Some of you that follow my blogs may have read an earlier piece on the foundations to fine motor skills, which in turn relates to this topic, however for my practice as an OT I support fine motor skills separately and then work on handwriting skills. So here it is broken down into what I would start with working on certain goal areas with families and children.
In my practice when working to set goals with families and children, they may create a goal, “For my child to be able to hold a pen effectively for writing at school and at home”. This is a great functional goal, however when broken down there is a lot to it.
Firstly, I would think about the child’s developmental age to give indications of where they could be functioning. I would complete a range of Occupational therapy assessments including looking into the gross motor skills. These assessments may include the Movement Assessment Battery for Children, the Miller Function and Participation assessment or developmental screening forms.
Again you would have seen in my previous blogs, that gross motor skills developmentally comes first and if we are not able to hold our self-upright in space (sitting on a chair), then how can we be expected to write.
If I have a client that only has fine motor goals, but I know that evidence suggests to work on gross motor skills to support fine motor, I would share this with the family and then give some strategies for family and daycare etc to carry out if they are able to.
Adaptive equipment can support seating and core strength at a desk also, such as wedge cushions which can tilt the pelvis to support sitting upright and hold core position while seated.
So, I would begin with where the child is functioning, and given some strategies to support core strength and strengthening upper body skills etc. This really depends on the assessment results, what the child is currently able to do and what the goal is (where they would like to be).
Secondly, I would assess the fine motor skills using Occupational Therapy assessment such as the Millers Function and Participation, fine motor screening checklists or handwriting assessments. This is often all done in one assessment, it really depends on what the child’s and family goals are. This could show any of the areas mentioned in the ‘foundations for fine motor skills blog’ to support for the child to be able to hold a writing tool. These may include hand strengthening, bilateral coordination, in hand manipulation and wrist extension.
Supporting these skills in a range of developmental appropriate activities will then support the goal, it is really important the child understands what they are doing, how it supports the goal they have created, and are interested in the activity. The more engagement in the task the more success.
Thirdly, We would practice writing skills. These could be pre-writing skills, working with large gross motor movements, working on horizontal, vertical, diagonal, and circular lines. This could include writing in sand, in shaving foam, or messy play. Using sensory objects to support writing is effective for many learning styles, some children/people are kinesthetic learners; this means they need to move and feel the movement with there tactile sense. This supports their physical memory and retaining what is being learnt.
It is so important a range of learning styles is offered for children, as they may not know how they best learn, so we can offer visual, verbal, sensory, and movement opportunities to teach topics such as writing.
In this same stage I would be supporting schools, daycare and families to work with their child vertically, such as drawing on easels or windows. This works the upper body and strengthens the muscles for writing.
Lastly, we would apply these skills to horizontal writing opportunities, beginning with strokes and marks on paper. Depending on the child’s developmental age and stage, it can be effective to use think and large writing tools. Such as rock crayons, tripod crayons or half a crayon. This allows the palm and hand to form around the writing tool and promote use of the thumb and fingers together.
The dynamic tripod grasp is the most ideal writing grasp, however it is important to know this is not what is needed for your child to write successfully. They may use a lateral tripod grasp, or static tripod grasp for some time. So long as they are able to write effectively and legibly for their age, and that the grasp is not causing them pain then this is acceptable. I have many teachers and parents wanting the ideal tripod grasp to be used, however we are all different and use different writing tools, which at times can require different grasps.
We need to think what the focus is for the child, is it to hold the pen correctly or be able to write their names, or sentences at school.
In terms of the goal we are reviewing in this blog, the child may work with a static tripod grasp or palmar grasp for some time developmentally, and I review this with the family and we can use visual pictures of how to hold our pen for the child to see. Also supporting where the elbow is for writing, we can use encourage the elbow to be held down to their side by holding a cushion or piece of paper with their elbow.
That covers a snapshot of how Occupational therapy can support your child in writing. As you read you can see there is a lot to it, and this can take time and practice of these skills. There is also visual processing skills and sensory processing which plays into writing and fine motor skill development also.
It is really important to ask questions along the way for your child, you may see peers in their same age performing differently to your child and again, this is okay as we all develop differently in our own time and space, however we can guide them to develop the skills to support these areas where possible and if it is something your child wants to work on also.
I hope you enjoyed this blog