An investigation of the factors affecting handwriting skill in children with hemiplegic cerebral palsy*

Purpose. This study investigated the effects of sensory-perceptual-motor and cognitive functions on handwriting skill in primary-school children with left-hemiplegic cerebral palsy, compared with that of their healthy peers. Methods. The study included 26 children aged 8–12 years with left hemiplegic cerebral palsy and 32 typically developing children of similar age with dominant right hand. The Minnesota Handwriting Assessment was used to evaluate handwriting skill. The Bruininks–Oseretsky Test of Motor Proficiency was used to assess motor performance. Cognitive function was assessed by the Lowenstein Occupational Therapy Cognitive Assessment. The Ayres Southern California Sensory Integration Tests were used to assess visual perception, kinaesthesia and graphesthesia. Results. Statistically significant differences were found between the two groups in sensory-perceptual-motor and cognitive function and handwriting skill (p < 0.05). There were also significant correlations between handwriting parameters and upper-extremity speed and dexterity, proprioception, bilateral coordination, visual and spatial perception and, visual-motor organisation in children with cerebral palsy (p < 0.05). Conclusions. The results showed that left-hemiplegic children with cerebral palsy whose right sides were dominant were significantly less competent at handwriting than their right-dominant, healthy peers. It was found that the impairment in proprioception seen in the non-hemiplegic side in children with cerebral palsy, and also the impairment in bilateral coordination, speed and dexterity of the upper extremities, visual and spatial perception, visual-motor organization, and tactile-sensory impairments negatively affected their handwriting skills. In the treatment approaches for children with hemiplegic cerebral palsy, comprehensive sensory-perceptual-motor assessments that involve both extremities must be performed in detail at the earliest possible stage, in order to minimize the existing problems with early-treatment policies. Developing the sensory-perceptual-motor and cognitive function of hemiplegic children would thus be possible, and they would be able to develop handwriting skill as a tool for their academic lives as healthy peers.

[1]  S. Cermak,et al.  Fine motor activities in elementary school: preliminary findings and provisional implications for children with fine motor problems. , 1992, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[2]  S J Amundson,et al.  Relationship between visuomotor and handwriting skills of children in kindergarten. , 1994, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[3]  Robert H. Bruininks,et al.  Bruininks - Oseretsky Test of Motor Proficiency , 1978 .

[4]  V. Berninger,et al.  RELATIONSHIP OF FINGER FUNCTION TO BEGINNING WRITING: APPLICATION TO DIAGNOSIS OF WRITING DISABILITIES , 1992, Developmental medicine and child neurology.

[5]  S. Chow,et al.  Perceptual-motor function of school-age children with slow handwriting speed. , 2000, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[6]  Alma Jean Ayres Baker,et al.  Sensory Integration: Theory and Practice , 2005 .

[7]  Asha V Asher.  Handwriting instruction in elementary schools. , 2006, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[8]  D. Marr,et al.  Handwriting Readiness: Locatives and Visuomotor Skills in the Kindergarten Year. , 2001 .

[9]  S. Hooper,et al.  Neurodevelopmental Study of Writing Disorders in Middle Childhood , 1992, Journal of developmental and behavioral pediatrics : JDBP.

[10]  Mei Hui Tseng,et al.  Differences in Perceptual-Motor Measures in Children with Good and Poor Handwriting , 1994 .

[11]  J. Reisman,et al.  Development and Reliability of the Research Version of the Minnesota Handwriting Test , 1993 .

[12]  Sidney Chu.  Occupational Therapy for Children with Handwriting Difficulties: A Framework for Evaluation and Treatment , 1997 .

[13]  Emanuela Pagliano,et al.  Hand function in children with hemiplegic cerebral palsy: prospective follow-up and functional outcome in adolescence. , 2003, Developmental medicine and child neurology.

[14]  A. Ayres,et al.  Sensory Integration and the Child , 1972 .

[15]  Improving handwriting through kinaesthetic sensitivity practice. , 1992, Australian occupational therapy journal.

[16]  A. Eliasson,et al.  Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia. , 2002 .

[17]  J. Ziviani,et al.  Handwriting: A Perceptual-Motor Disturbance in Children with Myelomeningocele , 1990 .

[18]  Linda Leonard Lamme,et al.  Handwriting: In an Early Childhood Curriculum. , 1979 .

[19]  Louise DuBois,et al.  Handwriting of children who have hemiplegia: A profile of abilities in children aged 8–13 years from a parent and teacher survey , 2004 .

[20]  A. Henderson,et al.  Testing the effect of kinesthetic training on handwriting performance in first-grade students. , 2002, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[21]  A. Eliasson,et al.  Comparing tests of tactile sensibility: aspects relevant to testing children with spastic hemiplegia , 2002, Developmental medicine and child neurology.

[22]  A F Maeland,et al.  Handwriting and Perceptual-Motor Skills in Clumsy, Dysgraphic, and ‘Normal’ Children , 1992, Perceptual and motor skills.

[23]  S. Cermak,et al.  Evaluating the visual-perceptual skills of children with cerebral palsy. , 1987, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[24]  A. Gordon,et al.  Relation between clinical measures and fine manipulative control in children with hemiplegic cerebral palsy , 1999, Developmental medicine and child neurology.

[25]  L. Meltzer,et al.  Developmental output failure: a study of low productivity in school-aged children. , 1981, Pediatrics.

[26]  Occupational Therapy Decision Making Guidelines for Problems in Written Productivity , 1999 .

[27]  A. Eliasson,et al.  The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. , 2006, Developmental medicine and child neurology.

[28]  C. Schneck,et al.  Comparison of pencil-grip patterns in first graders with good and poor writing skills. , 1991, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[29]  J. I. Laszlo,et al.  Kinaesthetic Sensitivity of Normal and Clumsy Children: a Reply to Lord and Hulme , 1988, Developmental medicine and child neurology.

[30]  Y. Swinth,et al.  Multisensory approach to handwriting remediation: perceptions of school-based occupational therapists. , 2002, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[31]  S. Cermak,et al.  The influence of ergonomic factors and perceptual-motor abilities on handwriting performance. , 1993, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.