To develop an occupational therapy kit for handwriting skills in children with dysgraphia and study its efficacy: A single-arm interventional study

Abstract

Background: Handwriting is a complex perceptual-motor skill dependent on the maturation and integration of a number of cognitive, perceptual, and motor skills. Handwriting develops through instruction and is a complex process of managing written language by coordinating the eyes, arms, hands, pencil grip, letter formation, and body posture. Handwriting Without Tears Methodology™ (HWT) is an established handwriting curriculum created by Jan Olsen and is used by occupational therapy (OT) practitioners in traditional one-on-one service delivery. It is also designed for full classroom implementation and instruction and is used in thousands of Mainstream and Special Schools across the world. Objectives: The objective of the study is to analyze the impact of handwriting intervention with OT Kit (OTK) in treating children with dysgraphia (OTK included HWT products, other multisensory material, and fine-motor activities) and to establish the norms on OTK to enable it to be used by therapists for handwriting intervention in India. Study Design: Single-arm interventional study design was chosen for the research. Methods: In a pre- and post-single-arm interventional study design, 40 children diagnosed as dysgraphia (age group 6–11 years; male:female: 31:9) were recruited from a regular school and OT clinic. The handwriting performance was assessed using HWT Screener™ for 1st, 2nd, 3rd, and 4th Grade from mainstream school and the Print tool®. The intervention using OTK was based on HWT program™, multisensory activities, and fine-motor activities. Results: Boys had difficulty in lowercase formations more than girls, and 9-year olds were found to have maximum difficulties in sequencing and memory components of written production. Variables of memory, placement, letter, and word spacing have shown maximum improvement. Where the primary outcomes are P < 0.05; 95% confidential interval [CI]: −4.15 to −1.61 (memory), −14.58 to −4.91 (letter spacing). Analysis of HWT screener shows memory, placement, orientation, and sentence formation to have maximum improvement in students of Grade 1st to 3rd where P < 0.05; 95% CI: −18.56 to −10.18 (memory) and P < 0.05; 95% CI: −12.49 to − 5.88 (placement). In Grade 4th variables, word and capital cursive have shown better improvement than lowercase cursive P < 0.05; 95% CI: −31.54 to − 11.49 (word cursive). Conclusions: OTK (HWT™ manipulatives, multisensory products, and fine-motor activities) was found to be beneficial in improving the handwriting skills in Indian children with dysgraphia. Significant benefits were seen in boys and younger children, when receiving HWT curriculum instructions.