Relationships between fine-motor, visual-motor, and visual perception scores and handwriting legibility and speed

Occupational therapists assess fine motor, visual motor, visual perception, and visual skill development, but knowledge of the relationships between scores on sensorimotor performance measures and handwriting legibility and speed is limited. Ninety-nine students in grades three to six with learning and/or behavior problems completed the Upper-Limb Speed and Dexterity Subtest of the Bruininks-Oseretsky Test of Motor Proficiency, the Beery-Buktenica Developmental Test of Visual-Motor Integration-5th Edition, the Test of Visual Perceptual Skills-Revised, the Visual Skills Appraisal, and a handwriting copying task. Correlations between sensorimotor performance scores and handwriting legibility varied from .07 to .38. Correlations between sensorimotor performance scores and handwriting speed varied from .04 to .42. Stepwise multiple regression analysis indicated that the variance in handwriting explained by these measures was ≤ 20% for legibility and ≤ 26% for speed. On the basis of multivariate analysis of variance only scores for the Developmental Test of Visual-Motor Integration differed between students classified as "skilled" and "unskilled" handwriters. The low magnitude of the correlations and variance explained by the sensorimotor performance measures supports the need for occupational therapists to consider additional factors that may impact handwriting of students with learning and/or behavior problems.     

Effectiveness of a Co-Taught Handwriting Program For First Grade Students

ABSTRACT

Our study examined the effects of Write Start, a classroom-embedded handwriting/writing program on handwriting and writing fluency for first grade students, co-taught by occupational therapists and teachers. Two first grade classrooms received the Write Start and two received standard handwriting instruction. This co-taught program included specific feedback during handwriting practice, small group activities, student self-evaluation, and peer supports. The students were evaluated on handwriting legibility, fluency, and written expression at baseline, immediately after the program, and 6 months later. When performance was compared between the two groups, the students in the Write Start program improved significantly more in legibility (d = .57) and fluency (d = .75) than students who received standard instruction. Gains in handwriting speed (d = .18), average legibility (d = .26), and written expression (d = .25) did not differ significantly between the two groups. A co-taught, inclusive handwriting/writing program can promote first grade students’ achievement of lower case legibility and writing fluency.     

Abnormal cerebral MRI findings and neuroimpairments in very low birth weight (VLBW) adolescents

BACKGROUND: High prevalence of abnormal cerebral MRI findings as well as major and minor motor, perceptual and cognitive impairments has been reported in very low birth weight (VLBW) children. AIM: To investigate whether cerebral MRI pathology relates to different types of neuroimpairments in adolescents with VLBW. METHODS: At age 15, 55 adolescents with birth weight < or = 1500 g (VLBW) were examined. Motor function was evaluated by Movement Assessment Battery for Children (ABC) and the Grooved Pegboard (GP) test, cognitive function by Wechsler Intelligence Scales, and visuo-motor and visual perceptual function by The Developmental Test of Visual-Motor Integration (VMI) with the supplementary tests of Visual Perception (VP), and Motor Coordination (MC). Executive functions were assessed by Wisconsin Card Sorting Test (WCST) and the Stroop test. Cerebral MRI was assessed semi-quantitatively for ventricular, white and grey matter pathology. RESULTS: There was a rather weak relationship between MRI pathology and neuroimpairments. Poor performance on the WCST was related with ventricular dilatation (VD), white matter reduction and corpus callosum thinning. There was a correlation between results on the VMI test and the Movement ABC test and MRI pathology, but the correlation became much weaker when children with cerebral palsy were excluded. There was no relationship between MRI findings and estimated intelligence quotient (IQ) scores. Normal MRI predicted normal or near normal neuropsychological functioning. CONCLUSION: Cerebral MRI pathology suggestive of perinatal white matter injury was related to disadvantages in performances on executive functions, to a lesser degree to motor and visual perceptual problems, but not to cognitive impairments in VLBW adolescents.     

Lead exposure and motor functioning in 4(1/2)-year-old children: the Yugoslavia prospective study

OBJECTIVE: To investigate associations between lead exposure and early motor development. STUDY DESIGN: We conducted standardized assessments of motor function (Bruininks-Oseretsky Test of Motor Proficiency and Beery Developmental Test of Visual-Motor Integration) at age 54 months in 283 children whose mothers were recruited in pregnancy from a smelter town and a non-lead-exposed town in Yugoslavia and who have been monitored twice yearly since birth. Blood lead concentration (BPb) was summarized in a measure reflecting the average of the child's semiannual serial log BPbs through 54 months. RESULTS: Multiple regression showed that taken together, anthropometric measures (birth weight, body mass index) and markers of a stimulating and organized home life (HOME scale, parental education and intelligence, availability of siblings) explained a significant 10% to 18% of the variance in motor functioning. Beyond these contributions, BPb was significantly associated with poorer fine motor and visual motor function but was unrelated to gross motor coordination. CONCLUSIONS: Modest associations between early lead exposure and fine motor and visual motor functioning appear even after statistical adjustment is done for other contributors to motor development. Associations with BPb are specific to these areas of motor skill; gross motor development was unaffected.     

Intelligence and behavior problems in 5-year-olds in relation to representational abilities in the second year of life

Assessments of sensorimotor skill, play, language, and developmental level were administered to 20 preterm and 20 full-term infants during sessions at 13 1/2 and 22 months of age. At 5-year follow-up, children were tested with the Wechsler Preschool and Primary Scale of Intelligence (WIPPSI) and the Developmental Test of Visual-Motor Integration (VMI). Behavior problems were also assessed. At 5 years, the preterm sample showed slight delays in cognitive functioning. Measures of development and language at 13 1/2 and 22 months and relational play at 22 months were most predictive of cognitive outcome. Children with behavior problems at 5 years differed from those without problems in terms of their play and language skills. These data suggest that measures of development, particularly language development, and of play are predictive of later cognitive and behavioral functioning.     

Preschool performance of children with normal intelligence who were very low-birth-weight infants

Children who were very low-birth-weight infants (less than 1,500 g), beneficiaries of modern neonatal intensive care, are now of school age. To evaluate their school performance 80 children born in 1976 who had very low-birth-weight (mean birth weight 1.2 kg, mean gestational age 30 weeks) were examined at age 5 years. Sixty-five children were neurologically intact and had normal IQ (greater than or equal to 85) on the Stanford-Binet; five children were neurologically abnormal and ten had IQ below 85. Of the 65 children with normal intelligence and no neurologic impairments, 46 were single births and enrolled in preschool. These 46 children were matched by race, sex, and family background with classmate control children who had been born at full term. Outcome measurements included the Slosson Intelligence Test, the Woodcock-Johnson Psycho-Educational Battery (including subscales of Picture Vocabulary, Spatial Relations, Memory for Sentences, Visual Auditory Learning, Quantitative Concepts, and Blending) and the Beery Developmental Test of Visual-Motor Integration. No significant differences in IQ were found between children who were very low-birth-weight infants and control children; however, children who were very low-birth-weight infants performed significantly less well on the Spatial Relations subtest of the Woodcock-Johnson and on the Visual-Motor Integration test. Similar results were found for nine sets of twins and their control children. Recognition of these perceptual and visual-motor problems may permit appropriate early remedial intervention and prevent the compounding of these difficulties.     

Comparison of the Properties of the Handwriting Speed Test (HST) and Detailed Assessment of Speed of Handwriting (DASH): An Exploratory Study

Background: Handwriting speed is an important component of students’ ability to adequately express their ideas, knowledge and creativity in a timely and effective manner. Aims: Psychometric properties of the Handwriting Speed Test (HST) and Detailed Assessment of Speed of Handwriting (DASH) and accuracy of the norms for identifying current Australian students with handwriting speed difficulties were examined. Methods: An exploratory, cross-sectional study was conducted involving students, with and without handwriting difficulties, in Years 3–12 (mean age: 12.0 yrs, SD = 3.0 yrs; range = 7 to 18 yrs) in New South Wales (NSW; Australia). Participants were recruited through occupational therapists and schools. Students completed the HST and all DASH subtests. Results: Thirty-two students with, and 139 students without, handwriting difficulties participated. Intra-rater and inter-rater reliability were found to be excellent; sensitivity was low and specificity high for the HST and DASH. No significant differences were found between test scores and normative data for students without handwriting difficulties (year/age groups with n > 10). Conclusions: The HST and DASH are reliable assessments of handwriting speed. Further research is required into discriminant validity of the HST and DASH and need for updated norms.     

Psychometric Properties of the Revised Developmental Coordination Disorder Questionnaire

The Developmental Coordination Disorder Questionnaire (DCDQ) is a parent-completed measure designed to identify subtle motor problems in children of 8 to 14.6 years of age. The purpose of this study was to extend the lower age range to children aged 5 to 7 years, revise items to ensure clarity, develop new scoring, and evaluate validity of the revised questionnaire. Additional items with improved wording were generated by an expert panel. Analyses of internal consistency, factor loading, and qualitative/quantitative feedback from researchers, clinicians, and parents were used to select 15 items with the strongest psychometric properties. Internal consistency was high (alpha =. 94). The expanded questionnaire was completed by the parents of 287 children, aged 5–15 years, who were typically developing. Logistic regression modeling was used to generate separate cutoff scores for three age groups (overall sensitivity = 85%, specificity = 71%). The revised DCDQ was then compared to other standardized measures in a sample of 232 children referred for therapy services. Differences in scores between children with and without DCD (p <. 001) provide evidence of construct validity. Correlations between DCDQ scores and Movement Assessment Battery for Children (r =. 55) and Test of Visual-Motor Integration (r =. 42) scores support concurrent validity. The results provide evidence that the revised DCDQ is a valid clinical screening tool for DCD.     

The Relationship Between Tests of Sensorimotor Integration,Tactile Sensitivity and Gross Motor Skills in Normal and Developmentally Delayed Preschool Children

To examine the relationship of tests of sensorimotor integration, tactile sensitivity, and gross motor skills among preschoolers, the investigators administered three assessment tools to a sample of 61 preschool children (12 non-handicapped children and 49 children with mild developmental delays). Tests used were the Assessment of Sensorimotor Integration in Preschool Children, the Tactile Sensitivity Checklist, and the Peabody Developmental Motor Scales. Modifications were made in the tools designed to assess sensorimotor integration and tactile sensitivity and are described in detail. The relationship of scores on the sensorimotor integration tool to chronological age was evaluated; a strong positive correlation was noted for the scores of the 12 non-handicapped preschoolers. A significant correlation between scores on the sensorimotor integration tool and those of the Peabody Developmental Motor Scales was noted for the entire sample of children. There was no significant relationship between scores on the sensorimotor integration tool and the Tactile Sensitivity Checklist. Strengths and limitations of the sensorimotor integration tool were discussed as they relate to potential use in a pediatric therapy setting.     

SOS: A Screening Instrument to Identify Children with Handwriting Impairments

ABSTRACT

Poor handwriting has been shown to be associated with developmental disorders such as Developmental Coordination Disorder, Attention Deficit Hyperactivity Disorder, autism, and learning disorders. Handwriting difficulties could lead to academic underachievement and poor self-esteem. Therapeutic intervention has been shown to be effective in treating children with poor handwriting, making early identification critical. The SOS test (Systematic Screening for Handwriting Difficulties) has been developed for this purpose. A child copies a sample of writing within 5 min. Handwriting quality is evaluated using six criteria and writing speed is measured. The Dutch SOS test was administered to 860 Flemish children (7–12 years). Inter- and intrarater reliability was excellent. Test–retest reliability was moderate. A correlation coefficient of 0.70 between SOS and “Concise Assessment Methods of Children Handwriting” test (Dutch version) confirmed convergent validity. The SOS allowed discrimination between typically developing children and children in special education, males and females, and different age groups.     

Family-Centred Care: A Critical Perspective

ABSTRACT

Purpose: Pain associated with hypermobility of wrist and hand joints can contribute to decreased handwriting output. This study examined the effectiveness of a neoprene wrist/hand splint in reducing pain and increasing handwriting speed and endurance for students with joint hypermobility syndrome. Methods: Multiple baseline, single system design (SSD) methodology was used. Four ninth grade students with handwriting difficulties because of joint hypermobility syndrome participated in this study. Results: Visual and statistical (two standard deviation band method) analyses indicated a significant decrease in handwriting speed when using the splint for three out of four participants. No significant change in pain or endurance was noted during intervention. There was a significant decrease in pain following withdrawal of the splint for three participants. Conclusion: Evidence from this study does not support use of this particular splint for decreasing pain and increasing handwriting speed and endurance for ninth grade students with joint hypermobility syndrome.     

Cognitive performance at school age of very low birth weight infants with bronchopulmonary dysplasia

The hypothesis was that bronchopulmonary dysplasia (BPD) adversely affects cognitive performance at school age. This prospective cohort study examined three groups of children at 8 to 10 years of age. Group 1 (n = 311) consisted of very low birth weight (VLBW) infants without BPD and Group 2 (n = 95) consisted of VLBW infants with BPD. Group 3 (n = 188) consisted of term infants without BPD. Regression analysis determined the effect of BPD on eight performance measures while controlling for possible confounding variables. Children in Group 3 had the best performance and children in Group 2 had the poorest performance on all measures. These differences were significant (p = .0001) for the Full Scale IQ, Performance IQ, and reading and math grades and ages. Children in Groups 3 and 1 performed better than children in Group 2 for the Verbal IQ (p = .0001) and the Developmental Test of Visual-Motor Integration (p = .0012), but for these two measures there was no significant difference between children in Groups 3 and 1. Thus, poorer performance was found in VLBW infants with a history of BPD.     

Predictive accuracy of the Miller assessment for preschoolers in children with prenatal drug exposure

The Miller Assessment for Preschoolers (MAP) is a standardized test purported to identify preschool-aged children at risk for later learning difficulties. We evaluated the predictive validity of the MAP Total Score, relative to later cognitive performance and across a range of possible cut-points, in 37 preschool-aged children with prenatal drug exposure. Criterion measures were the Wechsler Preschool & Primary Scale of Intelligence-Revised (WPPSI-R), Test of Early Reading Ability-2, Peabody Picture Vocabulary Test-Revised, and Developmental Test of Visual Motor Integration. The highest predictive accuracy was demonstrated when the WPPSI-R was the criterion measure. The 14th percentile cutoff point demonstrated the highest predictive accuracy across all measures.     

Predictive Accuracy of the Miller Assessment for Preschoolers in Children with Prenatal Drug Exposure

The Miller Assessment for Preschoolers (MAP) is a standardized test purported to identify preschool-aged children at risk for later learning difficulties. We evaluated the predictive validity of the MAP Total Score, relative to later cognitive performance and across a range of possible cut-points, in 37 preschool-aged children with prenatal drug exposure. Criterion measures were the Wechsler Preschool & Primary Scale of Intelligence-Revised (WPPSI-R), Test of Early Reading Ability-2, Peabody Picture Vocabulary Test-Revised, and Developmental Test of Visual Motor Integration. The highest predictive accuracy was demonstrated when the WPPSI-R was the criterion measure. The 14th percentile cutoff point demonstrated the highest predictive accuracy across all measures.     

Comparison of Cursive Handwriting Instruction Programs Among Students Without Identified Problems

The purpose of this study was to compare the effects of cursive handwriting programs in improving letter legibility and form in third-grade students without identified handwriting problems. Four months into the school year, cursive handwriting was assessed for a sample of convenience of 50 third-grade students. Subsequently, students received instruction for 10–15 minutes daily for 6 weeks using either Handwriting without Tears, Loops and Other Groups programs, or, as a control condition, continued instruction in the Zaner-Bloser program. Student handwriting for all programs improved from pretest to posttest. Posttest comparisons indicated no significant differences between programs. The results suggest that the method of handwriting instruction has a limited short-term impact on cursive letter legibility and form for children without handwriting problems.     

Effectiveness of a computer skills program to improve written communication in children with Developmental Coordination Disorder

Word processing using a keyboard is an option for children with Developmental Coordination Disorder (DCD) who have printing/ handwriting difficulties. A five-replication single-subject ABA design was used to explore the ability of 6 children with DCD (entering Grades 3-5) experiencing problems with printing/handwriting to learn computer skills. Following a two-week intervention all children were familiar with basic computer functions and showed improved word processing skills. Touch-keyboarding speed increased for the five children entering Grades 4-5, but only one child acquired a speed (letters/minute) comparable to printing/ handwriting. Four children demonstrated increased text production when generating a story, but none achieved speeds comparable to printing/handwriting. Five-finger touch-keyboarding proficiency was better for children in Grades 4-5. Therapists observed improved legibility and increased motivation. Results suggest that the child's grade, program support, and program length should be considered when making decisions about keyboarding.     

Using data visualization and signal processing to characterize the handwriting process

INTRODUCTION: Disturbances in handwriting legibility and speed are found among elementary school-aged children. The aim of this paper is to present a set of sophisticated analytical tools suitable for visualization and evaluation of handwriting disturbances. METHODS: Handwriting samples from 30 children, 15 proficient and 15 non-proficient handwriters, aged 8-9 years were collected with the aid of a digitizing tablet. Temporal and spatial measures of the handwriting process dynamics based on signal processing methods were developed and visually presented. RESULTS: Significant differences between proficient and non-proficient handwriters were found in handwriting characteristics such as the standard deviations of letter width (t=2.96, p=0.008), letter height (t=3.24, p=0.005) and pen elevation (t=2.91, p=0.008). Significant differences were also found for the number of pen lifts (t=2.27, p=0.03), for the value of the correlation coefficients between letter length and time (t= -6.62, p=0.000) and between the actual and computed number of words (t=2.79, p=0.01). CONCLUSIONS: The techniques described in this paper provide objective measures for handwriting performance presented in a way designed to help clinicians and educators visualize handwriting difficulties during clinical evaluation and intervention. Data visualization and analysis appear to enhance information concerning the spatial and temporal dynamics of handwriting.     

The Association of Motor Skills and Adaptive Functioning in XXY/Klinefelter and XXYY Syndromes

Aims: Klinefelter (XXY) and XXYY syndromes are genetic disorders in males characterized by additional sex chromosomes compared to the typical male karyotype of 46, XY. Both conditions have been previously associated with motor delays and motor skills deficits. We aimed to describe and compare motor skills in males with XXY and XXYY syndromes, and to analyze associations with age, cognitive abilities, and adaptive functioning. Methods: Sixty-four males with XXY and 46 males with XXYY, ages 4–20 were evaluated using the Beery Test of Visual Motor Integration and the Bruininks-Oseretsky Test of Motor Proficiency – 2nd Edition assessments, Vineland–2 adaptive scales, and cognitive testing. Results: Motor coordination impairments were found in 39% of the males with XXY and 73% of the males with XXYY. Both groups showed strengths in visual perceptual skills. Males with XXYY had lower mean scores compared to males with XXY across all assessments. Fine motor dexterity and coordination deficits were common. There was a positive correlation between VMI scores and adaptive functioning. Conclusion: Occupational and physical therapists should be aware of the motor phenotype in XXY and XXYY both to aid in diagnosis of unidentified cases and to guide intervention.