Handwriting development, competency, and intervention

Cognitive strategies utilised by early learners when writing alphabet-letters from memory

INTRODUCTION

Occupational therapy handwriting studies have shown cognitive instructional techniques are effective methods to assist beginning or challenged handwriters. However, information about how children's cognitive (thinking) skills impact their handwriting development is scarce. This study examined the cognitive strategy efficiency of early learners while writing the alphabet-letters from memory.

METHODS

Participants included 408 mainstream children in their first two years of formal schooling (Year 1 and Year 2). Children were asked to write the 26-lowercase alphabet-letters from memory. Data were collected using alphabet-letters generated by the children and observation of their cognitive strategy use while writing. The measurement tool employed was the Perceive, Recall, Plan, and Perform (PRPP) System of Task Analysis (Stage Two).

RESULTS

The results found that Year 1 and Year 2 children had difficulties applying cognitive strategies across all four PRPP quadrants while writing the lowercase alphabet-letters from memory. Application of the cognitive strategies from the Plan and Recall quadrants showed the most inefficiencies. The lowest PRPP subquadrant scores were observed in Evaluating, Recall Facts, Sensing, and Programming. Except for the Attending subquadrant and the descriptor 'Regulates', Year 2 children were significantly better than Year 1 children at applying cognitive strategies from all other PRPP quadrants and subquadrants.

CONCLUSION

The findings provide beginning evidence that efficient use of cognitive strategies from all four PRPP quadrants is important for children achieving proficiency in accurate and automatic alphabet-letter-writing skills. Recommendations for occupational therapy handwriting assessment and intervention are provided.

PLAIN LANGUAGE SUMMARY

Research suggests that occupational therapists can best help children with handwriting difficulties by using a cognitive approach. This approach involves instructing children how to form letters correctly, encouraging self-evaluation, and providing opportunities to practice handwriting. However, the cognitive (thinking) skills required for children to write alphabet-letters accurately are not well understood. To investigate this, a study was conducted on 408 mainstream children in their first two years of formal schooling (Year 1 and Year 2). The study examined how accurately the children could write lowercase alphabet-letters from memory and which cognitive skills they used to do so. The cognitive skills investigated were related to attention, perception, recalling, planning, and performing. The assumption tested was that mistakes in correctly writing alphabet-letters could be attributed to difficulties in using these cognitive skills effectively. The study found that Year 1 and Year 2 children made errors in over half of the 26-lowercase alphabet-letters they wrote. The cognitive skills, which scored the lowest were children's ability to evaluate their writing, recall how and where to write letters, gather information from their vision, and think carefully to ensure accuracy while writing. This implied that these thinking skills had the most impact on the children's ability to write alphabet-letters correctly. More research is needed to confirm these findings and determine the reliability of the tool used in this study to measure the children's thinking skills.

Handwriting speed in juvenile idiopathic arthritis using the detailed assessment of speed of handwriting

BACKGROUND

Handwriting is a commonly reported functional limitation for children with juvenile idiopathic arthritis (JIA). The aim of this study was to evaluate handwriting in children with JIA.

FINDINGS

Twelve children (mean age 13.0 years, SD = 1.9; range 9.1 to 15.6 years) with JIA completed the Detailed Assessment of Speed of Handwriting (DASH). The presence of hand and wrist arthritis, grip strength, disability, pain, and quality of life (QOL) was also assessed. The mean DASH score was 34.5th percentile (SD = 22.5). Eight (75%) scored below the 50th centile. DASH scores were negatively associated with grip strength (r = -0.31).

CONCLUSIONS

Handwriting difficulties are common in children with JIA. Handwriting assessment may be helpful to direct treatments, and advocate for support and accommodations in school.

Evaluating handwriting in children with developmental coordination disorder (DCD): Temporal, spatial, pressure and grip-force measures

BACKGROUND

Writing involves complex sensorimotor and biomechanical processes that regulate pressure on the writing surface. Researchers analyze writing to understand kinetics and kinematics by evaluating temporal, spatial, and pressure aspects, yet discerning writing surface pressure and pen-grip force remains challenging.

AIMS

To compare handwriting kinetics (pen grip-force and surface pressure) and kinematics (temporal-spatial) of children with developmental coordination disorder (DCD) with those of typically developing (TD) children.

METHODS AND PROCEDURES

Twenty-seven children with DCD aged 7-12 years and 27 TD children matched by age and gender copied a 29-word passage onto a computerized tablet. Temporal, spatial and surface pressure as well as pen grip-force were measured with a tablet and a wearable device respectively.

OUTCOMES AND RESULTS

The DCD group displayed significantly longer total writing time, mean letter time, and greater letter height, width, variance, spacing, area, and erasures than the TD group. Although there were no significant between-group differences in the surface pressure or maintaining pressure, the DCD group displayed weaker grip-force, p = .01, with greater variance.

CONCLUSIONS AND IMPLICATIONS

The DCD group's weaker grip-force dynamics correlated with reduced legibility, form, and prolonged writing duration, revealing insights into handwriting mechanisms, particularly grip force, crucial for effective clinical interventions.

Effects of routine physical therapy with and without kinesio taping in improving gross motor function in sitting and standing in spastic diplegic cerebral palsy children

OBJECTIVE

To determine the effectiveness of Kinesio taping along with routine physical therapy on improving gross motor function in sitting and standing among spastic diplegic Cerebral Palsy children.

DESIGN

Randomized controlled trial.

SETTINGS

University Teaching Hospital University of Lahore, Lahore.

PARTICIPANTS

53 participants with diagnosed spastic diplegic cerebral palsy were randomly allocated in control and experimental groups.

INTERVENTION

26 Participants were treated by kinesio taping which was applied in a criss-cross manner along with routine physical therapy program while the control group (n = 27) received NDT exercise program that comprises of stretching, functional reaching, weight-bearing exercises and walking.

OUTCOME MEASURE

Gross motor function was assessed using 2 components of Gross Motor Function Classification System (GMFCS-88), i.e., sitting as well as standing at the base line and after every 3rd week for 12 weeks follow up.

RESULTS

In study and control group the mean score of gross motor function for sitting at baseline was 33.96 ± 3.11 and 31.50 ± 3.32 respectively. After intervention, it changed to 47.70 ± 5.46 and 43.46 ± 1.81 respectively. Mean score for Gross Motor Function calculated at base line in study and control group for standing was 27.37 ± 1.14 and 26 ± 3.01 respectively. At the end of intervention, the score improved to 36.55 ± 4.27 and 33.69 ± 2.46 respectively.

CONCLUSION

In comparison to control group, significant increase in gross motor function of intervention group was seen after the 12 weeks of intervention. In this way, over back muscles the application of kinesio tape in a Criss-Cross manner may be helpful. Also it can be used as an additional approach along with routine physical therapy to improve standing and sitting in spastic diplegic children.

Visual-motor integration in children with unilateral cerebral palsy: application of the computer-aided measure of visual-motor integration

BACKGROUND

Children with unilateral cerebral palsy (UCP) are encouraged to participate in the regular school curriculum. However, even when using the less-affected hand for handwriting, children with UCP still experience handwriting difficulties. Visual-motor integration (VMI) is a predictor of handwriting quality. Investigating VMI in children with UCP is important but still lacking. Conventional paper-based VMI assessments is subjective and use all-or-nothing scoring procedures, which may compromise the fidelity of VMI assessments. Moreover, identifying important shapes that are predictive of VMI performance might benefit clinical decision-making because different geometric shapes represent different developmental stepping stones of VMI. Therefore, a new computer-aided measure of VMI (the CAM-VMI) was developed to investigate VMI performance in children with UCP and to identify shapes important for predicting their VMI performance.

METHODS

Twenty-eight children with UCP and 28 typically-developing (TD) children were recruited. All participants were instructed to complete the CAM-VMI and Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI). The test items of the CAM-VMI consisted of nine simple geometric shapes related to writing readiness. Two scores of the CAM-VMI, namely, Error and Effort, were obtained by image registration technique. The performances on the Beery-VMI and the CAM-VMI of children with UCP and TD children were compared by independent t-test. A series of stepwise regression analyses were used to identify shapes important for predicting VMI performance in children with UCP.

RESULTS

Significant group differences were found in both the CAM-VMI and the Beery-VMI results. Furthermore, Error was identified as a significant aspect for predicting VMI performance in children with UCP. Specifically, the square item was the only significant predictor of VMI performance in children with UCP.

CONCLUSIONS

This study was a large-scale study that provided direct evidence of impaired VMI in school-aged children with UCP. Even when using the less-affected hand, children with UCP could not copy the geometric shapes as well as TD children did. The copied products of children with UCP demonstrated poor constructional accuracy and inappropriate alignment. Furthermore, the predictive model suggested that the constructional accuracy of a copied square is an important predictor of VMI performance in children with UCP.

Qualitative age-related changes in fine motor skill performance among 3- to 6-year-old typically developing children

This study described intra-task fine motor skill components of the Manual Dexterity tasks (Posting Coins; PC, Threading Beads; TB, Drawing Trail; DT) of the Movement Assessment Battery for Children-2 Test for typically developing children and investigated age- and sex-related differences. Three- to six-year-old Dutch children (n = 182, Mage 4.5 ± 1.1 years, 51.1% boys) were observed with regard to intra-task fine motor skill components, and changes in intra-task components of the Manual Dexterity tasks were analyzed across age using of the Kruskal-Wallis test with post-hoc Mann-Whitney U tests, and differences between sexes using the Mann-Whitney U test. The following intra-task components were observed: grip type, manipulation, non-dominant or non-writing hand, grip position, posture, head, coin placement, placement of the bead on the lace tip and joint movement. Results showed that the younger children (3-year-olds) more frequently used a grasp with the full hand (PC, TB), more often put the coin on the container and sliding it in (PC), more often supported the side or top of the container (PC), used more bi-manual manipulation (transferring from hand-to-hand or hand, body or surface assist) (TB, DT), more frequently used primitive, too high grips, predominantly used their proximal joints, and did not support the paper (DT). This in comparison with more frequent use of three-point pinch, direct coin placement, grabbing the front or back of the container, in-hand-manipulation, mature grips and correct height, distal joint use and supporting the paper from the side or below by most 5- and 6-year-olds. Furthermore, most sex-related differences were found in the younger age-groups (3- and 4-year-olds) in the DT tasks with girls outperforming boys. Results from this study add to the knowledge on qualitative fine motor skill performance in a convenience sample of 3- to 6-year-old typically developing children. A limitation of the current study was the relatively small sample size of 6-year-old children. The strength of the current study is its novelty in providing qualitative descriptions of intra-task fine motor skill components in typically developing 3- to 6-year-old children.

The internal structure of handwriting proficiency in beginning writers

Fluent and automatized handwriting frees cognitive resources for more complex elements of writing (i.e., spelling or text generation) or even math tasks (i.e., operating) and is therefore a central objective in primary school years. Most previous research has focused on the development of handwriting automaticity across the school years and characteristics of handwriting difficulties in advanced writers. However, the relative and absolute predictive power of the different kinematic aspects for typically developing beginning handwriting remains unclear. The purpose of the present study was to investigate whether and to what extent different kinematic aspects contribute to handwriting proficiency in typically developing beginning handwriters. Further, we investigated whether gender, socioeconomic background, or interindividual differences in executive functions and visuomotor integration contribute to children's acquisition of handwriting. Therefore, 853 first-grade children aged seven copied words on a digitized tablet and completed cognitive performance tasks. We used a confirmatory factor analysis to investigate how predefined kinematic aspects of handwriting, specifically the number of inversions in velocity (NIV), pen stops, pen lifts, and pressure on the paper, are linked to an underlying handwriting factor. NIV, pen stops, and pen lifts showed the highest factor loadings and therefore appear to best explain handwriting proficiency in beginning writers. Handwriting proficiency was superior in girls than boys but, surprisingly, did not differ between children from low versus high socioeconomic backgrounds. Handwriting proficiency was related to working memory but unrelated to inhibition, shifting, and visuomotor integration. Overall, these findings highlight the importance of considering different kinematic aspects in children who have not yet automatized pen movements. Results are also important from an applied perspective, as the early detection of handwriting difficulties has not yet received much research attention, although it is the base for tailoring early interventions for children at risk for handwriting difficulties.

Kindergarten Visual-Perceptual and Motor Skills and Behavioral Traits Predict First-Grade Chinese Handwriting Legibility and Speed

IMPORTANCE

Clarifying the relationship between kindergarteners' characteristics and their future handwriting performance is beneficial for the early detection of children at risk of handwriting difficulties.

OBJECTIVE

To determine which visual-perceptual and motor skills and behavioral traits significantly predict kindergartners' Chinese handwriting legibility and speed in the first grade.

DESIGN

One-year longitudinal, observational design.

SETTING

Kindergarten and elementary schools.

PARTICIPANTS

One hundred six kindergarten children (53 boys and 53 girls; ages 5 or 6 yr) were recruited.

OUTCOMES AND MEASURES

The participants completed two subtests of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, Test of Visual Perceptual Skills-Third Edition, Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery™ VMI), and the Attention-Deficit/Hyperactivity Disorder Test-Chinese Version in kindergarten. Their handwriting legibility (character accuracy and construction) and speed were assessed by investigator-developed Chinese handwriting tests in the first grade.

RESULTS

Multivariate regression analyses indicated the independent predictive power of spatial relationships (p = .042) and inattention (p = .004) for character accuracy. Visual-motor integration (VMI; p = .008) and inattention (p = .002) were the key predictors of character construction. Manual dexterity (p = .001) was the only significant predictor of writing speed.

CONCLUSIONS AND RELEVANCE

Kindergarteners who perform poorly in spatial relationships, VMI, manual dexterity, and attention are likely to have less legible Chinese handwriting and slow writing speed in first grade. Plain-Language Summary: Children's visual-perceptual and motor skills and behavioral traits in kindergarten can predict their Chinese handwriting legibility and speed in first grade. This study found that kindergarteners who performed poorly in spatial relationships, VMI, manual dexterity, and attention were likely to have less legible Chinese handwriting and slow writing speed in the first grade.

Exploring cerebral laterality of writing and the relationship to handedness: a functional transcranial Doppler ultrasound investigation

Cerebral lateralization of oral language has been investigated in a plethora of studies and it is well established that the left hemisphere is dominant for production tasks in the majority of individuals. However, few studies have focused on written language and even fewer have sampled left-handers. Writing comprises language and motor components, both of which contribute to cerebral activation, yet previous research has not disentangled. The aim of this study was to disentangle the language and motor components of writing lateralization. This was achieved through the comparison of cerebral activation during (i) written word generation and (ii) letter copying, as assessed by functional Transcranial Doppler (fTCD) ultrasound. We further assessed cerebral laterality of oral language. The sample was balanced for handedness. We preregistered the hypotheses that (i) cerebral lateralization of the linguistic component of writing would be weaker in left-handers compared to right-handers and (ii) oral language and the linguistic component of written language would not be correlated in terms of cerebral lateralization. No compelling evidence for either of our hypotheses was found. Findings highlight the complexity of the processes subserving written and oral language as well as the methodological challenges to isolate the linguistic component of writing.

Effects of methylphenidate and physiotherapeutic treatment on graphomotor movements in children with ADHD

In addition to the core symptoms defining ADHD, affected children often experience motor problems; in particular, graphomotor movements including handwriting are affected. However, in clinical settings, there is little emphasis on standardized and objective diagnosing and treatment of those difficulties. The present study investigated for the first time the effects of methylphenidate as well as physiotherapeutic treatment on objectively assessed graphomotor movements compared to a control condition, i.e. parental psychoeducation, in 58 children (mean age: 9.52 ± 1.91 years) newly diagnosed with ADHD in an outpatient clinic for child and adolescent psychiatry. Families were invited to join one of the treatment groups. Before and after 8 weeks of treatment, children performed six different tasks on a digitizing tablet which allowed the objective analysis of three important kinematic parameters of graphomotor movements (fluency, velocity, and pen pressure) in different levels of visual control and automation. Graphomotor movement fluency and velocity improves over time across the groups, especially in tasks with eyes closed. We did not find clear evidence for beneficial effects of methylphenidate or physiotherapeutic treatment on children's overall graphomotor movements suggesting that treatments need to be better tailored towards specific and individual deficits in graphomotor movements.

Is There a Deficit in Product and Process of Handwriting in Children with Attention Deficit Hyperactivity Disorder? A Systematic Review and Recommendations for Future Research

Handwriting abnormalities in children with attention deficit hyperactivity disorder (ADHD) have sometimes been reported both (i) at the product level (i.e., quality/legibility of the written trace and speed of writing) and (ii) at the process level (i.e., dynamic and kinematic features, such as on-paper and in-air durations, pen pressure and velocity peaks, etc.). Conversely, other works have failed to reveal any differences between ADHD and typically developing children. The question of the presence and nature of handwriting deficits in ADHD remains open and merits an in-depth examination. The aim of this systematic review was, therefore, to identify studies that have investigated the product and/or process of handwriting in children with ADHD compared to typically developing individuals. This review was conducted and reported in accordance with the PRISMA statement. A literature search was carried out using three electronic databases. The methodological quality of the studies was systematically assessed using the Critical Appraisal Skills Program (CASP) criteria. Twenty-one articles were identified. Of these, 17 described handwriting quality/legibility, 12 focused on speed and 14 analyzed the handwriting process. All the studies (100%) with satisfactory methodology procedures reported an impaired product and process in children with ADHD, while 25% evidenced a difference in the speed of production. Most importantly, the studies differed widely in their methodological approaches. Substantial gaps remain, particularly with regard to ascertaining comorbidities, ADHD subtypes and the medical status of the included children. The lack of overall homogeneity in the samples calls for higher quality studies. We conclude with recommendations for further studies.

Relationships between Math Skills, Motor Skills, Physical Activity, and Obesity in Typically Developing Preschool Children

There is evidence of a relationship between motor and cognitive development. The literature has shown that of all the motor skills, fine motor skills are those that contribute most to mathematical performance in preschool children. As this is a sensitive period in the development of motor skills, low levels of physical activity in this period can compromise their development and contribute to weight gain and obesity. The aim of this study was therefore to analyze the relationship between mathematical and motor skills, physical activity levels, and obesity. The sample consisted of 62 preschool children (32 males) with an average age of 4.63 ± 0.81. The Weschler preschool and primary scale of intelligence-revised arithmetic test was used to assess mathematical skills. The tests to assess fine motor skills were the "Adapted Threading Beads Test" and the "Adapted Visuomotor Integration Test". The movement assessment battery for children-2, band 1, "Aiming & Catching", and "Balance" tests were used to assess gross motor skills. Levels of physical activity were assessed using the "Preschool-age physical activity questionnaire" and obesity using the body mass index. The results indicated that only the fine motor skills of visuomotor integration were included in the multiple linear regression model (F < 0.001; r = 0.464; R2 = 0.215; p < 0.001), with the exclusion of gross motor skills, physical activity levels, and obesity levels. Thus, it was concluded that mathematical skills were only directly and significantly influenced by visuomotor integration. However, visuomotor integration was positively and significantly associated with gross motor skills (r = 0.269; p < 0.05) and not with levels of physical activity and obesity. Thus, gross motor skills could contribute to improving visuomotor integration directly and consequently mathematical skills indirectly. The results of this study suggest that the implementation of structured physical activity programs can contribute to mathematical performance.

From Scribbles to Script: Graphomotor Skills' Impact on Spelling in Early Primary School

The acquisition of handwriting skills is a crucial goal in early primary school. Yet our comprehension of handwriting development, encompassing graphomotor skills and spelling, remains fragmented. The identification of predictors for handwriting skills is essential for providing early support. This longitudinal study aimed to explore the predictive roles of gender, working memory, and motivation to handwrite for graphomotor skills six months later and spelling skills one year later. Paper-and-pencil tasks (graphomotor skills, spelling), a tablet task (working memory), and a questionnaire (teachers' ratings of children's handwriting motivation) were employed. This study included 363 first-grade children (49.8% girls) aged 6-9 years. Results from a structural equation model, controlling for age and socioeconomic background, revealed that girls exhibited superior performance in graphomotor skills, while boys tended to spell more accurately. Furthermore, working memory predicted graphomotor skills but not spelling. Additionally, motivation to handwrite predicted both first-grade graphomotor skills and second-grade spelling. This study extends contemporary evidence, demonstrating that graphomotor skills predict spelling while considering gender and motivation. The findings underscore the pivotal role of graphomotor skills in spelling acquisition and suggest their contribution to spelling difficulties.

Handwriting legibility and fluency and their patterns of concurrent relations with spelling, graphomotor, and selective attention skills

Recent research suggests that handwriting comprises two separate subskills: legibility and fluency. It remains unclear, however, how these subskills differ in their relationship to other abilities associated with handwriting, including spelling, graphomotor, and selective attention skills. In this study, we sought to examine the extent and nature of concurrent relationships that may exist among these skills. Children in Year 3 (n = 293), Year 4 (n = 291), and Year 5 (n = 283) completed a large, group-administered battery to assess each of the above skills. Using multigroup structural equation modeling, we found that spelling, graphomotor, and selective attention skills together explained a moderate amount of variance in handwriting legibility (R2 = .37-.42) and fluency (R2 = .41-.58) and that these subskills differed in their concurrent relations. Graphomotor skills accounted for a relatively greater proportion of variance in legibility than did spelling. Conversely, there were relatively stronger contributions from variations in spelling ability to variations in fluency than from graphomotor skills. Furthermore, selective attention predicted handwriting fluency only, and it partially mediated the influence of graphomotor skills. This study further demonstrates that handwriting legibility and fluency are separable and complex skills, each differentially related to spelling, graphomotor, and attentional abilities even during later primary school years.

Exploratory Investigation of Handwriting Disorders in School-Aged Children from First to Fifth Grade

Handwriting disorders (HDs) are prevalent in school-aged children, with significant interference with academic performances. The current study offers a transdisciplinary approach with the use of normed and standardized clinical assessments of neuropsychomotor, neuropsychological and oculomotor functions. The aim is to provide objective data for a better understanding of the nature and the etiology of HDs. Data from these clinical assessments were analyzed for 27 school-aged children with HD (first to fifth grade). The results underline a high heterogeneity of the children presenting HDs, with many co-occurrences often unknown. However, it was possible to highlight three levels of HDs based on BHK scores: mild HD not detected by the BHK test (26% of children), moderate HD (33%) and dysgraphia (41% of children). The mild nature of the HDs not detected by the BHK test appears to occur at a relatively low frequency of the associated disorders identified during clinical evaluations. On the contrary, dysgraphia appears to be associated with a high frequency of co-occurring disorders identified in the clinical assessment, with a predominance of oculomotor disorders (55% of children), leading to visual-perceptual difficulties and a high level of handwriting deterioration. Finally, children with moderate HD have fewer co-occurrences than children with dysgraphia, but have more difficulties than children with mild HD. This highlights the importance of differentiating between different degrees of HDs that do not respond to the same semiologies. Our findings support the interest in performing a transdisciplinary and standardized clinical examination with developmental standards (neuropsychomotor, neuropsychological and oculomotor) in children with HD. Indeed, HDs can therefore be associated with a multitude of disorders of different natures ranging from poor coordination of the graphomotor gesture to a more general and more complex impairment affecting perceptual-motor, cognitive and/or psycho-affective functions.

Reliability, validity, and measurement invariance of a Chinese handwriting legibility scale among primary students in central China

Background

Chinese handwriting has a close relationship with spatial cognition, and the legibility dimension is prominent with its spatial-oriented characteristics. However, handwriting evaluation focusing on the detailed spatial aspects of the legibility dimension in the Chinese context is rare.

Aims and methods

We aimed to develop a Chinese Handwriting Legibility Scale (CHLS) and examine its reliability, validity, and measurement invariance among Chinese primary students of different grades. A total of 684 students aged 8-12 years were recruited from a mainstream primary school in central China and were asked to copy a Chinese template as legibly as possible within 4 min. The developed CHLS was used to assess these students' legibility performance.

Results

The seven-criteria CHLS favored content validity. The inter-rater reliability was good; however, the scoring instructions need to be refined. Principal component analysis (PCA) revealed a one-factor solution explaining 62.336% of the variance of the seven-criteria CHLS, and confirmatory factor analysis (CFA) confirmed its appropriateness. There was a high internal consistency (α = 0.902). In terms of measurement invariance, the factor structures and loadings of the CHLS were consistent across students of different grades; however, significant intercept variations were detected between students of Grades 2 and 4.

Conclusion

CHLS may be effective for evaluating Chinese handwriting legibility performance in the Chinese primary school context in the central region. Students' Chinese handwriting legibility performance may have developmental specificity in different grades.

Preliminary Adaptation of Motor Tests to Evaluate Fine Motor Skills Associated with Mathematical Skills in Preschoolers

Mathematics is the subject in which many school-age children reveal difficulties. The literature has shown that fine motor skills, namely fine motor coordination and visuomotor integration, have been more robustly associated with mathematical performance. Studies have shown the importance that instruments have to evaluate these skills, however, the characteristics of these instruments do not fit the reality of kindergartens, they are usually time consuming and expensive and are usually administered by specialists. Thus, the main objective of this study was to identify, select, adapt and validate motor tests to evaluate fine motor skills associated with mathematical skills to allow the kindergarten teachers to apply them simultaneously to the class, with few material resources, in a short period of time and without the need for a lot of training to apply, score and classify. For this purpose, firstly, it was necessary to understand the main difficulties highlighted by kindergarten teachers regarding the use of instruments to evaluate fine motor skills and, thus, elaborate criteria to identify and select the tests that best fit the reality of kindergartens. The test identified, selected and adapted to evaluate fine motor coordination was threading beads from the Movement Evaluation Battery for Children, 2nd Edition. The main adaptation of the test was related to time, that is, instead of counting the time it takes the child to string the total number of cubes on the string, we counted the number of cubes the child strung on the string in a pre-defined time. To evaluate visual-motor integration, the test identified, selected and adapted was the Visual-Motor Integration (6th Edition) test. The main adaptation was related to material resources, that is, it will be possible to apply the test using only one sheet per child instead of the seven suggested by the original test. After the preliminary adaptation of the tests, their validation was performed by means of the degree of reliability (test-retest) and predictive validity. The results indicated that the adapted tests presented an excellent degree of reliability (>0.9) and could therefore be used to administer them simultaneously to the class group. The adapted Visual-Motor Integration test seems to be the most suitable one to be used by kindergarten teachers, in a classroom context, to simultaneously evaluate students' fine motor skills and associate their results with mathematical skills.

Is it possible to estimate sex from signatures and handwriting? A review of literature, observations, and future perspectives

Estimation of sex holds great significance in the field of Forensic Science since it helps establish the identity of an individual during a crime scene investigation. Sex differences in human behaviour are the result of natural selection. Sexually dimorphic stimuli of cognitive and behavioural activities may influence the phenotypic expression of our motor skills. Human traits such as signatures and handwriting are phenotypic manifestation of these skills. These phenotypic biological and behavioural traits have inherent sexual dimorphism and may help to identify sex in different circumstances. For instance, to establish the sex of an individual or deceased, forensic samples of the human body such as voice samples, features of fingerprints and footprints, the skeleton, or its remains are helpful. Similarly, the sex of an individual may also be identified from their corresponding handwriting and signature. Handwriting experts can extract peculiar features from handwriting and signatures which could help establish whether the signatures belong to a male or a female. A female writer may have attractive, rounded, upright, tidy, skilled, well-formed strokes, artistic design, better penmanship, and greater length of the signature compared to the signature of a male. Here, we review the studies related to the identification of sex from signatures and handwriting and present inferences about vital features and methods of sex identification through handwriting. These mainly suggest that the accuracy of sex prediction from signature and handwriting ranges from 45 to 80%. We also present writing examples to show sex-based differences in the signature and handwriting of males and females. The female's handwriting is more decorative, arranged, aligned, neat, and clean as compared to that of the male. Based on the writing samples and the review of literature, we suggest that forensic handwriting experts may eliminate suspects based on the sex of the writer, which can simplify the identification process of disputed or questionable signatures and handwriting.

Teaching and Rehabilitation of Handwriting for Children in the Digital Age: Issues and Challenges

Handwriting is a determining factor for academic success and autonomy for all children. Making knowledge accessible to all is a challenge in the context of inclusive education. Given the neurodevelopmental diversity within a classroom of children, ensuring that the handwriting of all pupils progresses is very demanding for education professionals. The development of tools that can take into account the variability of the profiles and learning abilities of children with handwriting difficulties offers a new potential for the development of specific and adapted remediation strategies. This narrative review aims to present and discuss the challenges of handwriting learning and the opportunities offered by new technologies involving AI for school and health professionals to successfully improve the handwriting skills of all children.

Handwriting Evaluation Using Deep Learning with SensoGrip

Handwriting learning disabilities, such as dysgraphia, have a serious negative impact on children's academic results, daily life and overall well-being. Early detection of dysgraphia facilitates an early start of targeted intervention. Several studies have investigated dysgraphia detection using machine learning algorithms with a digital tablet. However, these studies deployed classical machine learning algorithms with manual feature extraction and selection as well as binary classification: either dysgraphia or no dysgraphia. In this work, we investigated the fine grading of handwriting capabilities by predicting the SEMS score (between 0 and 12) with deep learning. Our approach provided a root-mean-square error of less than 1 with automatic instead of manual feature extraction and selection. Furthermore, the SensoGrip smart pen SensoGrip was used, i.e., a pen equipped with sensors to capture handwriting dynamics, instead of a tablet, enabling writing evaluation in more realistic scenarios.

Handwriting Quality: Psychometric Properties of Two Evaluation Scales With a Czech Sample

IMPORTANCE

Approximately 7% to 30% of children contend with handwriting issues (HIs) in their school years. However, research studies to define and quantify HIs, as well as practical assessment tools, are lacking.

OBJECTIVE

To confirm the validity and reliability of two screening scales for HIs: the Handwriting Legibility Scale (HLS) and the Concise Assessment Scale of Children's Handwriting (BHK).

DESIGN

Structural equation modeling (SEM) and confirmatory factor analysis (CFA) of five different models were used to examine the construct and discriminant validity of both scales. Furthermore, internal consistency and interrater agreement were evaluated. The association among scales, grades, and children's self-evaluation was also explored.

SETTING

Elementary schools and state counseling centers in the Czech Republic.

PARTICIPANTS

On a voluntary basis, 161 children from elementary schools and state counseling centers in the Czech Republic were enrolled. The variable of children with typical handwriting development versus HIs was missing for 11 children. Thus, for discriminant validity analysis, 150 data records from children were used.

OUTCOMES AND MEASURES

The HLS and BHK were used to evaluate the handwriting quality of the transcription task. The Handwriting Proficiency Screening Questionnaires for Children was used for children's self-evaluation.

RESULTS

The study confirmed the validity and reliability of the shortened BHK and HLS. A strong relationship was found between the BHK and HLS, grades, and children's self-evaluation.

CONCLUSIONS AND RELEVANCE

Both scales are recommended for occupational therapy practice worldwide. Further research should focus on developing standards and providing sensitivity studies. What This Article Adds: Both the HLS and the BHK are recommended for occupational therapy practice. Practitioners should also take the child's well-being into consideration in handwriting quality assessment.

Attention-Deficit/Hyperactivity Disorder and Academic Functioning: Reading, Writing, and Math Abilities in a Community Sample of Youth with and without ADHD

Previous studies have shown that Attention-Deficit/Hyperactivity disorder (ADHD) is marked by impairments in academic functioning in reading, writing, and mathematics. Yet, virtually no studies have examined academic functioning in terms of both basic skills (e.g., word recognition, handwriting/spelling, arithmetic calculations) and more complex advanced skills (e.g., reading comprehension, writing composition, and mathematical problem-solving) within the same sample. In the present study, 518 children with ADHD were compared to a control group of 851 children without ADHD (ages 8-18) and assessed on a comprehensive battery of reading, writing, and math assessments. It was hypothesized that ADHD diagnostic status would uniquely predict performance on advanced skill measures even after controlling for performance on basic skills in that academic domain. ADHD status was associated with worse performance across all academic tests. Results also indicated that ADHD independently predicted performance for measures of writing composition and one measure of reading comprehension, even after controlling for performance on basic skills in those domains. However, ADHD did not independently predict mathematical problem-solving performance. These findings add to the literature on ADHD and academic functioning and indicate that inattention may weaken skills necessary for effective reading comprehension and writing composition.

Polygenic risk associations with developmental and mental health outcomes in childhood and adolescence: A systematic review

Background

Neurodevelopmental and mental health disorders in childhood constitute an emerging global concern, with adverse sequelae which span children's physical, psychological and social well-being. The aetiology of these disorders is likely complex, multifactorial and polygenic. Polygenic risk scores (PRS), an estimate of an individual's genetic liability toward a disorder, have been increasingly used in psychiatric research to explore genetic associations with disorders of interest. However, limited work delineates polygenic associations with development and mental health in childhood populations.We aimed to systematically review existing literature on associations between genetic risk (as measured by PRS) and neurodevelopmental and mental health outcomes in childhood and adolescence.

Methods

Following the recommended Preferred Reporting Items for Meta-Analyses (PRISMA) guidelines, databases were searched using key search terms. The search commenced in March 2021 and concluded in June 2021. The studies eligible for inclusion were full-text articles investigating polygenic risk associations with neurodevelopmental and/or mental health outcomes in childhood or adolescence.

Results

Fourteen studies were eligible for inclusion in this systematic review. The association between higher PRS for attention-deficit/hyperactivity disorder (ADHD) and adverse developmental/mental health outcomes in childhood and adolescence was reported by five studies. Additionally, associations between PRS for bipolar disorder or major depressive disorder and adverse outcomes of interest were also described by two studies; and two studies highlighted associations between schizophrenia PRS and mental health disorders in childhood. The remaining studies highlighted shared polygenic contributions between and within NDDs and mental health disorders in children.

Conclusion

The findings of this systematic review suggest that PRS for neurodevelopmental and mental health disorders may associate with adverse neurodevelopmental and mental health outcomes from early childhood to adolescence. In addition, these associations seemed not to be phenotype-specific, suggesting potential shared genetic variation across the phenotypes of interest.

Translation, Cross-Cultural Adaptation, and Psychometric Properties of Writing Readiness Inventory Tool in Context (WRITIC)

This article describes the translation and cultural adaptation process of the WRITIC (Writing Readiness Inventory Tool in Context) into European Portuguese. We examined the content and convergent validity, test-retest, and interrater reliability on the norm-referenced subdomain of the Portuguese (PT) WRITIC Task Performance (TP). To establish content validity, we consulted six experts in handwriting. Internal consistency was found with 70 children, test-retest reliability with 65, inter-rater reliability with 69, and convergent validity with 87. All participants were typically developing kindergarten children. Convergent validity was examined with the Beery–Buktenica Developmental Test of Visual-Motor Integration (Beery™VMI-6) and the Nine Hole Peg-Test (9-HPT). On content validity, we found an agreement of 93%, a good internal consistency with Cronbach’s alpha of 0.72, and an excellent test-retest and inter-rater reliability with ICCs of 0.88 and 0.93. Correlations with Beery™VMI-6 and 9-HPT were moderate (r from 0.39 to 0.65). Translation and cross-cultural adaptation of WRITIC into European Portuguese was successful. WRITIC-PT-TP is stable over time and between raters; it has excellent internal consistency and moderate correlations with Beery™VMI-6 and 9-HPT. This analysis of the European Portuguese version of WRITIC gives us the confidence to start the implementation process of WRITIC-PT in Portugal.

Relationship between Product and Process Characteristics of Handwriting Skills of Children in the Second Grade of Elementary School

The purpose of this study was to analyze the relationship between the quality and speed of handwriting and the process characteristics of the handwriting of children in the second grade of elementary school considered as a function of age and gender. A sample of 57 children (mean age 7.25 years, SD 0.43) participated in the study. The Concise Assessment Method for Children’s Handwriting (BHK) was used to assess the quality and speed of handwriting. The characteristics of the process of handwriting were assessed using MovAlyzeR® software. The handwriting of boys showed a significantly greater number of strokes and slanted more to the right than the handwriting of girls. Handwriting quality and speed significantly correlated with several process characteristics: the number of strokes, reaction time, duration, relative pen-down duration, average pen pressure, vertical size, horizontal size, road length, and average absolute velocity. This research contributes to the construction of normative values in the process characteristics of the handwriting of elementary school children and provides a promising step towards the early identification of difficulties that can lead to dysgraphia, thus preventing later difficulties in handwriting.

Deep Learning and Procrustes Analysis for Early Dysgraphia Risk Detection with a Tablet Application

Dysgraphia is a neurodevelopmental disorder specific to handwriting. Classical diagnosis is based on the evaluation of speed and quality of the final handwritten text: it is therefore delayed as it is conducted only when handwriting is mastered, in addition to being highly language-dependent and not always easily accessible. This work presents a solution able to anticipate dysgraphia screening when handwriting has not been learned yet, in order to prevent negative consequences on the individuals’ academic and daily life. To quantitatively measure handwriting-related characteristics and monitor their evolution over time, we leveraged the Play-Draw-Write iPad application to collect data produced by children from the last year of kindergarten through the second year of elementary school. We developed a meta-model based on deep learning techniques (ensemble techniques and Quasi-SVM) which receives as input raw signals collected after a processing phase based on dimensionality reduction techniques (autoencoder and Time2Vec) and mathematical tools for high-level feature extraction (Procrustes Analysis). The final dysgraphia classifier can identify “at-risk” children with 84.62% Accuracy and 100% Precision more than two years earlier than current diagnostic techniques.

Effects of physical activity on visuospatial working memory in healthy individuals: A systematic review and meta-analysis

Introduction

Physical activity interventions improve cognitive performance, especially visuospatial working memory (VSWM). However, evidence on the effects of these interventions in children, adolescents, and older adults remains scant. This meta-analysis aimed to identify the effects of physical activity on VSWM improvement in healthy individuals and the best exercise intervention program to improve VSWM capacity.

Methods

We searched for randomized controlled trials (RCTs) of exercise interventions targeting VSWM in healthy individuals from Web of Science, MEDLINE, BIOSIS Previews, PubMed, China National Knowledge Infrastructure, and Wanfang Data (Chinese) databases, from inception to August 20, 2022.

Results

Among 21 articles (1,595 healthy participants), the heterogeneity test statistic was I2 = 32.3%, p = 0.053. The mean quality scores of the included articles were 6.9 points (reaction time [RT] studies) and 7.5 points (Score studies). Moreover, 28 RCTs were included (10 RT studies and 18 Score studies), and the subgroup analysis found significant effects for elderly participants, children, interventions involving a higher level of cognitive engagement, low and moderate exercise intensity, chronic exercise, exercise duration ≥60 min, and exercise period ≥90 days. Physical activity had a small but significant positive impact on VSWM in healthy individuals. Current evidence confirms the effects of physical activity on VSWM capacity only in children and seniors but not in young adults. Other age groups, including adolescents and middle-aged adults, have not been studied. Prescription of interventions involving high-level cognitive engagement, low and moderate exercise intensity, chronic exercise, exercise for >30 min per session, and exercise for more than 3 months is recommended for children and seniors.

Discussion

Future RCTs would be to fill the gap in studies on adolescents and middle-aged adults, and report detailed exercise intervention programs about different age groups.Systematic Review Registration: PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022354737). INPLASY (https://doi.org/10.37766/inplasy2022.8.0053).

Investigating Visual Perception Impairments through Serious Games and Eye Tracking to Anticipate Handwriting Difficulties

Dysgraphia is a learning disability that causes handwritten production below expectations. Its diagnosis is delayed until the completion of handwriting development. To allow a preventive training program, abilities not directly related to handwriting should be evaluated, and one of them is visual perception. To investigate the role of visual perception in handwriting skills, we gamified standard clinical visual perception tests to be played while wearing an eye tracker at three difficulty levels. Then, we identified children at risk of dysgraphia through the means of a handwriting speed test. Five machine learning models were constructed to predict if the child was at risk, using the CatBoost algorithm with Nested Cross-Validation, with combinations of game performance, eye-tracking, and drawing data as predictors. A total of 53 children participated in the study. The machine learning models obtained good results, particularly with game performances as predictors (F1 score: 0.77 train, 0.71 test). SHAP explainer was used to identify the most impactful features. The game reached an excellent usability score (89.4 ± 9.6). These results are promising to suggest a new tool for dysgraphia early screening based on visual perception skills.

Association between motor and math skills in preschool children with typical development: Systematic review

Mathematics has been the subject in which many school-age children have revealed many difficulties. Research carried out in an attempt to understand the causes of failure in this area pointed to a positive association between mathematical performance and motor performance. Given the importance of math development in future school outcomes, knowing which specific motor components are most associated with math performance can help educators define better strategies for teaching mathematics. In this sense, the present systematic review study aimed to identify the components of motor skills most positively associated with mathematical performance in children with typical development who attend preschool. The PRISMA methodology (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used in this study. The databases searched were ERIC, PubMED, SciELO, Scopus and Web of Science. A total of 2,909 articles were identified, of which 18 were included in this systematic review. The main results showed positive associations between fine motor skills, namely fine motor coordination and visuomotor integration, and mathematical performance. The math skill of numerical counting was the most associated with FMS. The main characteristics of the instruments used showed that the tasks of copying figures or drawings are the most used to assess visuomotor integration and the tasks of handling objects with pinch-like movements are the most used to assess fine motor coordination. Given the importance of mathematical performance in future school results, identifying early children with difficulties in fine motor skills will help educators to design better strategies for teaching mathematical skills. In this sense, the need to identify instruments to assess fine motor skills in preschool children with characteristics that facilitate their administration by the educator in the classroom context, i.e., requiring little administration time, not requiring much experience or training, the possibility of being administered to the group/class, few material resources, and the results can be easily interpreted, classified, and associated with mathematical performance.

Validation of the Concise Assessment Scale for Children's Handwriting (BHK) in an Italian Population

Handwriting difficulties represent a common complaint among children and may cause a significant delay in motor skills achievement. The Concise Assessment Scale for Children's Handwriting (BHK) assesses handwriting skill in clinical and experimental settings, providing a quick evaluation of handwriting quality and speed through a copying text. The aim of the present study was to validate the Italian adaptation of the BHK in a representative primary school population. Overall, 562 children aged 7-11 from 16 public primary schools of Rome were included and asked to copy a text in 5 min using cursive handwriting. Handwriting quality and copying speed were measured. The included population followed a normal distribution for the BHK quality scores. Sex influenced the total quality scores, whereas school level influenced the copying speed. The BHK quality score was higher in girls (p < 0.05) and resulted as a stable parameter along the school years, without significant variations with regard to the years spent in handwriting exercise (p = 0.76). The handwriting speed was influenced by school level, and significant differences were found for each of the grades from the second to the fifth (p < 0.05), but not for gender (p = 0.47). Both BHK measures represent a helpful tool for the characterization and assessment of children with handwriting difficulties. The present study confirms that sex influences total BHK quality score, while school level influences handwriting speed.

Assessment of children's writing features: A pilot method study of pen-grip kinetics and writing surface pressure

The writing process is a complex task involving dexterous manipulation of the writing instrument by the hand digits and biomechanical ergonomic factors that contribute to handwriting efficiency and productivity. We describe a pilot study using an instrumented writing apparatus - a sensor (pen) and a digitized writing surface (tablet) - to measure the pen-grip kinetics (digit forces) and the pen pressure applied to the tablet during a writing task. Eight elementary school students with no handwriting difficulties copied a short story. The mean digit forces on the pen were compared with the mean pen pressure on the tablet at five interval points. Results revealed that the digit forces on the pen were significantly stronger than the pen pressure on the tablet. Results also showed significantly less digit-force variability throughout the writing task than the pen-pressure variability on the writing surface, which significantly lessened toward the end of the writing task. Information on these properties can broaden understanding of the elements that influence nonproficient handwriting in children with dysgraphia. Results also indicate the possible efficacy of a therapeutic tool for handwriting assessment and intervention using objective measurements during writing, warranting future studies with children with and without dysgraphia.

Development and Psychometric Evaluation of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) for School-Age Children

IMPORTANCE

Handwriting legibility is the main criterion for determining whether a child has handwriting difficulties. A comprehensive assessment of handwriting legibility with sound psychometrics is essential to timely identification of handwriting difficulties and outcome measurement after handwriting interventions.

OBJECTIVE

To evaluate the psychometrics of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) and to investigate Chinese handwriting legibility in school-age children using the CAM-CHL.

DESIGN

Cross-sectional, repeated observation, test-retest.

SETTING

Elementary schools in Taiwan.

PARTICIPANTS

We recruited 25 lower-grade children for the examination of test-retest reliability, 75 children from all grade levels, and 10 senior schoolteachers for the examination of the CAM-CHL's convergent validity and the investigation of handwriting legibility.

OUTCOMES AND MEASURES

Children were asked to copy a set of Chinese characters as legibly as possible. We used the CAM-CHL to assess handwriting legibility in four domains: Size, Orientation, Position, and Deformation. The schoolteachers were asked to subjectively assess the handwriting legibility using a 3-point Likert-type scale.

RESULTS

The CAM-CHL demonstrated good to excellent test-retest reliability and acceptable random measurement error in all legibility domains. The CAM-CHL had fair to moderate convergent validity with schoolteachers' perceptions. Additionally, upper-grade children had better handwriting legibility in the Size and Position domains than lower-grade children.

CONCLUSIONS AND RELEVANCE

The CAM-CHL, a comprehensive and objective method of assessing Chinese handwriting legibility, has sound reliability and acceptable validity, suggesting its potential as an outcome measure for school-age children. What This Article Adds: The CAM-CHL can be used in comprehensive evaluations of Chinese handwriting legibility in school-age children. The CAM-CHL has acceptable psychometrics for use as an outcome measure.

Working Memory and Manual Dexterity in Dyslexic Children: A Systematic Review and Meta-Analysis

Dyslexic children have impairments in working memory and manual dexterity. Studies have shown that when cognitive development has deficits, motor development is often impaired, indicating a strong interconnection between both domains, and the possibility of interference with each other's proper functioning. Thus, a new literature review is necessary to understand which components of working memory and manual dexterity are affected in dyslexic children and the possible relationship between them. This review aimed to perform a systematic review and meta-analysis to analyze both skills in dyslexic children. The protocol was carried out according to the criteria established by PRISMA being registered at PROSPERO under number CRD 42021238901. Six literature databases were searched to locate studies published between 2001 and 2021: EMBASE, ERIC, ISI Web of Science, PubMed, PsycINFO, and Scopus. 21 studies met the inclusion criteria. The findings suggest that dyslexic children have significantly poorer visuospatial and verbal working memory with more impairments in the phonological loop. No significant differences were found in manual dexterity.

Extremely preterm children and relationships of minor neurodevelopmental impairments at 6 years

Aim

This study investigated minor impairments in neurological, sensorimotor, and neuropsychological functioning in extremely preterm-born (EPT) children compared to term-born children. The aim was to explore the most affected domains and to visualize their co-occurrences in relationship maps.

Methods

A prospective cohort of 56 EPT children (35 boys) and 37 term-born controls (19 boys) were assessed at a median age of 6 years 7 months with Touwen Neurological Examination, Movement Assessment Battery for Children, 2nd edition (MABC-2), Sensory Integration and Praxis Test (SIPT), and a Developmental Neuropsychological Assessment, 2nd edition (NEPSY-II). Altogether 20 test domains were used to illustrate the frequency of impaired test performances with a bar chart profile and to construct relationship maps of co-occurring impairments.

Results

The EPT children were more likely to perform inferiorly compared to the term-born controls across all assessments, with a wider variance and more co-occurring impairments. When aggregating all impaired test domains, 45% of the EPT children had more impaired domains than any term-born child (more than five domains, p &lt; 0.001). Relationship maps showed that minor neurological dysfunction (MND), NEPSY-II design copying, and SIPT finger identification constituted the most prominent relationship of co-occurring impairments in both groups. However, it was ten times more likely in the EPT group. Another relationship of co-occurring MND, impairment in NEPSY-II design copying, and NEPSY-II imitation of hand positions was present in the EPT group only.

Interpretation

Multiple minor impairments accumulate among EPT children at six years, suggesting that EPT children and their families may need support and timely multi-professional interventions throughout infancy and childhood.

A Scoping Review of Grasp and Handwriting Performance in School-Age Children

OBJECTIVE

Handwriting is a critical functional skill that impacts academic participation and progress. Occupational therapists address components of grasp in their handwriting intervention as it is commonly assumed that grasp affects legibility, fluency, and endurance, yet research studies examining this relationship are limited.

METHOD

We used scoping review methodology to map existing research on grasp and handwriting performance in school-age children and to identify gaps in the literature.

RESULTS

Thirteen articles met search criteria and were categorized by grasp patterns and handwriting performance, and grasp force and handwriting performance. Findings suggest an inefficient grasp can lead to decreased handwriting legibility and fatigue. The current literature is inconclusive and several gaps were identified.

CONCLUSION

Additional studies should address research gaps through inclusion of children with special needs and interventions including lengthier handwriting tasks representative of a typical school day.

The impact of in-air features on the diagnosis of developmental dysgraphia

Handwriting problems, also known as dysgraphia, are defined as a disorder or difficulty in producing written language associated with writing mechanics. The occurrence of handwriting problems among elementary students varies from 10 to 34% . With negative impacts on educational performance, handwriting problems cause low self-confidence and disappointment in the students. In this research, a pen-tablet was employed to sample children’s handwriting, which revealed online features of handwriting such as kinematic and temporal features as well as wrist and hand angles and pen pressure on the surface. This digitizer could also extract the online handwriting features when the pen was not in contact with the surface. Such features are called in-air features. The purpose of this study was to propose a method for diagnosing dysgraphia along with an evaluation of the impact of in-air features on the diagnosis of this disorder. A rich dataset (OHF-1) of online handwriting features of dysgraphic and non-dysgraphic students was prepared. After the extraction of a huge set of features and choosing a feature selection method, three machine learning methods, i.e. SVM, Random Forest and AdaBoost were compared and with the SVM method, an accuracy of 85.7% in diagnosing dysgraphia was achieved, when both in-air and on-surface features were included. However, while using purely in-air data or merely on-surface features, accuracies of 80.9% and 71.4% were achieved, respectively. Our findings showed that in-air features had a significant amount of information related to the diagnosis of dysgraphia. Consequently, they might serve as a significant part of the dysgraphia diagnosis.

Handwriting and typing: Occupational therapy practice when supporting adolescents with handwriting difficulties

Introduction

While most children have developed effective handwriting by secondary school age, some have handwriting difficulties that hamper academic progress. Occupational therapists play a role in assessment and planning support, which may include introducing typing as an alternative. However, there is limited understanding regarding how decisions are made about recommending typing. This study explored the support provided to adolescents with handwriting difficulties by occupational therapists, and the contextual factors that influence their decision-making.

Method

Semi-structured interviews were conducted with 13 occupational therapists and analysed using thematic analysis.

Findings

Although there was shared practice underpinned by occupational therapy philosophy, there was also divergent practice due to different approaches. Roles and responsibilities, resources, and evidence and experience influenced occupational therapists’ practice. Understanding the adolescent’s motivation, the effect of handwriting difficulties on well-being and the need for a functional method to record schoolwork, was central to occupational therapists’ decision-making to recommend typing.

Conclusion

Strategies are needed to address the knowledge-practice gap, including evidence-based guidelines. Closer collaboration between occupational therapists and school staff could increase understanding of roles and highlight the unique occupational therapy contribution. Further research examining whether, when and how to introduce typing as an alternative to handwriting would support best practice.

A longitudinal perspective of hormone replacement therapies (HRTs) on neuromotor capabilities in males with 47,XXY (Klinefelter syndrome)

PURPOSE

The purpose of this study was to delineate the effects of variable hormone replacement therapies on neuromotor function in a large cohort of males with 47,XXY from birth to adulthood.

METHODS

A total of 270 participants aged 16 days to 17 years 11 months prenatally diagnosed with 47,XXY were assessed by their pediatric endocrinologist and were administered hormone replacement therapies accordingly. Infants and school-aged children with 47,XXY were administered neuromotor assessments during routine neurodevelopmental evaluations. For statistical analysis, participants were segregated on the basis of treatment status. Two-tailed t tests, 1-way analysis of variance, and post hoc analysis determined significant group differences on each assessment.

RESULTS

In infants, the early hormonal treatment (EHT) group performed significantly better than the untreated group on fine motor and motor composite domains. In school-aged children, we observed significantly improved scores on fine motor control, coordination, agility, and strength domains among males treated with EHT (or any combination thereof) compared with those who did not receive early treatment.

CONCLUSION

The highest treated combination group was associated with the highest neuromotor function, although the EHT group also often performed better than the other groups. This suggests EHT may be essential in promoting long-term optimal neuromotor outcome in males with an additional X.

Factors affecting cross-linguistic transfer of handwriting performance among elementary-school bilingual students

Introduction

Although many countries have diverse populations and bilingual students, most handwriting research focused on monolingual students, and the issue of cross-linguistic transfer gained less attention. Moreover, research on the effect of socio-linguistic factors on cross-linguistic transfer of handwriting is scarce. This study compared handwriting performance of fourth-grade students attending bilingual schools, who wrote in their primary (L1) to second (L2) languages, and the effect of socio-linguistic factors on the transfer of handwriting performance.

Method

Ninety-five typically developing fourth-grade students were recruited from three bilingual (Hebrew-Arabic) schools in Israel. Participants were administered a paper-pencil motor coordination task as well as reading and handwriting tests in their L1 and L2.

Results

Transfer effect was not uniform and was stronger among the Arabic-speaking group. Reading speed and handwriting automaticity in L2 and handwriting speed in L1 predicted 70% of the variance in L2 handwriting speed.

Conclusion

These findings may be explained by the complexity of Arabic orthography, as well as the low level of exposure of the Hebrew-speaking students to Arabic, which is a minority language. These results can guide occupational therapists in addressing factors affecting handwriting difficulties, and in considering socio-linguistic factors necessary for mastering handwriting in teaching a second language.

Fine motor skills and motor control networking in developmental age

Objectives

We investigated the relationships between fine motor skills, fitness, anthropometrics, gender and perceived motor performance in school beginners. The aim of our study was to delineate whether and to what extent fine motor control would show meaningful synchrony with other motor variables in the age of onset of handwriting in school.

Methods

A sample of N = 239 of 6‐to‐8‐year‐old children were tested with an array of tasks measuring fine motor (i.e., dexterity and speed) and grapho‐motor performance (tracing on a tablet screen), anthropometric indexes, and fitness (shuttle run) measures. A subset of 95 children was also tested for perceived motor competence.

Results

In spite of an overall poor anthropometric condition, our participants were relatively fit. As expected, older children performed better in both, fine motor tasks and the shuttle test. The girls were better in fine motor skills, and an original speed‐quality trade‐off in the drawing was found. However, the magnitude of difference by grade was greater for boys' fine motor skills than those of girls'. A network analysis revealed three specific clusters, (1) perceived competencies, (2) fitness, and (3) fine motor skills.

Conclusions

Given the relative independence of these areas of physical performance, we suggest focusing on these three clusters as distinct areas of physical education. Fine motor skills deserve further consideration, especially at an early school age. We have demonstrated that network analysis and technology devices used to evaluate motor development are useful and meaningful tools.

Calligraphy-based rehabilitation exercise for improving the upper limb function of stroke patients: protocol for an evaluator-blinded randomised controlled trial

INTRODUCTION

A common complication of stroke is upper limb dysfunction. Chinese calligraphy handwriting (CCH) is an aesthetical exercise developed from the traditional way of writing in China and holds potential to become a rehabilitation method to improve upper limb functions in patients with stroke. This study aims to design a randomised controlled trial to assess the effect of a customised CCH-based exercise for poststroke rehabilitation of upper limb dysfunction.

METHODS AND ANALYSIS

A single-blinded randomised controlled trial will be conducted on 60 stroke patients. The patients will be randomly allocated into three groups: (1) conventional occupational therapy (COT) group, (2) COT+CCH group, (3) COT+Graded Repetitive Arm Supplementary Program (GRASP) group. For the COT group, patients will receive COT treatment of 1 hour/day. For the COT+CCH group, patients will receive 30 mins COT treatment and 30 mins CCH training. For the COT+GRASP group, patients will receive 30 mins COT treatment and 30 mins GRASP training. All the interventions will be performed 5 days per week for a total of 3 weeks. The upper limb functions will be assessed before and after the interventions using a series of rating scales.

ETHICS AND DISSEMINATION

This study has been approved by the Research Ethics Committees of the Second Rehabilitation Hospital of Shanghai (study ID: 2020-32-01) and the Shanghai University of Sport (study ID: 102772021RT043). Results will be directly disseminated to the patients at the end of the study and to the public via publications in peer-reviewed journals and presentations in conferences.

TRIAL REGISTRATION NUMBER

ChiCTR 2100043036; Chinese Clinical Trials Registry.

Quantitative Assessment of Prewriting Skills in Children: The Development and Validation of a Tablet Assessment Tool

Our purpose in this study was to determine the feasibility of assessing children's prewriting with a new tablet tool, the Quantitative Assessment of Prewriting Skills (QAPS), while determining the validity of the QAPS for identifying visual motor skill differences. We recruited 10 children who were receiving occupational therapy (OT) services for visual motor deficits from a local OT clinic and 10 age-matched typically developing (TD) children from the local community. The QAPS assesses the accuracy of copying patterns on a tablet that records the child's finger position on the tablet, and the data are then analyzed for different dimensions of pattern copying. We found a large effect size difference in the QAPS total score between our two participant groups, with the OT group showing poorer performance than TD children; and, among nine assessment dimensions, roundness of a drawn circle showed the largest effect size difference between groups. The QAPS appears to be a promising tool for assessing visual motor skills, and it warrants additional testing in larger participant samples.

The Effects of an Integrative, Universally Designed Motor Skill Intervention for Young Children With and Without Disabilities

Many interventions feature a singular component approach to targeting children's motor competency and proficiency. Yet, little is known about the use of integrative interventions to meet the complex developmental needs of children aged 3-6 years. The purpose of this study was to examine the effects of an integrative universally designed intervention on children with and without disabilities' motor competency and proficiency. We selected children (N = 111; disability = 24; no disability = 87) to participate in either a school-based integrative motor intervention (n = 53) or a control condition (n = 58). Children in the integrative motor intervention both with and without disabilities showed significant improvement in motor competency and proficiency (p < .001) as compared with peers with and without disabilities in a control condition. Early childhood center directors (e.g., preschool and kindergarten) should consider implementing integrative universally designed interventions targeting multiple aspects of motor development to remediate delays in children with and without disabilities.

The Effects of Number and Separation of Support Lines on the Size, Velocity, and Smoothness of Handwriting

We examined the effects of number of and separation between support lines on handwriting characteristics of primary school students with satisfactory and unsatisfactory handwriting. Students (mean age 7.9 years) copied a text on paper with a baseline and with two or four support lines with a separation of 3 or 4 mm between the central lines. Handwriting size, velocity, and smoothness were determined for the four conditions relative to baseline. Children with unsatisfactory handwriting wrote larger and had more lifts during baseline condition. Writing between support lines, especially with small separation, immediately reduced the size of handwriting, but also adversely affected velocity and smoothness. Future research is needed to assess long-term effects.

Toddler motor performance and intelligence at school age in preterm born children: A longitudinal cohort study

BACKGROUND

Current knowledge regarding differences in verbal intelligence scores (VIQ) and performance intelligence scores (PIQ) in preterm born children is limited. As early motor performance may be essential for developing later visual-perceptual and visual-motor skills, early motor performance may be associated with PIQ.

AIMS

To evaluate whether in preterm born children motor performance at two years was associated with PIQ at eight years.

METHODS

Single-centre cohort study including 88 children born <30 weeks' gestation between 2007 and 2011, who completed the Bayley Scales of Infant and Toddler Development-III (BSID-III) at two years and the Wechsler Intelligence Scale for Children-III-NL (WISC-III-NL) at eight years. Outcome measurements (mean (SD)) were gross and fine motor performance based on the BSID-III, and PIQ and VIQ based on the WISC-III-NL. Linear regression analysis was performed to evaluate the association between motor performance at two years and PIQ at eight years.

RESULTS

At two years, mean BSID-III gross motor scaled score was 9.0 (SD 3.0) and fine motor score was 11.5 (SD 2.3). At eight years, mean PIQ was 94.9 (SD 13.5) and mean VIQ 101.8 (SD 13.7). A one-point increase in fine motor scaled score was associated with 1.7 points (95% CI 0.5-2.8) increase in PIQ. Gross motor scaled score was not associated with PIQ.

CONCLUSIONS

Fine motor performance in toddlerhood was related to PIQ at school age, with lower scores indicating a lower PIQ. Early assessment of fine motor performance may be beneficial in identifying children at risk for lower performance intelligence.