Friday, 17 June 2016

Sensory Strategies for Handwriting Skills



                                                 
                                                          


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Lewis is a 5-year old child who has recently joined pre-school. According to his parents he is very active, energetic and friendly boy who likes running in ground, spinning, jumping, watching Doctor Who and talking to everyone. After working with Lewis for a week, his class teacher discovered some unique habits, characteristics and behaviours of him which were as follows:
  • While sitting in his chair or writing he slouches without him knowing about it. Likes wandering in the classroom and “always on a go”. He cannot sit for more than 10-12 minutes in his place.
  • Doesn’t like playing with Lego or construction toys.
  • Easily distracted by background sounds or outside noise (e.g., bird chirping or vehicle passing by)
  • Gets confused with letters and numbers while reading and writing
  • He is right handed but often uses left hand to write.
  • While writing he goes out of space without realising it.

When these observations were discussed with school OT, she strongly recommended him for Sensory Integration assessment as all above stated features were part of sensory difficulties which were interfering in his handwriting, self-care, fine motor skills and day to day activities.

Handwriting is an important functional task for school aged children and primary way to express thoughts, ideas and knowledge, and emotions. Composing stories, expressing own emotions, copying numbers, from the blackboard, completing school assignments, writing formal letters, or applications all needs precise handwriting skill. 

According to Case-smith (1992), children began to draw and scribble on paper as soon as they are able to grasp a writing tool. The development of writing process in early years includes scribbling, drawing lines and circles.

During 7-8 years they learn to use the different functional tool such as
knife and fork, scissors, pencils, zippers, buttons, brooms. They learn to plan and sequence actions which are the important part of motor planning. 
Developing ideas, for building blocks, construction toys, Legos, sand castles, are taken enthusiastically. All these experiences of childhood enable a developing brain to work efficiently and organise incoming sensory information received from different sense organs.

However, for an atypically growing child these opportunities and playful scenarios are sensory challenges. They may experience stress in the case in the course of the day to day tasks related to fine motor, gross motor and handwriting skills.

These children are reluctant to write, easily tired, seen slouching in their chair, their desk is often disorganised, may drop things in hand and may display behavioural issues due to frustration, the anger of not being able to accomplish tasks in hand and other sensory difficulties.


According to research (Handwriting development, competency, and intervention, 2007) children spend 31 to 60 percent of their school day performing handwriting and other fine motor tasks. Poor handwriting can interfere with academic achievement and considered imperative life skill.


Handwriting skill being a complex in nature needs a lot of practice, patience, and preservance to master. Here are some of strategies and resources which can be helpful to a child with sensory issues however my insights are no substitute for working with an occupational therapist to develop the personalised intervention plan.


Proprioception Sense Issues:


Lack of motor planning which is the ability to conceptualise, plan and execute tasks affects writing strongly. Child’s writing incorporates holding a pen, putting the just right amount of pressure on paper and writing tool, sensory awareness of fingers and other significant motor tools which are influenced by proprioception.

During handwriting proprioceptive input provides information regarding grasp of writing tool, rubber, paper, and surface.


If a child has less mature pencil grasp, or he tires easily, drops things in hand, it can be concluded that he requires appropriate proprioceptive input.
  • May lack judgement about the amount of pressure needed to exert on paper.
  • May drop things in hand and look weak.
  • May erase so hard which may cause holes in sheet due to poor modulation issues.
  • May use the least pressure while writing on paper due to which writing is illegible
  • May get tired easily or tend to slump over the desk.
  • May avoid extended hours of sitting and writing
  • May complain about pain in his hand, arm and neck if writing for prolonged hours.
  • May have the poor grip on pencil due to poor modulation.


Proprioception Sense Strategies: 


     Fidgets help to reduce fidgeting, anxiety or impulsivity.

Exercise bands (Thera-bands) are the good source of strengthening 
hand and wrist muscles and providing resistive exercises.

To improve tension forearms, forearms and hands give a gentle clasp.

Sensory Stress ball helps in strengthening hand muscles and reduces anxiety.

Movement breaks: 2-3 minutes of break can increase the efficacy and concentration by 15-20 minutes. Scheduled movement break is important maybe once or twice a day.The book 404 Deskside Activities for Energetic Kids: Movement Breaks toKeep Kids' Attention in the Classroom written by Barbara Davis is an effective resource for sensory classrooms.

Use Carpenters’ pencil as it is thick, rectangular in shape and supports in holding easily.

Plastic Bendable Pencils :used for children who likes chewing pencil tops for oral stimulation.

Use HB Pencil for if the child writes too light and the marks are not legible.

Use Soft lead 2B pencils if the child writes too hard leaving holes in paper.

Clutch Pencil (0.7 mm) helps to strengthen thumb muscles. Both propelling and clutch pencils are more efficient than wooden pencils as the child doesn’t have to waste time sharpening pencils.

Use CLAW pencil grip to eliminate thumb wrap and fist grips.

Use paper towel under the sheet if child presses too hard while writing or creates holes.

Animal Walks: These can be done in the classroom or home setting easily such as Bunny Hop, frog jump and alligator walk.

Wrap clay around the pencil and ask the child to maintain the shape of clay. Shape distortion means he is using too much of force while writing.

Pencil Grips and paper alterations:


Encourage the child to use short pencils or Golf Pencils. These pencils prevent a child from holding or grasping from too the high on shaft which gives an elongated wrap-around grasp.

Use of slant board can be an effective strategy which can be made by covering 4” by 3” ring binder with duct tape as it gives better arm position.

Use grid paper and ask the child to write numbers within the boxes.

    Use raised line paper for tactile issues.They help to stay within line.

Posture (Ergonomics for Seating):

a.    While sitting on chair hips, knees, and ankle should be
perpendicular to each other.
b.   Back should be straight and ninety-degree angle should form at the elbow.
c.    Wrists should be in resting position.
d.   Table and chair should have appropriate height.
e.   The seat back should be angled at 15 degrees.
f.    The child should lean forward with body weight supported by the floor with feet on the ground.
g.   Provide slanting desk or tilt table desktop for achieving ideal reading and writing angles for vision and spine.
h.   Elbow rests prevent straining of shoulders and neck muscles.
i.     Reading angle should be about 60 degrees from horizontal.
j.     Writing angle should be about 10-20 degrees.

Vestibular Sense Issues:

This sense is called as vestibular sense. Our relationship to parents can be called secondary when explaining importance and relation to gravity in our lives. Due to this sense essential skills such as bilateral integration, eye-hand coordination and balance are accomplished during child’s growth and development.Usually, children with poor vestibular sense have poor bilateral integration.

  • The child may have difficulties in coordinating both the sides of the body that are left and right side confusion will be prominent.
  • May get easily confused with instructions or directions that are why they easily forget classroom routes.
  • May have difficulties in dancing, playing the drum, eating with knife and fork as hands and feet may not work in coordination.
  • Maybe ambidextrous or have poor hand preference.
  • May have trouble with maths.
  • May have disorganised desk, room, and surroundings


Vestibular Sense and Bilateral Coordination Strategies & activities:


Involve child in activities such as bike riding, football playing, throwing the ball, skating, horse riding, swimming.

Playing musical instruments improves bilateral coordination.

For better eye-hand coordination target games are a good resource.

Play nut-bolt games with a child for improving fine motor skills.

Hitting ball with rolling pin or rolled up newspaper

Cutting with scissors - large shapes then smaller followed with angular ones

Climbing frames, tug of war

Star Jumps, Hopping 

Disorganisation:

Labelling and Categorisation: Use sticky tags for labelling folders such as work done, work to be done, notices, to be read and other labels can be made according to requirements and relevance. It supports the child to distinguish and different folders and binders as well as subjects.

Visual Reminders: These can be in the form of picture posters, sticky notes, widgets, or coloured writing on the board. At home write reminders with red or green colour opens outside shower doors or on the mirrors. Adults can use smart phones to set reminders.

Timers: Digital timers or sand timers are the good sources of getting visual input for time.

It is always better to show or demonstrate what you are telling or expecting from the child. Verbal instructions should be clear, simple and precise without any confusions.

Colour code all the textbooks,folders, and supplies.

Visual-Auditory Processing Issues:

  • May have difficulties in forming or staying in line when drawing,
    colouring or painting.
  • May have difficulties in cutting along the lines or glueing properly.
  • May have difficulties in placing cut-outs in the correct place in crafts project.
  • May be sensitive and easily distracted to noise, visual stimuli or background sounds.
  • May look confused often.
  • May loose page while reading writing, copying

Auditory-Visual Sense Strategies:
Drawing shapes, patterns, letters, numbers in different types of medium such as sand, playdoh, shaving form etc.

Let child start with horizontal

Encourage maze games for better eye control, and hand control.

Reduce too much of visual stimulation.

Construction toys, building blocks, Lego can support

  

  Tactile Sense Issues:

  • May dislike being touched or approached from behind.
  • May dislike getting hands messy in finger paint, glue and shaving form.
  • May seem distressed when having nail cutting or toe nail cutting.
  • May chew pencil, shirt collar, hair or rubber while writing or reading in the classroom or home.
  • Maybe sensory seeker and have the tendency to touch everyone and everything.

Tactile Sense Strategies:
      Inform child before touching him.
 Try painting or messy activities in the vertical plane followed with     slanting and horizontal
Try plastic bendable pencils for chewing purpose and oral stimulation.


Olfactory Sense Issues and strategies:

·        May be distracted by different smells in the classroom such as deodorants, perfumes etc.Teachers should avoid using strong deodorants and perfumes.