Handwriting: The Role of OT

Occupational Therapists (OTs) play an integral role in both handwriting development and intervention. Handwriting is a complicated and complex skill that can often be taken for granted. As OTs, we are able to address the many factors that affect handwriting, both with the client and within the environment to improve the quality and function of handwriting.

What is Handwriting?

 Handwriting is defined by both: “the act of writing” and “someone’s particular style of handwriting”.

Handwriting is writing performed by the hand with a utensil  (ex: crayon, pen, or pencil). Further, it is the motor skill of the hand with the ability to form letters. At a young age, children start by simply placing writing utensils, such as a crayon, to paper. The focus is simply creating dots or strokes intentionally on paper. Later, children learn the basics of handwriting strokes and then continually progress to how to form the alphabet and letters within their name.  Creating letters and writing one’s own name is a big accomplishment as a child. 

Writing vs. Pre-Writing

Writing is the ability to print all letters, independently and correctly. It includes the proper start and sequence of letter formation, placement, size, orientation, and legibility of letters. 

Functional writing includes the ability to write all letters, and numbers, create words, and sentences, progress to paragraphs, and write in all subjects required for school demands. 

Pre-Writing includes all activities that encourage skills that will later be required for writing tasks. This includes social behaviors for a classroom, vocabulary and direction following, alphabet knowledge including letter and number familiarity, fine motor skills, and general awareness of size, shape, and position. 

Motor Requirements of Pre-Writing and Writing 

When the average person thinks of handwriting, they may picture the hand, holding a pencil or pen. When an OT thinks of handwriting, we are often thinking of the foundation of the rest of the body, the seated posture in the chair, the stability of the shoulder and positioning of the wrist, and the use of an assisting hand to steady the paper, the handwriting grasp, and control the writing utensil. OTs assess the strength and endurance of all body parts required for writing, in addition to the fine motor muscles of the hands and the eyes in order to complete the task.

Why is Handwriting so important? 

Handwriting is a functional skill that will serve a child and a person for life. If this is something that children find difficult, then handwriting can be a point of contention for children. They can feel defeated, frustrated and annoyed to practice handwriting skills. They may avoid handwriting activities altogether and have low self-esteem when it comes to normal daily tasks or classroom assignments. 

As adults, we may feel that writing individual letters may hold little meaning, however, we must remember that this skill grows from strokes to form letters, letters combined to create words, and writing words to write sentences. Writing serves a purpose as a rudimentary skill but also a form of self-expression to relay thoughts and feelings, and many find within it a psychological release. Let us not forget that this is an important skill that affects individuals' participation in school and other creative outlets. Writing becomes a form of function and self-expression.

How do Occupational Therapists address Handwriting?

Occupational Therapists are skilled in “task analysis” which means the study of skills and components that are required in order to complete a task. 

OTs are able to evaluate overall handwriting function and underlying skills required for the task, taking into account the skill level and age of the child, as well as determine what is expected of the child for their age, their family, and their life.

Is the child in school?

Does this child have special needs?

What are the expectations and desires of the parent?

Is it for the child to write their own name or is it for them to complete small paragraphs? 

These are just a few questions we might consider when addressing handwriting skills for a client.

Skills involved with Handwriting  include: 

• Movements of the upper extremity, wrist, and fingers + stability of the trunk

• Grasp and the strength of the hand muscles

• Addressing proper utensil grasp and finger placement on a writing utensil

• Refinement of fine motor muscles 

  • In order to produce small fluid movements to create easy, legible strokes

• The direction of writing  strokes and starting point & direction of letter formation

• The pressure of the writing utensil, both in the hand and on the page

• Placement and utilization of an assisting hand, angle of the paper

• Overall seated posture and ergonomics during writing/coloring activities

• Core stability and Endurance for seated posture during handwriting task 

• Attention to task/ability to focus

• Cognitive: knowledge of shapes, forms, and symbols of letters

• Cognitive: letter formation ( developmental skill / knowledge) 

• Motor: visual motor skills/development involved in HW

• Ability to cross midline fluidly 

Handwriting is just ONE of the many things we can address at Helping Hands Therapy, in both individual and group settings. If you're interested in receiving therapy or learning more, give us a call: 757.698.4681

Stay tuned for Part 2: Handwriting, coming in October, where we’ll cover: 

• What is a Developmental Handwriting Approach?

• What is a Remedial Handwriting Approach?

• What can Parents do at home?

• Parent’s FAQs

See you soon!

Shelby Stoaks O'Connor is a Pediatric Occupational Therapist with over 10 years of experience working with children. She has also worked in outpatient clinics, acute care hospitals, and skilled nursing settings.