Handwriting

One of the most common referrals for occupational therapy is “messy handwriting.” Teachers will often report this concern to parents and child study teams. Teachers and parents alike will have children complete handwriting books, worksheets, redo messy assignments, give constant reminders to write neatly, type assignments, etc. etc.

So is poor handwriting something a parent needs to be worried about? Should it be addressed with an evaluation and intervention? Let’s discuss.

OT’s look at handwriting with a unique set of eyes. We breakdown the skill into small components. Handwriting is a by-product of well-developed fine motor skills and visual perceptual skills. Fine motor skills refer to the efficient use of small muscles within the hand. We first assess the anatomical structures, range of motion and strength of the upper extremity. Special attention is paid to movement patterns like reach, grasp, release, in-hand manipulation skills (moving a coin from the finger tips to the palm without dropping), pencil grip and using both hands together to perform functional tasks.

I ALWAYS check the visual system. This is often overlooked in many OT assessments and is absolutely vital. An intact ocular motor system is needed for legible handwriting and overall academic success. Again, we begin with the anatomical structures of the eyes, acuity, eye muscle movements and then move on to more complex functions like perception and processing skills.

Only after I gathered all the information on fine motor and ocular motor status, do I ask a child to actually write for me. I prefer to use standardized assessments with age norms. This tells me valuable information regarding the child’s ability to copy, write and draw figures and words when compared to his/her same aged peers.

Finally, I put all of the above pieces together and I have the answer to what is causing “messy handwriting”. I can then make an intelligent decision on whether skilled intervention is needed. At this point, I devise a treatment plan, which is always going to consist of fine motor exercises, ocular motor activities, visual perceptual tasks and then lastly some small amounts of writing. Addressing ALL the underlying components listed above will improve “messy handwriting.”

An informative picture of various pencil grips which may, or may not impact handwriting.
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