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Occupational Therapy Handwriting Recommendations
The number one way to help handwriting is to find out what the underlying problem is: usually a visual perceptual problem (how the brain processes visual information), fine motor delays (poor weight bearing history, lack or delay of creeping and crawling, weak joints or muscles), and/or other developmental delays. It is important to make sure that a developmental optometrist and occupational therapist have evaluated the child to treat the underlying problems.
1. The arches in the palms and fine motor coordination are all developed best by weight bearing on the palms of the hands through crawling (on the belly) at least 5 minutes a day, and creeping (on all fours palms of hands and knees) for 5-10 minutes a day. Additional weight bearing activities that are of vital importance include: wheelbarrow walking (start rolling on belly from hands and feet rocking back and forth, then move up to walking off the ball with belly on the ball, then only legs to walk out on hands, then wheelbarrow with someone holding knees, then only holding ankles. Wheelbarrow walk with hands on a straight line, then a triangle, then a circle, then work up to crossing hands over the tape line, then walk up stairs all for up to 40 steps.
2. Regular opportunities for performing other hand strengthening exercises after the weight bearing such as squeezing modeling clay, theraputty, or other thick putty between thumb and fingers. Place raw beans, coins, raw popcorn in the putty and have child "fish" them out using finger tips and thumb and fingertips to push ans squeeze them out. Also, squeeze toys, dog chew toys that are squeezed, clothespins, tongs, etc.
3. Fine motor tasks such as stringing beads, placing tiny objects into a small container, using tongs to pick up cotton balls or other objects and release into small opening, copying bead and block designs, parquetry blocks, throwing a ball or bean bag at a target greater than five feet away, moving coins, beans, and paperclips from palm to finger tips and back to palm, and lacing boards. Emphasize using only left hand, without assistance from right, then right alone. Using closthespins, modeling clay, and other manipulatives to increase finger strength and coordination. Write letters, numbers, spelling words, and shapes on end of paperclip and have them match and "clip" onto matching letter on a folder or index card.
4. Using consistently lined paper ( don't switch from 1 inch to 2 inch, then back, it makes for confusion in letter sizing) with definite lines to stay within for handwriting so that they can make consistently sized letters. Highlight the lines, or use blue sky, red fence, green grass paper. Or, try raised line tactile paper to give a tactile "bump" cue.
Use Handwriting without Tears programs!!!!!
5. Adjust desk height to no greater than 2 inches above them elbow crease so that their elbows and pinky finger can rest on the desk when performing handwriting and desk top skills.
Feet should have full support and rest on floor while seated in chair, with ankles, hips, and knees at a 90 degree angle.
6. Use letter and number strips on the top of the desk. Using green lines or dot for start on left and red for the end of the line on right.
7. Opportunities to copy geometric shapes and letters on a vertical surface such as a chalkboard or easel, use golf pencils or small pieces of chalk to encourage distal finger control.
8. Opportunities for visual perceptual tasks such as balancing games, creeping and crawling, bdpq, code charts, soldier walks, steeping arrows, copying greater than 6 block or bead designs, copying complex shapes from a picture, complex shape sorters, parquetry block designs, games such as find the missing part, or complete the picture work books, or where is Waldo type visual games.
9. Writing on a vertical surface such as chalkboard using very small pieces of chalk, felt boards, or velcro games.
10. Working on puzzles and other visual activities on the floor laying on their stomach with their upper body propped on elbows to increase proximal shoulder stability and upper torso strength.
12. Encouraging upper body gross motor activities such as climbing, carrying heavy objects (books, jugs of water, buckets) and lifting above shoulder level, arm ladders on the playground, hand walking with knees held by peer or adult, animal walking on all fours, pushing a peer in the swing, and overall gross motor play to increase postural strength, stability and endurance.
13. Movement activities associated with eye-hand coordination such as swinging while throwing a ball at a target, standing on an balance board while playing catch, or jumping on a trampoline and throwing a ball.
14. Regular breaks from sit down tasks and visual tasks every 20-30 minutes with a gross motor/sensory motor activity (i.e. walking, jumping, stretching, dancing to music, laying on belly to do work, etc.) Brain Gym is wonderful!
15. Start learning keyboarding early!
16. Ask the OT for special pencil grips, best writing tool (often a felt tip fine point pen), and special pencils such as weighted pencils.
Using Raised Line Graph Paper or Blue Sky Paper found at Teacher Centers or in school therapy catalogs. Use Handwriting Without Tears Handwriting program!!!!!
Posture and Stability
Look at correct sitting posture and appropriate chair and table heights. A child's feet should be flat on the floor and the desktop should be 2 inches above the bent elbow.
Use the 90 - 90 - 90 rule. Ankles, hips, and knees should be bent to a 90-degree angle for appropriate sitting posture.
If table is too high, elbows will be up and out to sides. If table is too low, the child will slump in their chair or rest their head on their hand.
Use footstool to support feet if the child's feet do not rest flat on the floor. Allow students to work in various positions other than seated (standing at a vertical surface, lying on the floor propped on elbows). Do warm-up activities to provide kinesthetic input to large and small muscles groups.
Working on a vertical surface promotes the wrist extension and shoulder stability necessary for control of the fine movements involved in writing.
When working on a vertical surface, paper or work should be positioned just above eye level.
Examples of ways to incorporate vertical surfaces into your classroom:
For younger students:
There are two types of grasps: efficient and inefficient. An efficient grasp the pencil is held between the pads of the thumb and index finger while resting on the middle finger. An acceptable variation of this is when the pencil is held between the pads of the thumb and index/middle fingers while resting on the ring finger.
The most efficient pencil grasp is pencil resting between the first two fingers with pencil between the pads of these fingers and the thumb in prehension on the side. This is the most ergonomically correct position for the joints. If a child is using an efficient grasp, their thumb and index finger should form a circular shape.
An inefficient grasp can include any of the following: fisted grasp, pencil held between the pads of the thumb and all four fingers, thumb wrapped over the top of the index and middle fingers, thumb tucked under the index finger, the hand held in a thumb down position, index and middle fingers wrapped around the pencil, or thumb pressing the pencil into the side of the index finger (thumb and index do not form a circular shape). See Quick Fixes for ideas on ways to promote an efficient pencil grasp.
Paper slant To best align paper, have student clasp hands in front of him/her and lay them on the desk. Their arms and bottom edge of desktop should form a triangle. The paper should be aligned parallel to the arm of the dominant hand. The paper should be at an approximate 45-degree angle. The non-dominant hand should be used at all times to stabilize the paper.
Kinesthetic Learning The following are various methods used to facilitate learning of proper letter, number and shape formation.
Use pencil grips on pencils to teach and practice correct finger placement: The Pencil Grip or Stetro Grip
Have student hold a novelty eraser tucked under the ring and little fingers while writing, cutting, drawing or using manipulatives. This promotes the use of the thumb, middle and index finger for skilled movement and the ring and little fingers to support the hand.
Sharpen or break pencils down to about 2 inches in length to encourage efficient pencil grasp and better control of the pencil.
Place Cylindrical Foam sleeves that are approximately an inch long on writing utensils to increase the diameter and promote proper finger placement.
Use large/chubby writing utensils such as large sidewalk chalk broken into 2-inch pieces, Jumbo Crayons broken into two inch pieces, or Sure Grip Crayons.
Use masking tape outline on the desktop to indicate how paper should be slanted.
If the student writes with too much pressure on the pencil, have him/her write with a 0.5 lead mechanical pencil and/or have him/her write with their paper on a carpet square or placemat. Or write with a felt tip fine point pen for too much pressure writers, or too little pressure writers, or for those that get tired easily.
These techniques will teach a student how to vary the pressure used on the pencil to avoid breaking the lead or putting holes in the paper.
If a student writes with a "hooked wrist", have them do written work on a vertical surface just above eye level.
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