What Should I Do About an Awkward or Unusual Pencil Grasp?

What Should I Do About an Awkward or Unusual Pencil Grasp?

Students often modify their own pencil grasp, such as avoiding the use of the thumb, collapsing into flexion or “fisted” pattern, and the grip patterns used by students are varied.  This can be a minor problem resolved with some teaching, or there can be an underlying problem of hand weakness that will require some additional help.

When helping your child or student who has self-modified their pencil grasp in an unusual or awkward pattern, there are three other important things to consider.  (1) Paper-Arm:  The important first step is to observe and correct the arm/paper position and the position of the hand relative to the line being written on.  I would always start with this – asking a student to tip their paper (45 degrees for left or right hander, slightly more for left-hander) and put their hand under the line they are writing on, before assisting them to hold their pencil in a tripod pattern.  This can sometimes result in an immediate improvement of poor student-modified grasp patterns, as it positions the wrist so that the thumb and fingers can come together easily.  (2) Demonstrate relaxed tripod:  I would demonstrate an appropriate tripod grip and see if the student can imitate it, also encouraging a very “gentle” grasp.  Eliminating excess grasp tension (e.g., “white-knuckled” grip) is important, and will prevent early fatigue and pain.  (3) Observe for thumb-finger movements:  Observing if the student has the ability to move the thumb & fingers together in small “translation” movements while holding the pencil is important.  These movements are needed to write with ease and speed, and are not possible when using an excessively tense grip.

Students sometimes cannot assume a tripod pattern, or maintain it while writing, and so begin to self-modify their grip in an unusual or awkward way, or change their grip often.  In many cases students with weakness, hyper-mobile joints or other problems modify their own pencil grasp in various ways,  such as avoiding the use of the thumb, collapsing into flexion or “fisted” pattern, because of weak hands.  Though doing this out of necessity, most often their self-modification is dysfunctional, will not result in any improvement over time, and in fact may make matters worse.  See Student #1, below:

Students modify their grasps in many ways (See five pictures below), some more simply (e.g., failure to use their thumb tip) and others in more complex ways, but all with similar consequence – lack of “ease,” inefficiency and harder work than necessary.  Some students write neatly despite their grip, but their endurance becomes problematic at some point as demands increase in higher grades. See the following 5 examples of student “self-modified” pencil grasp patterns, below:

Poor self-modified pencil grasp patterns:

 

 

 

 

 

 

Certainly, there are deformities that are permanent that cannot be changed, and children with orthopedic conditions (e.g., amputation, arthrogryposis) will find a way – any way, to write.  However, the students pictured above do not have a permanent limitation.

Rather than allowing a child to modify his own grasp, which students understandably often do because of weakness, I would recommend providing them direct help using a two-step approach.

Step #1:  Adapted Grip:  A temporary modification should be provided to the student that provides the needed support of the thumb & fingers that will result in progressive improvements in a student’s grasp.  This is done through the use of an adapted grip to provide the external stabilization & support needed by the specific individual.  One grip does not work for everyone, any more than eyeglasses would.  When well chosen, this will place the hand in a more functional and efficient position and provide the support needed to help further develop the hand.  Ideally, the support itself will encourage further development of the hand by placing the hand in a position that encourages the proper muscles to be used and strengthened (e.g., intrinsics).   As the the hand and pencil grasp improves, the support is again modified, with less support given and a more refined grasp encouraged.  See the four below examples of effective external support for pencil grasp for different students, using a:  ball grip, Jumbo Pencil Grip Brand Grip, Regular Pencil Grip Brand Grip, and a Stetro Grip.

Effective Adaptations for Pencil Grasp:

 

 

 

 

 

 

 

Step #2:  Direct Hand Musculature Work:  Some children will also need direct work to improve stability in the hand (including those with hyper-mobility).  This work can substantially change hand stability, which combined with the modified pencil grasp tools can substantially improve pencil grasp and control.  An example is shown below, showing Student #2′s hands before and after hand musculature work – note the change in hands at rest (Before:  hand widely open, without curvature of fingers;  and After:  Finger curvature, thumb resting above the plane of palm, hollow in palm, and thenar (@ base of thumb) and hypothenar eminences (@base of little finger) areas developed.)

Student #2:  BEFORE  & AFTER


In my “I Can Do It!”® Handwriting manual, I provide a 5-step method to evaluate grasp to find the best tool to help.  The ICDITM  Hand Development Rubric provides a way for therapists to quantify pencil and other grasp patterns, to monitor progress in hand stability and function as treatment progresses, and explain to parents.  Outstanding improvement can be made with direct hand work, as shown below.  This student (#1) with significant hyper-mobility showed notable joint collapse against even minimal resistance (See nine pictures below – & note that those pictures of range of motion shows joints ranged minimally, not to limit of ROM)  The “after” photo of this student #1 shows that there was appreciable improvement in pencil grasp with intervention.

Student #1:  BEFORE:

 

 

 

 

 

 

 

 

 

 

 

STUDENT#1:  AFTER

If the stability of the tripod group related only to handwriting (though an important life skill), it would perhaps be considered by some to be of less vital importance to an individual.  However, tripod stability is also important to all manipulation.  The child below shows lack of thumb use and joint stability when encountering just minimal resistance.  In addition to the writing difficulties that accompany such weakness, functional skills such as opening a milk container, buttoning & unbuttoning buttons, opening food packages, and tying shoes become difficult to impossible for these students.  Hand use is vital to daily life!

Student #3: BEFORE 

 

 

 

The good news, however, is that improvement in stability in the hand results in improved manipulation for this student, now with thumb use and a stable hand, as shown below:

Student #3:  AFTER:

 
Children with weakness or hyper-mobile joints can show progressive improvements in hand function with persistent effort, and their ability to manipulate against resistance will substantially improve.  This student (#4) showed significant hand weakness and joint collapse when manipulating.

Student #4:  BEFORE

 

 

However, the development of hand musculature improved his stability and power to manipulate objects against resistance.

Student #4:  AFTER

 

 

 

I advocate that students, including those with weakness and hyper-mobility, be given (1) The assistance needed to maintain a stable pencil grasp pattern, while simultaneously receiving (2) The help needed to improve strength and stability of the hand.  Rather than allowing a student to dysfunctionally modify his own pencil grasp, carefully chosen adapted equipment should be provided that provides the needed external stabilization and shaping in a functional though initially “immature” position.   Modifications should be made along the way to decrease the support provided as stability increases, until the student can be fully independent.  Understanding that improvements can be made, even with hyper-mobility, is an important step in resolution of the difficulty and enabling good function.

The length of time required to make such significant hand development changes is variable, and depends upon factors such as whether or not weakness is combined with hyper-mobility of the joints, frequency of intervention possible, ability and willingness of student or family to do “homework” to help strengthen his hands, etc.  Daily work is most effective.  Student #2, for example, was highly motivated to change his hand function, had a motivated teacher who allowed work in class in-between activities or while listening to lecture, and made this change in less than two months.  Student #4 made this change in approximately 6 months with some independent work accompanying treatment sessions.  Student #1 required years of in-school therapy (without additional student or family work) to make this substantial change.  However, all students are now much more functional in manipulation as well as writing.

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How Does “I Can Do It!”® Handwriting Resolve Reversals?

Joan Scanlon-Dise, OTR

Prevention is the ideal method of dealing with letter formation errors such as reversals (as well as all other handwriting difficulties), and the “I Can Do It!”® Handwriting Program has been designed to accomplish this goal.

When  a student exhibits reversals, whether due to a faulty instructional program or a child who is “self-taught” to write, focused intervention is vital for success.  Letter reversals occur in varying degrees.  For the purpose of this article,  consider the following three levels of reversal difficulty:  First, at the simplest level (Level I), children with single letter reversals have only an isolated problem (e.g., reversing only b/d) without any other accompanying handwriting problems.  Second, at the intermediate level, students may exhibit multiple reversal errors, with otherwise good overall formation (Level II).  Third, in the most serious case, children exhibit reversals combined with overall handwriting delays with reversals as one type of  form error in their writing (Level III).   The intervention required depends upon which level of performance the student exhibits.  Samples of these levels are illustrated below.  You can clearly see that each progressive level would require greater intervention.

Level I

Single Reversal Error
without other handwriting problems

Level II

Multiple Reversal Errors

but with otherwise good overall formationLevel III

One or more reversal(s)

combined with overall handwriting difficulty

The “I Can Do It!”® Manuscript Handwriting Program has methods to address a multitude of handwriting needs, including each of the “Five Factors” that impact proper letter formation (that were previously described in the author’s last blog article).  Students who do not develop these specific skills often develop reversals, but they can be corrected if intervention is focused on the achievement of these skills.  For students at Level I or Level II, with letter reversals without other handwriting difficulties, the following “I Can Do It!”® activities are used:

Factor #1: Memory of the letter form – the visual “picture” of the letter (e.g., “b”) and the name (“bee”):
YFO – 1, 2, 3, & 4
ABC’s
TWP & FONT
CS-EZ, CS-GEN
VR

Factor #2, 3, & 4: Memory of the proper stroke sequence & correct direction of  strokes used to make the letter & knowledge of distinctive features of  letters (similarities and differences), including letter building to learn how lines combine to make letters:
SS
HRH & HRW
PZ and PZ-M  – (6.5” or 19”)
HS
TM & LMR
VR
ABC-123
FM 1 & 2
WP
ES
SSS
SAM
WSF
WWT
SBS 1, 2 & 3

Factor #5:  Letter Formation generalized beyond single letters to the alphabetical sequence, words, sentences, and compositions:
WP
LWSS
SBS – 3B
SBS – 3C
ES & SP
SAM-L
WS

For students with reversals combined with other serious handwriting difficulties (Level III), in addition to the activities used at Levels I &II (above), other “I Can Do It!”® Program activities are used.  Examples would include:
Pencil grasp problems – HA, WMP, RYH, VS

Pencil control problems – SSG, SSS, LG, PD-H, PD-A, PP, VS, AW, RYH, SM, WP, VS

Vertical alignment problems -TMB, TSH, TWZ, WSF

Inattention, lack of confidence or discouragement - EMM, ICDI, TU, WM

The “I Can Do It!”® Manuscript Handwriting Screening is used to determine the specific needs of the student.  Based on this information, intervention is specifically guided through the use of the General Instructional Sequence for Beginner Writers or the alternate Developmental Sequences.

Copyright 2012, Joan Scanlon-Dise, OTR

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Letter Reversals: Worry or Not a Worry? Part II: The Five Keys to Successful Intervention & An Analysis of Current Remedial Approaches – Do They Make the Grade?

Letter Reversals
Worry or Not a Worry?

Part II:  The Five Keys to Successful Intervention
&
An Analysis of Current Remedial Approaches -
Do They Make the Grade?

Joan Scanlon-Dise, OTR

Prevention of reversals is always better than having to provide intervention later on to remedy them, as is true with most problems.  Prevention of reversals avoids the long term struggle and hindrance to written language development that they cause.

Handwriting instruction designed to prevent or remediate reversals is most successful if the  teaching activities are specifically targeted.  The author has determined five factors that are key to the mastery of proper letter formation. If our early handwriting instruction is focused on mastery of these five factors, we can achieve the goal of preventing reversals.   Early intervention is best approach, avoiding the difficulty altogether.  When reversals are already a problem for a student, we can successfully intervene to correct his long-term memory and help him learn to write error-free and effortlessly if we focus on mastery of the five factors.  We’ll analyze several current remedial approaches in light of the five factors to see how useful they really are, and grade them based on their ability to resolve reversals.

Do letter reversals matter?  If you have not read Part I of  Letter Reversals:  Worry or Not A Worry? you may want to do that before reading further.  It is important to realize that handwriting both aids students in achieving  composition ability (16)  in students of all ages, (4)  and can predict later academic success. (17, 19) When a student’s handwriting is very automatic, this frees up his working memory for the task of composing. (4, 5, 10, 16) As writing is crucial for students to communicate their knowledge in school (20) the achievement of ease, automaticity and fluency in writing is undeniably critical for their academic success.

The consequences of poor handwriting include:  student frustration, (13) decreasing persistence and motivation, (7) difficulty writing quickly to get enough written in the allotted time, lower grades earned, (1) and difficulty writing letters interfering with working memory and the process of composing.

What are these five factors that are key to mastery of proper letter formation?

First, an established memory of the letter form – the visual “picture” of the letter (e.g., “b”) and the name (“bee”).   Students with reversals often have poor visual memory of b & d, g & q (or other reversible letters) and cannot recall them from memory when needed.  As a result, they do not “picture” the letter before writing it, and after writing it they cannot identify if their written letter is correct or reversed.

[For students who are already composing and have established reversals, it is important also to check the student’s memory of the “picture” (“b”) & sound (“buh”) match, as confusion with this will cause errors during composing (e.g., causing a child who is writing the word “boat” to correctly say the sound “buh” but incorrectly write the letter “d” instead of  “b”).]

Second, the student must have  a fully established memory of the proper stroke sequence to make the letter.  For example, a “b” is correctly made with a down line first, and then an around line, while a “d” is correctly made with “c” first then a down line (see below).

Consider this illustration of the problem caused by failure to use proper sequence of strokes when writing letters.  A student makes each of these letters – b, d, p, q, g, #9 – with a down line first, using a stroke sequence and movement pattern for all these letters that is similar in that they all “feel” the same, which causes confusion.  He makes the down line first, then must pause to decide which way the “around” line should be written.  Just try     printing each of these (b, d, p, q, g, #9) this way yourself – making the “down” line first with each letter…they will look just fine, but note how they “felt” very similar when writing.  This is what causes the dilemma that the student faces – once they make the down line they aren’t sure which way to go next and may have to guess each time (though you do not have this problem because you already know which letter is which).

This stroke sequence confusion is a problem for students who are just learning – and this is why  it is important to have uniquely different stroke sequences and movement patterns for say, the b and d, which will “feel” different and so they will be less confusable.  Kinesthetic (movement) memory is important in learning to write, but students who write each “down” line first for all of these do not benefit from this very important method of establishing memory.

This stroke sequence confusion often is caused by children learning to write by “copying” rather than receiving direct instruction in how a letter is made.  When a child just “copies” a letter he sees, and “draws” it any way he chooses, he likely sees the down line as the strongest feature of the letter and copies it first.  The more times the child writes s letter, the more his chosen stroke sequence becomes established in his memory.  You might ask    why it matters as long as the end product looks good – the quick answer is that reversals often result, speed of writing can be hindered as left to right sequence is not used, and stroke sequences for later cursive writing are not established and makes learning cursive unnecessarily more difficult for the child.

Third, fully established memory of the correct direction of strokes used to make the letter (for example, a horizontal line should be made left to right – “over,”  and a  vertical line should be made from top to bottom – “down” (see below).  A student who reverses the letter Z, for example, most often begins the letter Z making a horizontal line going the wrong way (from right to left), and when he continues without picking up his pencil the result is a reversed letter (see below).

Fourth, fully established knowledge of distinctive features of letters (similaritiesand differences).  For example, students must learn that an “S” begins with a “c” (is in the “c-family,” so to speak).  This grouping reduces memory load, so students can establish memory of forms more quickly in their long term memory, so important to preventing and correcting reversals.  This grouping also increases consistency of formation so that letters with a similar shape will look similar, and words are written very readably (see below).  In contrast, inconsistency in formation leads to a greater memory load, so students with reversals often do not establish letters in their long term memory.  The resulting inconsistency in the formation of letters (that should have the same shape) also makes words less readable.

Fifth, fully established letter formation generalized beyond single letters to the    alphabetical sequence, words, sentences, and compositions.  This generalization from single letters to writing them correctly in words and compositions does not happen “automatically,” it must be practiced. (7, 8, 11, 21)  Students with reversals that have been corrected in single, isolated letters will continue to reverse in words and sentences unless intervention directly works to correct this as well.

What types of activities are typically recommended
for the remediation of reversals, and
do they work?

Let’s analyze some activity types based on the five factors, and give them each a report card grade – from A through F.

These Right-left Identification Activities:  Grade:  F

More often than not, letter reversals are right/left reversals (e.g., writing d for b) rather than top/bottom reversals (e.g., writing p for b).  Young students are often confused about the concepts of right and left, and so often right/left activities are recommended when a student exhibits reversals.  Let’s analyze this -

The intended goal of these activities is to improve right/left awareness and left to right directionality in order to resolve right/left reversals of letters and words.  Examples of activities often suggested include:  Hokey Pokey, Simon Says, Twister, playing games involving following commands regarding left and right – catching and throwing a ball, chalkboard games, jumping/hopping over a line, standing in front of a mirror (with the R/L image reversed).

One problem with this approach is that these games require prior knowledge of right and left – they do not directly teach the skill.  This approach is similar to using a math fact contest to teach math facts.  While a math contest or game is great to challenge the speed of recall in students who know their facts, it does not directly teach math facts.  Instead, such a contest would be understandably frustrating to a student who did not know his facts.  In addition to this “test vs. teach” drawback of this approach, there is also a problem of transfer.  If these games did indeed teach Johnny which of his hands was left and which was his right, they do not teach Johnny what he needs to know to avoid reversals.  It has not taught the needed letter formation skills related to left and right.  Transfer from one skill to another is not automatic, but must be directly taught [e.g., learning basic shapes does not automatically translate to making letters (3)]  Knowing his left hand from his right hand does not teach Johnny to make his “over” line from left to right, so if he writes his Z by making the beginning “over” line from right to left, and he continues the remaining strokes without lifting his pencil, he writes a reversed letter Z.  It also does not teach Johnny to make each letter form with a left-to-right sequence of strokes (e.g. make a “b” with down line first then an around line, while making a “d” with a “c” first then a down line).  This method also does not teach Johnny the left-to-right direction for writing letters within words (was vs. saw) or words in sentences across the page (“The cat is black.” vs. “kcalb si tac ehT”).

A precise and explicit goal-directed route is essential in all teaching.  We cannot afford to get side-tracked in our initial instruction or our remedial intervention and lose sight of the goal, because time is of the essence.  Although students do need to learn their left from right to help reversals, and to use a left to right approach when forming letters, words and sentences, the right/left identification activities above do not teach this.  These activities receive a GRADE- F, because they do not achieve any of the five factors underlying good letter formation.  A child’s knowledge of right/left on himself  (and on his paper) is important, but there are direct routes to teaching this that are effective, and it is critical that instruction move immediately beyond this to the needed letter formation skills related to left and right.

Jingles & Sayings:  Grade – F

An “association” method is often recommended as a way to teach a student to discriminate between two reversible letters.  For example, using sayings and jingles such as:  L & J go the opposite way,”  or “We moVe because M has a V in the middle.  We waaaait with W because W has an A in the middle.

One problem with this approach is that you are adding a “translation” step to the process.  You have to look at the letter, consider your “jingle,” then determine which of the two letters you are looking for.  A good analogy is the learning of a second language.  Constant “translation” from English to the other language is discouraged.  Immersion in the language is often recommended so that you learn to “think” in that language, rather than mentally “translating” each word, so you can become proficient and fluent.  To become proficient and fluent in reading and writing letters, you have to simply know, so you can read/write quickly and automatically without the need to stop and “figure out” or translate.

A related problem with the use of association is the additional memory required.  You need to recall not only the letter forms, but the related jingle and what it means (e.g. “To avoid N & Z confusion, the student must learn N has two lines up and down.  Z has two lines side to side.  N is going up to Neptune.  Z is going over to the zoo, and must learn what this means.).   As we noted above, some students who experience reversals also struggle with memory.  In fact, the memory difficulty is sometimes the cause of the reversal – because one letter was never fully mastered and established in long term memory before the teacher introduced another letter, and another.  Students with memory difficulty need a reduction, not an increase, in memory load.  Again, this method earns a Grade of  F because it fails the test for a precise, explicit, goal-directed route to resolving reversals.  It does not achieve the goal of any of the five factors underlying good letter formation.

Thumbs Up hands & spelling “bed:”  Grade – F

A popular method used by many reading teachers for b/d discrimination involves using “visual imagery -” they encourage students to use their fisted “thumbs up” hands as an abstract model of “b” and “d,” recall the word “bed,” and look at their hands to determine which way the letter they “see” faces, to see which one is which.  Others recommend different visualizations, such as:  b looks like a person with a big belly, while d looks like a person with a big bottom. This does not clarify the confusion for a child, because certainly both “b” or “d” can look like either of these “images,” depending on which way the “person” (with big belly or big bottom) is facing, left or right, so pre-knowledge of “b” and “d” is needed to use this!

The limitation of these approaches again involves the need for the “stop & figure out” method, requiring the child to translate, as described above.  This is a time-waster, adds numerous steps to what must be automatic recall, just “knowing” the letter and its name/sound match.  This method is similar to encouraging a child to use his fingers to add rather than learning his math facts.  The needed automaticity is not developed – rather than just immediately recognizing a letter he sees, he will need to go through time-consuming steps to figure it out.  Let me illustrate this method  during reading.

The child encounters a word with “b” or “d,” and doesn’t know which it is.  He puts his book down, makes a fist with “thumbs up” with both hands.  He thinks of the word bed, and reviews how his left hand is a “b,” the “e” is in-between his hands, and his right hand is a “d.”  He decides which hand “looks” like the letter he is looking for (hopefully he remembers what the letter he needed to identify in the book looks like and doesn’t have to look back at the book).  He picks up the book again, finds his place, looks at the word/letter in question, determines if the letter says “buh” or “duh,” and begins again to read the word/sentence.  If he was in the middle of a sentence, he probably doesn’t remember what the first part said, so his comprehension will suffer.  And what if he has to do this 3 times in a sentence?

In addition to the problem of translation, there is an additional practical difficulty because the model disappears when the child again uses his hands to pick up the book he was reading or his pencil to write.  When Johnny is writing, he “loses” his model of the “b” (which is made with his left fist) if he is a left-hander as soon as he picks up his pencil to write, while the right-hander immediately loses his “d” model.  If a child needs a model to refer to, the model must remain in view for his use, but the use of this method will not allow that.

In addition to the “stop & figure out” drawback, this “visual imagery” method may fail because of its abstract nature as well.  Young children are quite literal in their understanding, and require concrete, visible, real examples to aid their learning.  Though it may seem easily evident to adults, youngsters may neither be able to “see” a person with the fat belly or bottom in the “b” or “d,” nor “see” the b & d in the thumbs-up hands.

Grade – F

What children are supposed to “see” in these hands:

Grade – F

Young students have difficulty early on generalizing a letter form even if a different font, so one can easily see how a left thumbs up does not look like a letter “b” to them!  Teachers notice how their students struggle to recognize letters of differing fonts when students cannot recognize a magnetic letter in a font that differs from the handwriting program font.  Generalization only occurs after the basic form has been well established in memory.  It is easy to understand why Johnny cannot yet recognize all different types (fonts) of  b’s, when he has not yet learned to recognize a simple basic letter “b” yet.  Initial memory can be more quickly established with a simple, consistent font.  For students who struggle with memory, recalling the steps required or the visualization may be problematic as well.

This thumbs-up “bed” method is not recommended, as it is not specifically goal directed. It fails to teach the automatic recognition of the whole letter form or how to make it.  This activity also earns a Grade of F because  it does not achieve the goal of any of the five factors underlying good letter formation.  It may even encourage a child to use this “crutch” and hinder memorization practice.  This method is not recommended – the direct teaching of memory of letter form, name, and sound should be the focus instead, to achieve automaticity and long term success.

Dough building of letter forms:  Grade – D

Some recommend the use of  dough or  claylike material to practice “building” letters. Building letters is a helpful activity when learning letter formation because experience with active construction allows later mental manipulation (6) and this activity helps the child learn the “parts” (lines) that build the letter.  Though this “part-whole” awareness is vital to mastery of factor #2  (memory of the stroke sequence needed to make the letter),  there are clear downsides to building letters this way.

One fault of this activity is that it involves a very slow “building” process (e.g., rolling out pieces before building), so too few repetitions are possible within an intervention session.  When a child is just learning, many repetitions of the correct building and sequence of strokes is needed to ensure proper memory is established.  When a student has reversals in his writing, he has likely written the letter incorrectly hundreds of times, so he will need a very substantial number of  correct repetitions to change and correct his memory.  So while the use of dough material can be fun, and can be useful as a supplemental secondary play activity, it is not effective for use as the primary activity for direct instruction to achieve the goal of establishing correct letter formation.

A second fault of this activity is that the “lines” (parts) used to build the letter are made by the child in random sizes, not specific sizes.  This reduces or eliminates the ability to the “fit” dough letters on 3-line writing structure, which is an important shortcoming because correction of letter errors very often requires simultaneous correction of vertical alignment within the 3-line writing line structure.  This makes the activity less useful, as dough letter forms are poor or inconsistent, contributing further to a confused memory.

It is much better to provide a letter building activity that allows consistent and accurate practice with correct “fit” within the lines with every try – to establish correct visual memory of letter shape, proportion and alignment.

This activity fails the test for an expedient route to practicing “building,” so it earns a GRADE of  D.  It does score slightly better than previous activities, as it can make a play activity that can be supportive of the goal, but clearly it is not adequate as the primary method to achieve the intervention goal.  If used as a supportive secondary activity, the challenge will be to insure monitoring (e.g., by Mom and Dad) to see that the child practices building the letter properly.  For example, monitoring to insure that the child is using the proper sequence of strokes and making the letters of consistent size and proportion, important to establishing a correct initial memory or correcting a faulty one.

Letter Stencils:  Grade – C

There are many letter and number stencils available commercially, some with the complete alphabet on one stencil with small letter forms (one-inch) and others with larger separate stencils containing two letter/number forms (two-inch).  The student places the stencils where the letter is to be written, inserts the pencil in the stencil and follows the path to write the letter.

Stencils can be helpful, and this approach is certainly closer to the functional and practical goal of writing letter forms, but there are important cautions to consider.  If one of the contributing factors in the child’s reversals is an improper sequence of strokes, close monitoring is needed to insure that the student is doing this practice correctly.  If the child writes both his b/d with “down line” first, for example (rather than using the appropriately unique stroke sequence), the final product may look fine, but the stroke sequence error that is contributing to the reversal will not be corrected and the reversal will remain an ongoing problem.  The stencil alone will not stop this – monitoring will be needed.  It can be helpful to add a start location in the form of a sticker to the stencil, but monitoring will continue to be needed to ensure the child uses the provided start location.  Close monitoring is also needed regarding the direction of strokes used (e.g., l is “down,” not up, and the over line is left to right, not right to left) and to be sure the student is writing the correct letter when using the stencil (not writing a  “b” for a “d,” for example).  For the classroom teacher, monitoring is a practical challenge because the teacher’s attention is necessarily divided to meet the needs of all his students.

Three additional disadvantages of stencils include the following:  First, the small size of stencil letters makes them less useful than other methods using large letter forms during intervention practice.   Early practice of writing letters (and re-learning) that involves larger amplitude movements (2) is more helpful than small amplitude movements, as the student can “feel” the movement more easily.  As kinesthetic memory 15 is helpful to aid memory, “feeling” larger movements is valuable and works more quickly to resolve reversals and change a faulty memory.  Second, the quality of the letter produced can also be a problem with the use of stencils, as a stencil has plastic portions that interfere with letter strokes (but are necessary to hold the pieces in place).  This results in closure errors of letter forms, which can cause confusion or establish a poor habit in beginner writers (as shown below).

As adults, we could certainly write the down line of the “b”, then re-adjust the stencil to close the gaps.  Expecting this of a beginner writer is unreasonable – they most often have difficulty aligning the whole letter.

The third disadvantage of stencils (though not specific to reversals) is that some students will have a very hard time trying to align the stencil on the writing lines.  This is especially problematic when using one large stencil of the complete alphabet.

Stencils receive a GRADE of  C because they can be a helpful compensatory method to enable correct letter formation during written classwork thereby avoiding continued writing of reversed letters, provided that the student knows reversible letters by sight,  does not choose the wrong stencil letter (e.g. b/d), and is independent with the stencil (consistently forms the letter correctly – both correct sequence and direction of strokes – without help).

Kirshner’s “Magic Rulers:” (If modified) - Grade – C

Kirshner’s “magic ruler” (14)  is a device designed to be used by the student when writing in order to avoid reversing letters and numbers, or to be used during repeated practice of a letter form to help resolve reversals.  The “ruler” has a bar or star along the side of the ruler, coinciding with the specific letter to be written.  For example, a vertical bar (line) along the right edge of the ruler coincides with a letter such as b.  The student places the ruler where he wants to write his “b”, and writes the “down” line for the “b” along the right edge near the vertical bar.  He then finishes the “b” by making the “around” line.  While holding the ruler in place, he cannot reverse the b without writing on the ruler, so a reversal is avoided.  For letters such as “s”, a star along the left edge of the ruler indicates where to start the letter.  With the ruler held in place, if the student begins at the star, he cannot reverse the s without writing on the ruler, so the reversal is avoided.

There are clear downsides to the magic rulers, with 50% of the letter/number forms on the original “magic rulers” rather than correcting it (though likely to contribute to difficulty with letter formation rather than correcting it (though modifications can be made to the ruler to correct the deficiencies and make the tool more useful).  For example, the proper stroke sequence is not necessarily facilitated by the “magic ruler.”  In the case of “b,” the correct sequence may be facilitated by the vertical bar on the ruler, though certainly monitoring by an adult will be needed to ensure this when as student is experiencing reversals and has a poorly developed habit.  However, in a similar way, the vertical bar on the magic ruler for the “d” may directly encourage writing in the wrong stroke sequence because it emphasizes (with the vertical bar) what should be the second stroke in making the letter rather than the first stroke (For example, in the case of “d” – the student is encouraged (by the presence of the vertical bar) to make the “down” line first, rather than the “c” stroke we want made first to allow a uniquely different stroke sequence than the letter “b,” as described above).  Changing the vertical bar on the ruler to a star for the “d” would be helpful, however.  This change (shown below) encourages the proper beginning the formation of a letter “d” with a “c-stroke” rather than a “down” line.

This same difficulty with improper stroke sequence is also noted with the magic ruler for other forms as well, including:  a, g, q, and numbers 6 & 9.  Again, changes would be needed to encourage the proper beginning stroke, and avoiding encouraging a downstroke for each of these forms.

The magic ruler does not encourage the proper start location for #7, or for letters “e,”  “f,” “n” and “m,” and it incorrectly suggests (with the vertical bar) that both a “Z” and #6 contain a “down” (vertical) line, and so may encourage common formation errors.  In addition, the magic ruler encourages an improper part/whole formation and direction of strokes for the lower case “m” and “n,” encouraging two “hills” without a down line as the beginning stroke of each letter, a common error in beginner writers that teachers observe and must re-teach often.

If the ruler is modified, and a student can (and will) use the “magic ruler” independently without help from the teacher, it can be a very helpful tool to prevent a student from making repeated reversals during his daily classroom writing.  This can be helpful to achieve the necessary high proportion of correct letter formations vs. errors (reversals) made daily.  Students must make the letter correctly (not reversed) the vast majority of the time in order to resolve the reversal.  If the letter is made correctly throughout the day using this tool, this can help to establish the correct visual memory of the letter form (goal #1), as the student sees the correct letter with each formation.  It does require monitoring though, to insure that the student is using the correct direction and sequence of strokes.  In addition to regular classwork, direct intervention is also needed to resolve reversal errors, and for this the “magic ruler” is not an ideal method.

One of the disadvantages of this tool, like the stencils, is the small size of the letter forms made, so it does not take advantage of the kinesthetic memory (our “earliest, most reliable memory channel” (18)).  that  activities involving large writing provide.  For repeated letter writing for practice to alter memory, small size is not as effective as large writing, so the “magic ruler” is not an ideal method.

As with the stencils, another disadvantage is that close monitoring is needed to ensure that the student is writing his letters correctly rather than in error when using the “magic ruler.” For example, if the child writes both his reversed b/d with “down line” first (rather than using the appropriately unique stroke sequence) the final product may look fine when the “magic ruler” was used, but the stroke sequence error (that is contributing to the reversal) will not be corrected and the reversal will remain an ongoing problem.  The “magic ruler” does not resolve these reversal-causing issues so close monitoring will be needed.  In cases where the student does not use proper sequence and direction, independent use of the tool is not recommended.

The “magic ruler” neither facilitates the use of correct direction of strokes, nor does it increase knowledge of the distinctive features of letters.  The pictures on the ruler (designed to be key words) may be confusing to the student if they are different from those used by the child in his reading program.  This may confuse the student about the letter name/sound match.  Covering the original keyword drawing (with a label printed with the keyword picture from the child’s reading program) may be helpful in reducing confusion in this case.

Like the stencils, the “magic rulers” receive a GRADE of  C, provided they have been modified to encourage proper direction and sequence of strokes and proper letter formation.  They can be a helpful  way to prevent continuous reversals in daily classwork, thereby helping to establish the correct memory of the letter form “picture,” though like the stencils, close monitoring is needed to be sure the student is using the correct direction and sequence of strokes.  For the repeated letter writing practice needed to resolve established reversals, the small letter size is not of great value.  Rather than a long term solution or “fix,” they can be helpful as a temporary crutch.

If your child or student is struggling with reversals, how do you know which of the five factors
is interfering with his letter writing success?

Give a simple test to your child or student. Dictate the letters of the alphabet to him, one at a time, not in “abc order,” but either in random or backward (“z to a”) order.   Make a list of all the letter (upper and lower case) and number forms in the order you will dictate them, leaving space near each one to take notes.  Make three simple observations to see if the correct 1) letter, 2) sequence of strokes (left to right), and 3) direction of the strokes are written.  (Have the child later repeat a letter formation if you miss one as you take notes.)  The pictures below show examples of how you can write your notes quickly by using arrows (for direction) and numbers (for sequence of strokes used).

You can also indicate with a start-dot where the child began with an arrow, if continuous strokes are used.

If the child is able to write words or sentences, dictate these as well, with words that include the reversed letters in different positions within words (e.g., beginning:  boat, duck;  middle:  table, made, and end:  tub, sad ).

After completing the dictation, analyze and make a list of the letters reversed, noting if sequence or direction of strokes are in error, if reversals are made in isolated letters, in words, or in sentences.  If reversals are present, ask the child to find them, to see if he can visually recognize his own reversals.  If not, give him a copy of the alphabet to refer to and have him try again to find them.  This information will tell you where to start.

SUMMARY

In summary, the five factors that are keys to the mastery of proper letter formation are also the five keys to successful intervention when reversals exist.  The child must have (or develop) an established visual memory of the form and the corresponding name (and/or sound).  He must make the letter in the proper sequence, the proper direction, and have an established knowledge of the distinctive features of letters.  He must have a fully established memory of the letter form generalized beyond single letters to the alphabetical sequence, and to words and sentences for ease in composing.

Bad habits are hard to change, (12) as we all know, and because this is true of handwriting as well, it is best to ensure that your initial instruction in handwriting prevents reversals.  Prevention is prudent, highly effective and strongly advised.

If you have to resolve already-established reversals in a student’s writing, however, there are solutions.  Now that you’re familiar with the five factors, use them to analyze the program you are using (or considering) in a common-sense way to see if it works to improve the five factors (e.g., Ask yourself – “Will this activity (1) establish the memory of the letter form and name?).  Choosing activities carefully is vital in order to provide timely and effective intervention to either prevent reversals or eliminate existing ones.  It is critical that the limited time available for intervention be used wisely for the success of our students.

If you are a parent, and feel you need additional help, do the recommended screening of your child described above, and seek the advice of a teacher or pediatric occupational therapist experienced with successful remediation of reversals.  Take the samples of your child’s writing (and these articles on reversals) with you.  If your child exhibits a reversal error or two, you may be given a specific method to intervene.  On the other hand, if more formation errors exist, a standardized measure of handwriting may be advised, with a more overall intervention plan offered.

The “I Can Do It!”® Manuscript Handwriting Program has been very specifically designed to directly work to prevent reversals and has been highly successful in achieving this by providing the beginner writer with instruction in all five factors.  Students who are already writing but exhibiting reversals receive direct intervention in all five factors to resolve them.  Check out this great program if you are serious about helping students succeed, as “I Can Do It!”® students are doing every day.  Raise the bar!   Go to www.ICanDoItHandwriting.com for more information.

Copyright 2012.  Joan Scanlon-Dise, OTR

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Citations:

1.  Baily, C.A. (1988).  Handwriting:  ergonomics, assessment, & instruction.  British Journal of Special Education, 15 (2), 65-71.
2.  Bara, F., Gentaz, E. Cole, P., & Sprenger-Charolles, L. (2004).  The visuo-haptic and haptic exploration of letters increases the kindergarten-childrens’s understanding of the alphabetic principle.  Cognitive Development, 19, 433-449.
3.  Beery, K.E. & Beery, N.A. (2004).  The beery-buktenica developmental test of visual motor integration, 5th Edition.  Minneapolis, MN:  Pearson.
4.  Berninger, v.W. (1999).  Coordinating transcription and text generation in working memory during composing:  Automatic and constructive processes.  Learning Disability Quarterly, 22 (2), 99-112.
5.  Christensen, C.A. (2005).  The role of orthographic-motor integration in the production of creative and well-structured written text for students in secondary school.  Educational Psychology, 25 (5), 441-453.
6.  Elkind, D. (1987).  MisEducation.  NY:  Alfred A. Knopf.
7.  Graham, S. (1992).  Issues in handwriting instruction.  Focus on Exceptional Children, 25, (2).
8.  Graham, S. (1999).  Handwriting and spelling instruction for students with learning disabilities:  a review.  Learning Disability Quarterly, 22, 78-98.
9.  Graham, S., Harris, K.R., & Reid, R. (1992).  Developing self-regulated learners.  Focus on Exceptional Children, 24 (6), 1-16.
10.  Graham, S., Harris, K. R. & Fink,B. ( 2000).  Is handwriting causally related to learning to write?  Journal of Educational Psychology, 92 (4), 620-633.
11.  Graham, S. & Miller, L. (1980).  Handwriting research & practice:  A unified approach.  Focus on Exceptional Children, 13, 1-16.
12.  Graham, S. & Weintraub, N. (1996).  A review of handwriting research:  progress and prospects from 1980 to 1994.  Educational Psychology Review, 8 (1), 7-87.
13.  Jones, D. & Christensen, C.A. (1999).  Relationships between automaticity in handwriting and students’ ability to generate written text.  Journal of Educational Psychology, 91 (1), 44-49.
14.  Kirshner, A.J. (1994).  Remediation of Reversals. Novato, CA:  Academic Therapy Publications.
15.  Laszlo, J. I. & Bairstow, P.J. (1984).  Handwriting:  Difficulties and possible solutions.  School Psychology International, 5 (4), 207-213.
16.  Medwell, J. & Wray, D. (2008).  Handwriting – A forgotten language skill?  Language and Education, 22 (1), 34-47.
17.  Moore, R.L. &  Rust, J.O. (1989).  Printing errors in the prediction of academic performance.  Journal of School Psychology, 27 (3), 297-300.
18.  Sheffield, B. (1996).  Handwriting:  A neglected cornerstone of literacy.  Annals of Dyslexia, 46 (1), 21-35.
19.  Simner, M. (1982).  Printing errors in kindergarten and the prediction of academic performance.  Journal of Learning Disabilities, 15 (3), 155-159.
20.  Stein, M., Dixon, R.C., Isaacson, S. (1994).  Effective writing instruction for diverse learners.  School Psychology Review, 23 (3), 392-406.
21.  Ste-Marie, D.M., Clar, S.E., Findlay, L.C., & Latimer, A.E., (2004),  High levels of contextual interference enhance handwriting skill acquisition.  Journal of Motor Behavior, 36 (1), 115-26.


 

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Letter Reversals: Worry or Not a Worry?

Letter reversals experienced by young children are often said to be “totally normal” until after age seven, and their parents are told “don’t worry” unless they continue past grade two.  This appears to be accepted as fact, but it does raise questions – if your child was saying “I eated my lunch” would you immediately model the correct grammar, or would you not worry about it until after age seven?  If your child was practicing a math “fact,” “2+3 = 8,” would you correct him or not worry and wait until his seventh birthday?  Are letter reversals different?  Let’s consider two points-

First, we know that the ability to quickly recognize letters is of course necessary for Johnny to fluently read, that he must be able to automatically write letters to achieve fluent writing;  and that both reading and writing skills are vital to his academic achievement.  Back to reversals, it is important to also know that students with delayed reading mastery are found to have a higher incidence of reversals, and that letter formation errors have been found to predict academic achievement. 9  Children who reverse letters in reading may read “dog” as “bog,” “dark” as “bark.”  Children who reverse letters in writing may write “good” as “qood.”

Secondly, we can all agree that “bad habits” (of any kind) are hard to break.  Reversals are no different.  Habitually repeating an error causes it to become well-established, and correcting a faulty memory is hard work and takes much time and effort.  Just imagine a faulty memory you struggle with – always confusing someone’s name, the spelling of a word, a math fact, or a street name.  Once you “learn” it wrong, it can be terribly difficult to erase and correct the faulty memory – you may always question yourself about a certain person’s name, thinking “I know I always confuse that!”  Some students who have reversals have the additional challenge of a weak memory – a fact that further complicates and delays correction.  Do you want your child to struggle with reversals of  b/d, p/q, and many other letters? (73% of upper case and 58% of lower case letters can be reversed)  Do you want your child to have the ongoing experience of this preventable and resolvable difficulty that may indeed hinder his academic success?

Consider students who do not reverse letters.  They show automatic, confident, immediate memory of letters, name letters quickly and easily, and their “practice” writing and reading letters is reliably accurate.  They write the full alphabet with ease and speed in the time expected of their grade level, and after learning all their letters, they can very easily write words – with their attention now directed to properly sequencing the letters to spell the word.  Soon they can skillfully learn to write sentences, with the focus of their attention where it should be – on developing their grammatically correct sentence, beginning with a capital letter, “sounding out” or spelling words, spacing between words, and using ending punctuation.  These children soon build the skill and confidence needed for later challenges in higher level writing involving sequencing events to tell a story, comparing and contrasting, writing descriptive essays or persuasive opinion and argument on a topic, or writing effective business letters.  Is this what you want for your child?

On the other hand, students who have reversals generally show slow, hesitant, confused or poor memory of letter forms and naming of letters, are slower to establish memory of new forms, and need additional practice.  They make more errors in practice, and are dependent upon models for a longer time.  When writing they are hesitant and inconsistent, they make many errors, erasures and strike-overs, and they often understandably become quite discouraged.  This is true of both normally developing students who have reversals as well as students with learning disabilities, though there may be a difference regarding the degree of the problem in the two groups.  When Johnny is asked to write the full alphabet, he is slow and takes more time than expected of his age.  When expected to write words and sentences, his attention is quite divided – not only does he have to attend to developing his sentence, spelling, spacing, capitalization, and punctuation, but he is still struggling with “simple” letter formation!  Despite his delay, instruction moves forward, and his repeated errors in his daily classwork further establishes the confused or incorrect letters in his memory.  The lack of easy, automatic letter formation makes composition work more difficult for Johnny than for the student sitting nearby.  Is this what you want for your child?

The author is not suggesting that every child who ever reverses a letter will do so persistently – some will do this on a rare occasion.  (Handwriting is complex, difficult, and hard work for students – though most adults have certainly forgotten this.)  However, when you first begin to see your child reversing letters, neither you nor any expert could say if your child is one who will rarely do so, or if he is one of those destined to struggle with reversals for a long time.  When a child begins to show reversals, should you ignore it, or immediately, gently and supportively offer correction?  Why allow a confused or incorrect memory to be established in the first place?  Just ask a child who experiences reversals – he will tell you he no longer wants to be confused!

Some have suggested that you should not worry about or correct students’ reversals in Kindergarten because the more that children write, the easier it becomes and their reversals will all disappear by the end of Grade 2.  These statements beg the question -  Really,  how will that happen?  Having worked for many years with children experiencing these difficulties, I can tell you that those proposing the notion that reversals “magically” disappear are sadly misinformed.  A Kindergarten teacher who told Johnny’s mother “Don’t worry, he’ll outgrow it” is likely completely unaware of how the reversal difficulty impacted Johnny in grades 1-3 and beyond.
Some also suggest that when students begin to write cursive that reversals will “disappear,” another erroneous statement.  Students who experience print reversals are very often similarly challenged in cursive, as shown in the following writing completed by a young child who reversed b/d in print.  He continues to repeat this error in cursive.
Looping confusion is a common cursive error exhibited by students who reversed in their manuscript writing. 


For over 30 years, the author has watched students with reversal problems write laboriously slow, constantly erasing or striking over as they attempt to write, pausing to think or ask “Is this a b?” and failing to learn the joy of writing with ease and fluency until after much work is done to resolve the reversal errors.  The fact that reversals interfere with students’ early ability to write and that greater writing expectations are now required in earlier grades makes it crucial to resolve reversals as quickly as possible, and do so in a logical, direct, and expeditious manner as soon as they are observed.

The author has identified  five factors that when achieved contribute to the development of proper letter formation.  An upcoming article will outline these five factors, how failure to master them can result in the  development of reversals, provide an analysis of commonly recommended methods to deal with reversals,  and outline successful techniques.  The optimum approach, of course, is to work during early handwriting instruction to prevent reversals from developing at all, by using a straightforward approach to ensure the development of these skills.

Handwriting is a necessary tool used in most subjects in school, and your child will need to use it to communicate his knowledge.  Is he prepared to do so with the needed ease, effortlessness and automaticity that will make it an effective tool for written work, or will he struggle to do so?  It is a choice you make.

Copyright 2012 Joan Scanlon-Dise, OTR

References:

1.  Berninger, V.W. (1999).  Coordinating transcription and text generation in working memory during composing:  Automatic and constructive processes.  Learning Disability Quarterly, 22 (2), 99-112.
2.  Berninger, V.W., Vaughan, K.B., Abbott, R.D., Abbott, S.P., Rogan, L., Brooks, A., Reed, E., Graham, S. (1997).  Treatment of handwriting problems in beginning writers:  transfer from handwriting to composition.  Journal of Educational Psychology, 89 (4), 652-666.
3.  Connelly, V. & Hurst, G. (2001).  The influence of handwriting fluency on writing quality in later primary and early secondary education.  Handwriting Today, 2, 5-57.
4.  Edwards, L. (2003).  Writing instruction in kindergarten:  examining an emerging area of research for children with writing and reading difficulties.  Journal of Learning Disabilities, 36 (2), 136-148.
5.  Graham, S., Harris, K.R. & Fink, B. (2000).  Is handwriting causally related to learning to write?  Journal of Educational Psychology, 92 (4), 620-633.
6.  Graham, S., Harris, K.R., & Larsen, L. (2001).  Prevention & intervention of writing difficulties for students with learning disabilities.  Learning Disabilities Research & Practice, 16 (2), 74-84.
7.  Jones, D. & Christensen, C.A. (1999).  Relationships between automaticity in handwriting and students’ ability to generate written text.  Journal of Educational Psychology, 91 (1), 44-49.
8.  Medwell, J. & Wray,D. (2008).  Handwriting – A forgotten language skill?  Language and Education, 22 (1), 34-47.
9.  Simner, M. (1982).  Printing errors in kindergarten and the prediction of academic performance.  Journal of Learning Disabilities, 15 (3), 155-159.
10.  Spear-Swerling, L. (2006).  The importance of teaching handwriting.  Retrieved from:  LD Online.  WETA.

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Your Child’s Pencil Grasp – Does It Matter How He Holds His Pencil?

Your child is to have surgery.  Do you want the surgeon to use a delicate, deft tripod grasp of his scalpel for precision?  Your dentist to use a precise grasp while using a dental scaler around your daughter’s delicate gums?

Comparably, would you want your daughter to use a two-handed grasp on the steering wheel when driving your car to prepare for the unexpected?  Your son to follow his football coach’s advice to leave some “daylight” in his palm as he grips the ball to make that perfect pass?

Specific grasping patterns are recommended for innumerable tools for ease, accuracy, and effectiveness in performance, including surgical scissors, a golf club, baseball bat, crochet hook, camera to reduce “camera shake,” kayak paddle, violin bow, ping pong paddle, fly fishing pole, cowboy lariat, wood lathe chisel, tennis racket, an art paint brush or a baseball.  We all understand and agree that when you learn a new activity, learning the grasp, tension and movement pattern with the “tool” is part of the skill to be learned.  Would we recommend new students learning a skill grasp the tool any which way, or would we teach them specifically how to best hold and move the tool – is this not an essential part of becoming skilled in the new task?

Handwriting is an emotional topic for parents and teachers.  Some people suggest that pencil grip is unimportant, while describing their own fisted or unusual grip and how they write neatly despite it.  One writer indicated that if you discuss and attempt to correct a child’s pencil grip, you will make a child feel bad about themselves, while another expressed how it always really bothered him when people questioned him about his grip.  Certainly, sensitive and supportive assistance must always be provided to students, with care to prevent such feelings of criticism that may cause loss of self-esteem.  Rather than only insisting that students change, it is more helpful to provide demonstrations that convince them of the value of a precision grasp.  Though pencil grasp is certainly not the only thing we need to consider when a handwriting problem surfaces, it is an important factor that should be considered, evaluated, and improved.

Orthopedics and kinesiology remind us that a “defining and universal characteristic” 1 of humans is tool use, as is the prehension pattern “…with the ability to oppose the thumb to the fingers.” 2  A precision or prehension grip “…is used whenever accuracy and precision are required.  The radial digits (index and long fingers) provide control by working in concert with the thumb to form a “dynamic tripod” for precision handling.” 3

Rather than a static hold that actually blocks movement, a precision grip is dynamic and moving and provides us dexterity.  This allows for a higher degree of function, because it allows a “greater variety of movements,” and allows the hand to “act while grasping.” (Kapandji )  “In order to maintain a dynamic relationship, the thumb should circumduct and oppose.”4 “Tip-to-tip pinch forms an “O” between the thumb and index finger.” 2   Such refined movement is possible for us as humans, and enables us to learn and achieve many skills.

All of us understand that precision is important in fine manipulative tasks.  Most of us would certainly accept advice on the “best grasp” of a tool to perfect our performance in an area of interest to us, for instance to throw a curveball or a fast ball.  Though some deny its importance, precision, dynamic, dextrous movement also matters for good handwriting skill.  The denial that this is important may result from strong emotions surrounding handwriting rather than any logical and substantive argument.

Why does it matter? Some students struggle writing legibly, others with achieving adequate writing speed to take notes and complete work in expected time frames.  It has been proven that poor handwriters get lower grades, and that a high percentage of older students experience writer’s cramp and pain.  But that is another article!

My experience, having evaluated and helped students with handwriting difficulties for years, is that students can benefit in their writing ease, endurance and legibility when they master the skill of a dynamic tripod grasp.  When we help them achieve it they can have better function for life!

Copyright 2011 Joan Scanlon-Dise, OTR

1.  Johnson-Frey, Scott (2003).  What’s So Special About Human Tool Use? Neuron, 39, 201-204.
2.  Oatis, Carol A., 2009, Kinesiology: The Mechanics & Pathomechanics of Human Movement, Lippincott Williams &     Wilkins.
3.  Magee, David J. (2008).  Orthopedic Physical Assessment.  St. Louis, Missouri:  Saunders.
4.  Tubiana, Raoul (1981). The Hand. Philadelphia, PA:  W.B. Saunders.

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