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PubMedDate not supplied

Handwriting instruction in elementary schools.

OBJECTIVE: Classroom teachers teach handwriting, but when problems arise, students are referred to occupational therapy for remediation. This study, conducted by occupational therapists, reviews handwriting instruction by classroom teachers in one school district. METHOD: Teachers from kindergarten through grade 6 were asked to complete an open-ended questionnaire regarding handwriting instruction. RESULTS: Teachers differed in their methods of instruction, including in the programs and paper used, and practice provided. Teachers of grades 5 and 6 had to continue to review handwriting instruction, because all students could not fluently use handwriting as a tool of expression. CONCLUSION: Elementary students need structured instruction to develop the motor skill of writing. School-based occupational therapists can support effective handwriting instruction by interpreting information from motor learning theory pertaining to instruction and practice, which supports acquisition, transfer, and retention of handwriting skills. They also need to be cognizant of prior handwriting instruction when addressing handwriting difficulties.

Age Factors↗
PubMed2001

Effects of methylphenidate on kinematic aspects of handwriting in hyperactive boys.

Poor handwriting in hyperactive children often contributes to academic failure. Beneficial effects of methylphenidate on the quality of handwriting have been shown. Using a digitizing tablet, the handwriting of 21 hyperactive boys was examined both during methylphenidate treatment and following withdrawal of the drug. Half of the hyperactive boys were tested first on methylphenidate and then following withdrawal of the drug and the remaining hyperactive boys were examined in the reverse order. Twenty-one control boys underwent the same examination. Velocity and acceleration of handwriting movements were measured. Furthermore, every writing specimen was independently rated by four examiners regarding the quality of handwriting. Following withdrawal of the drug, the quality of handwriting specimens of hyperactive boys was poorer than during treatment with methylphenidate. Statistical comparison of writing movements of hyperactive boys on and off methylphenidate revealed that the medication resulted in a deterioration in handwriting fluency. The results showed that following withdrawal of medication, hyperactive children did not differ from control boys in handwriting movements. The improvement in hyperactive behavior through methylphenidate was associated with increased legibility and greater accuracy of handwriting. The intention to write neatly may interfere with the fluent writing process.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Motor dysfunction in patients with liver cirrhosis: impairment of handwriting.

Motor dysfunction is an important clinical finding in patients with liver cirrhosis and mild forms of hepatic encephalopathy. The mechanisms and clinical appearance of motor impairment in patients with liver cirrhosis are not completely understood. We studied fine motor control in forty four patients with advanced liver cirrhosis (excluding those with hepatic encephalopathy grade II) and 48 healthy controls using a kinematic analysis of standardized handwriting tests. We analysed parameters of velocity, the ability to coordinate and the level of automatisation of handwriting movements. Furthermore, we studied the association between impairment of handwriting and clinical neuro-psychiatric symptoms. As compared with control subjects, patients showed a statistically significant reduction of movement peak velocity in all handwriting tasks as well as a substantial increase of number of velocity inversions per stroke. Using a z-score based assessment we found impairment of handwriting in fourteen out of forty four patients (31.8 %). The deterioration of handwriting was associated with clinical symptoms of motor dysfunction, such as bradykinesia, adiadochokinesia, dysmetria of upper extremities and gait ataxia. This is the first study that quantitatively investigates impairment of handwriting in patients with liver cirrhosis. Our findings suggest the application of kinematic analysis of handwriting for diagnostics of motor dysfunction in patients with mild forms of hepatic encephalopathy.

Adult↗
PubMed2006

Attention and movement execution during handwriting.

Two studies were performed in order to test the hypothesis that movement execution during handwriting in skilled writers is independent of attention. Study I examined the relationship between attentional functioning and kinematic aspects of handwriting movements in 24 adult participants. A digitizing tablet was used for the assessment of handwriting movements. Participants were asked to perform a simple writing task and various components of their attention were assessed. Correlation analysis indicated no significant relationship between attention functions and both kinematic aspects of handwriting movements and quality of handwriting. In Study II, 20 participants underwent total sleep deprivation (TSD) for 24h. While attention, as assessed with alertness and vigilance tasks, deteriorated during TSD, the execution of handwriting movements, as assessed with a digitizing tablet, improved markedly. The quality of handwriting was not affected by TSD. These findings may suggest an independence between attention and movement generation during handwriting.

Adult↗
PubMedDate not supplied

Teachers' survey on problems with handwriting: referral, evaluation, and outcomes.

OBJECTIVE: The purpose of this study was to describe the factors that led elementary school teachers to refer students with handwriting difficulties to occupational therapy, the criteria they used to determine acceptable handwriting, and the handwriting outcomes they looked for after occupational therapy services. METHOD: A paper questionnaire composed of 31 close-ended questions was mailed to 400 first- through fourth-grade regular education teachers from 32 states to collect data from the 2000-2001 school year. The data were analyzed descriptively using frequency counts and converted to percentages. RESULTS: Information was obtained from 314 teachers. The main factor for handwriting referral to occupational therapy was that the student was not improving with classroom assistance alone. Teachers chose not being able to read student's writing as the main criterion they used to determine if the student's handwriting was acceptable, and increased legibility was the most important outcome they desired following occupational therapy services for handwriting remediation. CONCLUSION: The perceptions of regular education teachers on problems with handwriting can provide valuable information to occupational therapy practitioners when providing consultation and direct services related to handwriting in schools.

Adult↗
PubMedDate not supplied

The effects of sensorimotor-based intervention versus therapeutic practice on improving handwriting performance in 6- to 11-year-old children.

OBJECTIVE: The aim of this study was to investigate the effects of two interventions (sensorimotor and therapeutic practice) on handwriting and selected sensorimotor components in elementary-age children. METHOD: Thirty-eight children 6 to 11 years of age with handwriting dysfunction but no identified educational need were randomly assigned to one of the two intervention groups or a control group. Intervention groups met four times per week over 5 weeks. Handwriting was measured pre- and postintervention using the Test of Handwriting Skills. Visual perception (motor-reduced), visual-motor integration, proprioception, and in-hand manipulation were also measured. RESULTS: Children receiving therapeutic practice moderately improved handwriting whereas children receiving sensorimotor intervention declined in handwriting performance. The control group did not change significantly. Sensorimotor impairment was noted at pretest in three or four components and selected sensorimotor component function improved with intervention. CONCLUSION: Therapeutic practice was more effective than sensorimotor-based intervention at improving handwriting performance. Children who received sensorimotor intervention improved in some sensorimotor components but also experienced a clinically meaningful decline in handwriting performance.

Child↗
PubMed2002

Individuality of handwriting.

Motivated by several rulings in United States courts concerning expert testimony in general, and handwriting testimony in particular, we undertook a study to objectively validate the hypothesis that handwriting is individual. Handwriting samples of 1,500 individuals, representative of the U.S. population with respect to gender, age, ethnic groups, etc., were obtained. Analyzing differences in handwriting was done by using computer algorithms for extracting features from scanned images of handwriting. Attributes characteristic of the handwriting were obtained, e.g., line separation, slant, character shapes, etc. These attributes, which are a subset of attributes used by forensic document examiners (FDEs), were used to quantitatively establish individuality by using machine learning approaches. Using global attributes of handwriting and very few characters in the writing, the ability to determine the writer with a high degree of confidence was established. The work is a step towards providing scientific support for admitting handwriting evidence in court. The mathematical approach and the resulting software also have the promise of aiding the FDE.

Adolescent↗
PubMed2003

Assessing handwriting speed of children biliterate in English and Chinese.

The assessment of multiliterate handwriting performance is rarely reported despite increased globalization. The present study describes the psychometric properties of a handwriting speed test developed for children who are biliterate in English and Chinese. This included interrater reliability, test-retest reliability, interitem correlation, construct validity, and concurrent validity. The test's reliabilities between two raters and over a 1-wk. interval were high with ICCs ranging from .89 to .99. Interitem correlation between the English and Chinese items was .87. The presence of age trends but not sex differences was a positive indicator of the test's validity. Correlations of .91 and 1.00 between the Chinese and the English items of the Handwriting Assessment Tool with the Chinese Handwriting Speed Test and Handwriting Speed Test, respectively, provided evidence of concurrent validity. These preliminary results showed the Handwriting Assessment Tool is reliable and is a potentially useful handwriting test for children biliterate in English and Chinese. The feasibility of assessing biliterate handwriting speed performance with the same set of scoring criteria for different writing systems was supported.

Child↗
PubMed2005

Kinematic analysis of dopaminergic effects on skilled handwriting movements in Parkinson's disease.

Patients with Parkinson's disease (PD) exhibit impairments in the execution of highly practiced and skilled motor actions such as handwriting. The analysis of kinematic aspects of handwriting movements has demonstrated that size, speed, acceleration and stroke duration are affected in PD. Although beneficial effects of dopaminergic therapy in regard to execution of movements have been reported, the effects of pharmacological therapy on these measures have not been examined in detail. The present study has compared kinematic aspects of handwriting movements of 27 healthy subjects and 27 patients with PD both on their usual dopaminergic treatment and following withdrawal of dopaminergic medication. Healthy subjects were matched with PD patients according to age, sex, handedness and education level. A digitising tablet was used for the assessment of handwriting movements. Subjects were asked to perform a simple writing task. Movement time, distance, velocity, acceleration and measures of fluency of handwriting movements were measured. Compared with healthy subjects, the kinematics of handwriting movements in PD patients were markedly disturbed following withdrawal of dopaminergic medication. Although dopaminergic treatment in PD patients resulted in marked improvements in the kinematics of handwriting movements, PD patients did not reach an undisturbed level of performance. The results suggest that dopamine medication results in partial restoration of automatic movement execution.

Aged↗
PubMed1977

The effects of methylphenidate on the handwriting of children with minimal brain dysfunction.

Fifty children with minimal brain dysfunction who had handwriting deficits received methylphenidate or placebo under double-blind conditions. Twenty-six children (52%) showed improvement in hand-writing following treatment with methylphenidate for four weeks. One child receiving placebo had improvement in handwriting, but his handwriting improved further after he was switched to methylphenidate. In general, handwriting tended to deteriorate promptly when drug treatment was discontinued. Thirty-six patients (72%) receiving methylphenidate for four weeks were rated behaviorally improved by teachers; in contrast, seven children (14%) showed behavioral improvement following treatment with placebo. Improvement in attention and behavior, which was ascertained by the use of Conners' Abbreviated Teacher Rating Scale, did not always correspond with improvement in handwriting. Advances in handwriting skills following treatment with methylphenidate may have been directly related to improvement in fine motor coordination. Gains in handwriting were maintained for up to 26 months of follow-up in 21 children who received methylphenidate on a long-term basis.

Attention Deficit Disorder with Hyperactivity↗
PubMed1999

Positive correlation between reduction of handwriting area and D2 dopamine receptor occupancy during treatment with neuroleptic drugs.

We investigated the relationship between fine extrapyramidal-motor symptoms (reduction of handwriting area) and D2 dopamine receptor occupancy under neuroleptic treatment. The handwriting of 18 schizophrenic patients before and during treatment with typical (haloperidol, haloperidol decanoate) and atypical (clozapine, risperidone) neuroleptic drugs was examined. Data analysis of the handwriting's examination was carried out with a planimetric computer programme. At the time of the second test of handwriting, D2 receptor occupancy was determined with single photon emission tomography (SPET) using [(123)I]iodobenzamide ((123)I-IBZM). In all patients, a reduction of handwriting area and a D2 receptor occupancy were found. The correlation between reduction of handwriting area and D2 receptor occupancy for typical and atypical neuroleptic drugs was linear and statistically significant (r=0.9; P > 0.001). Our findings point to the possibility that the reduction of handwriting area may be used as a clinical indicator of D2 receptor occupancy under treatment with neuroleptic drugs.

Adult↗
PubMed2005

Evaluation and classification of types of Chinese handwriting deficits in elementary schoolchildren.

The handwriting problems of elementary schoolchildren were investigated in this study. A questionnaire for evaluation of Chinese handwriting was developed and then administered to 165 children with handwriting deficits. Factor analysis indicated that the questionnaire has six major dimensions, including construction of characters, accuracy, developmental delay, pencil grip, gross movement, and emotional reaction. These six dimensions were utilized to search for subtypes of handwriting deficits. By further sampling, another 209 children were administered the handwriting evaluation questionnaire to classify their handwriting deficits. According to the severity of deficits on different dimensions of the questionnaire, K-means clustering was utilized to classify the children into four subtypes of mild, severe, motor-originated, and academic learning dysfunction subtypes. The classification by subtype might be helpful in planning interventions for children with handwriting deficits.

Child↗
PubMed1995

Attention-deficit hyperactivity disorder: a longitudinal case study of handwriting characteristics.

This longitudinal case study focuses on handwriting samples of a female diagnosed with Attention-Deficit/Hyperactivity Disorder from 12 years of age to 21 years of age. Diaries and journals produced for class assignments and later for this research yielded 293 handwriting samples. 15 characteristics of handwriting were measured and statistically analyzed to follow changes in handwriting across time. At seven years of age while in elementary school the subject was diagnosed with ADHD and placed on Ritalin (methylphenidate). At puberty the drug was discontinued. During two summers she visited grandparents, once alone and once with two sisters with whom she was in conflict. Her handwriting deviated from its pattern of general decrease in size and increase in uniformity during these visits. The changes over time of three handwriting characteristics (slant of "l," heights and areas of the lower loop of the "g," and area of the left loop of the "I") also deviated from the general pattern of her handwriting change.

Adult↗
PubMed1996

Factors that relate to good and poor handwriting.

OBJECTIVE: This study investigated the relationships between specific performance components, eye-hand coordination, visuomotor integration, in-hand manipulation, and handwriting skill. METHOD: A sample of 48 typical first grade students were identified as good and poor handwriters by their teachers. Each child completed the Motor Accuracy Test; the Developmental Test of Visual-Motor Integration (VMI); two tests of in-hand manipulation, including a rotation and a translation task; and the Minnesota Handwriting Test (MHT). RESULTS: All test scores for the subjects with good handwriting were significantly higher than those of the subjects with poor handwriting. Each performance component test was significantly correlated to MHT scores. Translation, VMI, and rotation scores were significant predictors of MHT scores, accounting for almost 73% of variance. A discriminant analysis using the performance components correctly classified 98% of the students as good or poor handwriters. CONCLUSION: In-hand manipulation has significant association to handwriting skill.

Child↗
PubMedDate not supplied

Handwriting difficulties in primary school children: a search for underlying mechanisms.

OBJECTIVE: This study investigated the contribution of perceptual-motor dysfunction and cognitive planning problems to the quality or speed of handwriting in children with handwriting problems (HWP). METHOD: Twenty-nine children with HWP and 20 classroom peers attending regular schools (grade 2 and grade 3) were tested with regard to visual perception, visual-motor integration, fine motor coordination, and cognitive planning abilities. RESULTS: The HWP group scored significantly lower on visual perception, visual-motor integration, fine motor coordination, and cognitive planning in comparison with classroom controls. Regression analyses showed that visual-motor integration was the only significant predictor for quality of handwriting in the HWP group, whereas fine motor coordination (i.e., unimanual dexterity) was the only significant predictor of quality of handwriting in the control group. CONCLUSIONS: Results suggest that two different mechanisms underlie the quality of handwriting in children with and without handwriting problems. Poor quality of handwriting of children with HWP seems particularly related to a deficiency in visual-motor integration.

Child↗
PubMed2003

Color separation of signature and stamp inks to facilitate handwriting examination.

The questioned documents laboratory often encounters cases where handwriting that is to be examined intersects with some interfering factor such as a rubber stamp, typewriting or background printing. In these cases, line direction, beginning and ending features of letters and other fine details of the handwriting may be lost in the "noise" of the intersecting ink. The purpose of this paper is to show several new digital photography methods that may be used to "subtract" the effect of the intersecting ink, thereby enhancing that of the handwriting ink in order to enable the document examiner to conduct a complete examination. These methods have the advantage of being fast and do not involve the use of expensive material or equipment. Several new methods are described that may be used to separate the colors of the handwriting ink from that of the intersecting ink: the analog method and several digital methods such as RGB-HSB-CMYK, L*a*b color, and color separation using the Channel Mixer function of Adobe Photoshop. Successful application of these color separation methods to specific handwriting ink/rubber stamp ink color combinations shows that the effect of the intersecting ink may indeed be minimalized if not canceled altogether. Application of the suggested methods may well make the difference between a nonconclusive handwriting examination and a full analysis of the questioned handwriting.

Journal Article↗
PubMed2006

Assessing the handwriting process in healthy elderly persons using a computerized system.

BACKGROUND AND AIMS: Despite the importance of handwriting in everyday life, virtually no literature can be found documenting the extent and range of everyday handwriting performance and ability among healthy elderly persons. The aim of this pilot study was to examine the kinematic characteristics of the handwriting process of healthy elderly persons and its correlates. METHODS: Fifty-three healthy participants (aged 60 to 94) living in the community, performed five functional writing tasks using a computerized system which documented the handwriting process. RESULTS: In air time (i.e., the time of non-writing while writing) accounted for approximately half to two-thirds of total writing time. Higher age was consistently associated with longer on paper and in air time, as well as with lower speed and lower pressure. CONCLUSIONS: The results of this pilot study indicate that kinematic analysis of handwriting provides important information about the handwriting process among elderly people.

Activities of Daily Living↗
PubMed2003

Effects of nicotine chewing gum on a real-life motor task: a kinematic analysis of handwriting movements in smokers and non-smokers.

RATIONALE: In laboratory tasks nicotine has consistently been shown to improve psychomotor performance. OBJECTIVES: The aim of the present experiment was to assess the effects of nicotine on a skilled task of everyday life in smoking and non-smoking healthy adults. METHODS: Assessment of handwriting movements of 38 non-deprived smokers and 38 non-smokers was performed following the chewing of gum containing 0 mg, 2 mg or 4 mg of nicotine. A digitising tablet was used for the assessment of fine motor movements. Subjects were asked to perform a simple writing task. Movement time, velocity and acceleration of the handwriting movements were measured. Furthermore, every writing specimen was independently rated by two examiners regarding the quality of handwriting. RESULTS: Kinematic analysis of writing movements revealed that nicotine could produce absolute improvements in handwriting. Following nicotine administration, reduced movement times, increased velocities and more fluent handwriting movements were observed. These improvements were more striking in smokers than in non-smokers. No effects of nicotine were found with regard to the quality of handwriting. CONCLUSION: The results suggest that nicotine can enhance psychomotor performance to a significant degree in a real-life motor task.

Adult↗