As an occupational therapist who works with children, messy handwriting is a complaint I hear about often. In fact, difficulty with writing is one of the most common reasons children are referred to me in the school setting. Teachers have tried everything they know to do, and still the child’s writing is too messy to decipher. So why is it that some children can print neatly, and others work so hard at it, but still struggle?
There are several reasons that a child may have difficulty with handwriting, and among them are: hand weakness, inefficient grasp, poor in-hand manipulation skills, shoulder and/or core weakness, difficulty with motor planning, decreased body awareness, decreased attention to task, and poor visual-motor skills. Most of the time the issue is a combination of several of these things, with one issue that leads to another, making things more complicated to address effectively if you don’t know where to start.
Weakness is one of the more common reasons children struggle with handwriting, but it isn’t always just an issue of weakness in the hands. Writing requires strength in the small intrinsic hand muscles, but it also requires strength in the muscles of the core and shoulder, which provide stability to the arm during fine motor tasks. Weakness of any of these muscle groups may result in poor motor control over the writing utensil, making forming letters, placing them on the line, and sizing them correctly more difficult. When a child is weak, we often see inefficient grasp patterns on a writing utensil, such as a fisted grasp, which allow the child to maintain control over the writing instrument, but requires the use of larger muscle groups in the shoulder or arm to produce the movement. These muscles are made for producing big movements, not the small, precise and well controlled movements the small muscles of the hands can.
The ability to write in an adult is largely kinesthetic. This means that we are able to write from motor memory, and we don’t really have to think about it or have to look at what we are doing to write a letter “c” or to sign our names, and our handwriting is pretty consistent in size and appearance. Our hands and our brains have it worked out, and our eyes don’t need to be very involved in the process anymore. In children who are learning to write, this is not yet the case. Their success in writing is dependent on their ability to look at and make sense of what they see cognitively, and the brain’s ability to give correct instructions to the hand to imitate what is seen. They need to be able to visually attend to what they are doing throughout the process, with their eyes giving feedback to their brains about whether the motor plan was successful or needs to be refined because the letter wasn’t the right size, or didn’t look like the letter it was supposed to be.
If your child is struggling with handwriting, and practice alone isn’t helping, an evaluation by an occupational therapist can help figure out why, and work with you to develop an individualized plan to make writing easier for them.
Katie Koehn, OTR, West Texas Rehabilitation Center
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