This document provides an assessment of a child's handwriting skills by an occupational therapist. It notes concerns about the child's poor pencil grip, writing difficulties, and fine motor issues. The therapist conducted standardized tests to evaluate the child's visual motor integration, visual perception, and motor coordination. Intervention recommendations include activities to improve strength, positioning, grasp patterns, visual motor skills, bilateral coordination, and fine motor skills. Brain gym exercises are also suggested to help integrate body and mind.

1. HANDWRITING
ASSESSMENT
Dr. Ravi Ranjan Kumar
Clinical Specialist Occupational Therapist
BOT(NIOH) MOT(Jamia Hamdard)
Email us at -raviotist@gmail.com
Call us on: +919990308806

2. Handwriting is complex perceptual-motor skill that is dependent upon the
maturation and integration of a number of cognitive, perceptual, and motor skills,
which is developed through instruction (Hamstra-Bletz and Blote,1993;
Maeland, 1992).
It is an academic skill that allows individuals to express their thoughts and
feelings and communicate with others.
It is a complex process of handling language by pencil grip, letter formation, and
body posture. Handwriting efficiency requires mastery of multiple skills,
including vision, coordinating the eyes, arms, hands, memory, posture, and body
control, as well as the task of holding a pencil and forming letters.

3. •Legibility? (All or most of the words written can't be read out
of context.)
•Neatness? (The handwriting is messy or poorly controlled.)
•Comfort? (The child is experiencing pain, strain or discomfort
when writing.)
•Pressure? (S/he is pressing too hard or not hard enough, or
pressure within one piece of writing is variable.)
•Speed? (S/he writes very slowly, producing too little writing,
or too fast, becoming inaccurate.)
•Motivation/enjoyment? (S/he is reluctant to write or gives up
too easily.)
Areas of concerns

4. General Parents Concerns And Observations
• Shaky handwriting
• Letters poorly formed
• Writing drifting un-aligned across the page
• Size of letters seem too large or too small
• Writing difficulty to read
• Teacher/School have identified difficulties
compared to other children
• Incorrect pencil grip present/ No tripod grip
present
• Hand/arm physically shaking when writing
• Poor fine motor control
• Postural problems
• Multi-tasking issues

5. Visual Motor Integration (Taking in visual information and using it
appropriately for motor output such as writing, drawing, throwing a ball,
using a utensil, etc.)
This portion of the test involves the child copying various shapes and
forms which increase in difficulty
▪Visual Perception (The ability to appropriately process visual input.)
▪This portion of the test focuses on matching two shapes when one is
among similar shapes.
▪Motor Coordination (Skilled control of motor movements.)
▪This portion of the test requires the child to draw within the guidelines of
shapes that also increase in difficulty. They have to demonstrate pencil
control to remain inside the lines.
Standardized testing typically starts with The
Developmental Test of Visual Motor Integration (AKA the
Beery VMI).

6. Advaya - 8 year/M, Grade 3rd
Parent Concerns
 Posture is incorrect
 Erasing is a problem, cant understand force.
 Poor Pencil grip.
 Very fidgety and lies down after writing every word.
 Reluctant to write and gives up too easily.
 Until the beginning of class 3rd there was no spacing
between words.
 Alphabet formation isn’t correct despite repeated
reminders.
 Spelling mistakes even while copying.
 Shows aggression when asked to correct mistakes.
 Seems he doesn’t have much control on pencil.
 He still cant draw the horizontal line while writing hindi
words.

7. Therapist Observations
 Difficulty in holding pencil.
 Difficulty in Pencil grip.
 He finds it difficulty in pressure modulation.
 He applied less force while writing on paper
or Thera putty.
 Difficulty in visual-motor tasks and motor
planning.
 Poor sitting posture while writing.
 Difficulty in doing multi-functional and brain
gym activities.
 Difficulty in In Hand Manipulation.

8. ASSESSMENT
When evaluating the actual task of children's handwriting, following 4 areas are
considered:
✓Domains of handwriting - copying, manuscript to cursive transition, ability to
integrate auditory directions and a motoric response (dictation).
✓Legibility components - letter formation, letter alignment, spacing, size and slant
✓Writing speed - the number of letters written per minute
✓Ergonomic factors - writing posture, upper-extremity, stability, mobility and pencil
grasp pattern.

9. The findings are based on assessment using
structured activities.
Fine motor coordination-
 He had difficulty to understand how to
coordinate fingers for the fine movements for
task like picking up small beans and putting
them in a cup, stringing beads or macaroni.
 Visual Discrimination-he needed verbal prompts
to stick bindi or see the differences between
similar objects(Eg.Coins and especially
currencies)

10. Graph motor
 In writing he holds the pencil too close
to tip with tripod grasp. The impression
of pencil while writing is very tight and
with jerky movement, and initially he
needed repeated prompts to correct the
sitting posture while writing. His neck
extended, shoulder was abducted,
forearm supinated and wrist flexed.

11. Fine Motor- In Hand Manipulation
 He had difficulty in shifting coins one by one,
translation from palm to finger finger and
takes time to complete the task during putting
pasta in bowl, sticking buttons with glue on
paper.
 Bilateral Coordination-he had difficulty to do
quick match, clip game, use of scale, tweezer
activity and 2Dor3D tracing and also he found
it difficult to coordinate both sides of body
during brain gym tasks like cross crawls,
double doodle and making lazy eighth and
animal walks(Crab walking, duck walking,
bear, elephant walking)

12. Multitasking and Sequencing
He had difficulty during small bean bags
catching in sequence, paper folding, origami,
coloring within boundaries, paper tearing on
folded line and paper tearing with scale.
 Intrinsic muscle strength of hand-He had
problem during clay activities to make
small and big balls ,baby snakes with use of
palm and fingers and scissors. He also had
difficulty in holding the rubber band and
modulate force for fixing it on geo board.
He easily give up in task of exercises with
1Kg heavy.

13. Proprioceptive processing
 He used to write with lot of pressure
and force while writing, coloring on
paper or clay.
 Writing speed and spacing-His writing
speed was slow and couldn't complete
the task with in a time limit, and he
couldn't manage the spacing between
words and his writing wouldn’t legible.

14.  Directionality. He wouldn’t able to find
it to scanning and matching with
stickers and scan letters from left to
right and up to down sequences.
 Attention, Thinking and Focusing: He
got distracted and watched what other
peers is doing and forgot what task he
was doing and also lost during writing
and skip writing activity. Now he less
get distracted.

15. Visual Perception
 He had difficulty to relate the
visual perceptual worksheets like
design copying, spatial
orientation, scanning or
matching,2Dto3D copying and
follow a sequence etc. But
couldn't complete the task and
asked for help

16. Intervention

17. Strength and Stability
❖ Hand writing – Core muscles
✓In order for us to develop control over the smaller muscles of the hand we
must have support or control in our trunk, and in all of the other joints
leading up to the hand.
✓The hand itself needs adequate strength to hold on to a writing utensil and
isolate control in individual muscles.
✓Watch for slumping, poor grasp pattern, or fatigue
Activities For Shoulder and Postural Stability:
•Animal walks that encourage weight bearing on the arms, i.e.. Crab walk,
bear walk and duck walk.
•Rolling heavy ball against the wall
•Hoopla activities
•Slant board
•Hanging bar

18. Positioning
Feet and back supported at a 90 degree angle
Desk height about 2 inches above elbow
resting at side
Sometimes a seatbelt can add extra stability
and help child to focus if needed
Slant boards
Slant boards can help with forearm and wrist
support needed to isolate finger movements.
Clips on slant boards can hold the paper in the
appropriate position (30-45 degree angle) if
bilateral coordination is difficult.
Slant boards can also improve posture and visual
awareness

19. Handwriting warm ups (Let’s Practice!)
Brain gym, Physical fitness and Yoga Calm programs have an extensive
program that can help integrate body and mind to improve learning
potential
Wood Pieces and Mat Man
➢Learn the language of big line, little line, big curve and little curve
➢Learn directionality-top, bottom, above, below, right, left
➢Mat man teaches body awareness
➢Laminated capital letter cards with perceptual activities on the back
➢Make letters and shapes on the mat or on the floor

20. The pencil is pinched between the thumb pad and the index finger pad. The
pencil rests on the middle finger. Can hold something in last 2 fingers.
➢ A-OK: 1. Make the A-OK sign
2. drop or tuck the other fingers
3. Place the pencil between the thumb and index finger pads.
➢ A shorter pencil means less space for cramming in unnecessary fingers. It
basically forces kids to pinch with thumb and index finger. This is why the
popular curriculum Handwriting Without Tears uses their own brand of short
pencils
➢ Pinch and flip: 1. Place pencil on table pointing away from you.
➢ 2. Pinch pencil sharpened end and pick it up. Pinch the pencil where you should
hold it-on the point where the point meets the wood.
➢ Hide something under their pinky and ring fingers. These two fingers are
supposed to bend toward the palm while the thumb, index, and middle fingers
do all the work
HOW TO HOLD THE PENCIL ?

21. ACTIVITIES TO IMPROVE IN –HAND
MANIPULATIONS
TRANSLATION SHIFT ROTATION
Putting penny in piggy bank
???????

22. ACTIVITIES TO IMPROVE GRASP PATTERNS
Playing with playdoh/putty (hiding objects in putty or
rolling into log and making shapes
Playing tug of war with small strings, lace, etc.
Form circles with thumb and index finger and raise to eyes
for glasses

23. ➢ Activities- Advaya
❑Visual perceptual worksheets.
❑Pattern play games
❑Craft and origami
❑Writing( skip words, against the wall)
❑Scanning and Matching activities
❑Geoboard
❑Quick Match
❑Money games ( Currencies)
❑Thera putty
❑Spirograph activities

24. HOW TO IMPROVE VISUAL-MOTOR PERCEPTION
• Perceptual worksheets-tracing, mazes, finding hidden pictures,
matching
• Visual models
• Verbal cues
• Different types of lined paper
• Scanning Tasks
ACTIVITIES TO IMPROVE FINGER ISOLATION
•Use items to manipulate such as tongs to pick up marbles, coins or tokens,
cotton balls or any small items.
•Cutting activities with scissors
•Finger puppets
•Keyboarding
•Songs that have different hand gestures or isolated finger motions
•Pressing gripper with different fingers at a time

25. ACTIVITIES TO IMPROVE ACCURACY
❑Tracing or cutting on straight or curved lines
❑Rainbow writing-repetitive tracing with different colors
❑Origami
❑Making figure of eight with thread around fingers
❑Pattern plays /Creative Design
❑Money game
❑Skip writing
❑Quilling
❑Activities with bindi clubbed with other tasks

26. ACTIVITIES TO IMPROVE BILATERAL
COORDINATION
1. Holding and turning paper when cutting
2. Tying shoes, buttoning, zipping
3. Stringing beads, Pearls and wires
4. Stabilizing paper when coloring
5. Bat and ball activities
6. Large screw and bolt activities
7. Brain gym warm ups
8. Double Doodle
9. Lazy eight exercises
10. Pipes and straws
11. Tracing alphabets
12. Tracing shapes , stencils , spirograph

27. BRAIN GYM EXERCISES
Double
Doodle
Lazy Eight
Exercises

28. ❑Hook ups
❑ Making Big X
❑Cross Crawls
❑Back Cross Crawls
❑Thinking Caps (Ears)
❑Write or Draw with non dominant hand
❑Massage on clavicle
❑Opposite elbow touching opposite knee

29. Thank you
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