functions. The selection, data extraction, and methodological quality assessment of these studies were performed in duplicate. We retrieved and analyzed information regarding the studies' methodological approaches and synthesized results. The 11 studies that met our inclusion criteria showed that, in individuals with CP, impairments in tactile discrimination, proprioception, and stereognosis are related to motor functions in terms of overall manual ability, grip strength, postural control and locomotion. Thus, clinical practitioners should attend to somatosensory aspects of motor impairment in individuals with CP. More research is needed to clarify the direction of these associations.

Signing below the dotted line: signature position as a marker of vulnerability for visuospatial processing difficulties

Almost one-third of the participants in a neuropsychological study signed the consent form below the given line. The relationship between a signature position on or below the line and participants' cognitive function was investigated. Fifty drug-dependent individuals, 50 of their siblings, and 50 unrelated control participants completed a battery of neuropsychological tests using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Individuals signing below, rather than on, the line performed more poorly on tests of visuospatial memory, but no differently on other cognitive tests. Signature positioning may be a soft sign for impairment of the mechanisms involved in visuospatial memory.

Efficacy of an Explicit Handwriting Program

The aim of this study was to investigate the effects of an explicit handwriting program introduced during the first grade of elementary school. Grade 1 children ( N = 23) with an age range of 6.1 to 7.4 yr. (15 girls, 8 boys) were administered an additional handwriting program of two weekly sessions of 45 min. over six weeks. Another group of 19 Grade 1 children (11 girls, 8 boys) received only the regular handwriting program of one weekly session. The Concise Assessment Scale for Children's Handwriting was administered to measure the changes in quality and speed of handwriting. The children given the explicit program showed better quality and speed of handwriting than did the control group. Their handwriting was more regular, with fewer ambiguous letters and fewer incorrect relative heights.

A Systematic Review of Interventions to Improve Handwriting

Background. Handwriting difficulties are among the most common reasons for referral of children to occupational therapy. Purpose. To determine the effectiveness of handwriting interventions. Methods. A systematic review was carried out. Included studies were randomized or nonrandomized controlled trials of interventions that could be used by an occupational therapist to improve written output (printing or writing) among school-aged children identified as having difficulties with handwriting. Electronic searches of relevant databases were conducted up to January 2010. Findings. Eleven studies met the inclusion criteria. These studies tested (1) relaxation and practice with or without EMG, (2) sensory-based training without handwriting practice, and (3) handwriting-based practice (including sensory-focused or cognitive focused handwriting practice). Regardless of treatment type, interventions that did not include handwriting practice and those that included less than 20 practice sessions were ineffective. Implications. Effective occupational therapy for improving handwriting must include adequate handwriting practice.

Kinesthetic sensitivity and related measures of hand sensitivity in children with nonproficient handwriting

PURPOSE

This study compared measures of hand sensitivity and handwriting quality in children aged 10 to 12 years identified by their teachers as having nonproficient or proficient handwriting. We hypothesized that children with nonproficient handwriting have decreased kinesthetic sensitivity of the hands and digits.

METHODS

Sixteen subjects without documented motor or cognitive concerns were tested for kinesthetic sensitivity, discriminate tactile awareness, diadochokinesia, stereognosis, and graphesthesia. Eight children were considered to have nonproficient handwriting; 8 had proficient handwriting. Nonparametric Mann-Whitney U tests were used to identify differences between groups on sensory tests.

RESULTS

The 2 groups showed a statistically significant difference in handwriting legibility (P = .018). No significant difference was found on tests of kinesthetic sensitivity or other measures of sensation.

CONCLUSIONS

Children presenting with handwriting difficulty as the only complaint have similar sensitivity in hands and digits as those with proficient handwriting. Failure to detect differences may result from a small sample size.

Handwriting development, competency, and intervention

Failure to attain handwriting competency during the school-age 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, in-hand 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.

Evaluation of the kinesthetic sense and function of the hand in early period in operated cervical disc hernia

A prospective study made into cervical disc hernias. To determine the kinesthetic sense and hand functions, which are important for the patients with cervical disc hernia to return to work life and daily activities that need skill. Neurosurgical department. Data Symptoms in cervical disc hernias and hand functions are affected depending on long-term pain. The evaluation of the hand is essential in assessing the patients' overall recovery and ability to return to daily activities and work life. Thirty-four patients with cervical disc hernia, who were operated on, were included in the study. Eight different test positions in the assessment of the hand's kinesthetic sense and hand function sort (HFS) in the evaluation of the hand function were applied. The disability levels of the patients were determined with The Neck Pain and Disability Scale, on the preoperative and postoperative discharge day and in the postoperative second month. Patients were divided into groups according to the side involved. In the evaluation of the kinesthetic test of the hand, only in the postoperative second month was a significant difference observed between the 1, 2, 3, and 4 test positions of the right side of the groups. On the other hand, no significant difference was found between the groups in the assessment of the hand function. In the measurement of hand functions and disability levels, strong and important correlations were determined. An early assessment of the hand's kinesthetic sense and function is instrumental in the patients' evaluation of recovery and resumption of work.

Low elementary movement speed is associated with poor motor skill in Turner's syndrome

The article aims to discriminate between 2 features that in principle both may be characteristic of the frequently observed poor motor performance in girls with Turner's syndrome (TS). On the one hand, a reduced movement speed that is independent of variations in spatial accuracy demands and therefore suggests a problem in motor execution. On the other hand, a disproportional slowing down of movement speed under spatial-accuracy demands, indicating a more central problem in motor programming. To assess their motor performance problems, 15 girls with TS (age 9.6-13.0 years) and 14 female controls (age 9.1-13.0 years) were tested using the Movement Assessment Battery for Children (MABC). In additionally, an experimental procedure using a variant of Fitts' graphic aiming task was used to try and disentangle the role of spatial-accuracy demands in different motor task conditions. The results of the MABC reestablish that overall motor performance in girls with TS is poor. The data from the Fitts' task reveal that TS girls move with the same accuracy as their normal peers but show a significantly lower speed independent of task difficulty. We conclude that a problem in motor execution is the main factor determining performance differences between girls with TS and controls.

Hand positioning sense in children with spina bifida myelomeningocele

This study was undertaken to establish whether children with myelomeningocele have abnormal kinaesthesia of the hands. Twenty-one children with myelomeningocele and 21 control children aged between six and 12 years were involved in the study. The level of kinaesthetic awareness in the hands was measured by examining the child's ability to copy hand positions, using visual cueing and kinaesthetic cueing. Both accuracy and speed of copying hand gestures were assessed. Children with spina bifida were significantly less accurate in achieving hand positions than the control group (chi square(1) = 22.60, p < 0.001), with 73% of the children with spina bifida achieving accurate replications compared with 87% in the control group. Furthermore, children with myelomeningocele were shown to be slower than the controls (F(1,280) = 15.49, p < 0.001). The impaired kinaesthetic awareness found in this study is considered to be one of the factors behind the poor hand function observed in children with myelomeningocele.

Kinaesthetic acuity and fine motor skills in children with attention deficit hyperactivity disorder: a preliminary report

Two groups of 9-year-old children (24 children with attention deficit hyperactivity disorder [ADHD] and 24 controls) were assessed for kinaesthetic acuity and fine motor skills with medication withdrawn. Results showed significantly poorer performance on both tasks for children with ADHD, but only a weak association between fine motor and kinaesthetic performance. The implications are discussed, particularly the role of attention to proprioceptive signals in children with the diagnosis of ADHD.