Frame of Reference for Development of Handwriting Skills
This frame of reference identifies functions and dysfunctions in five areas of handwriting for children, including proximal posture, components, use of writing tools, grasp, and handwriting. Good proximal control is required for functional and effective distal control of the writing tools. Either excessive postural stability or lack of postural stability during writing tasks is considered as dysfunctions. Components including ocular-motor skills, attention, and memory are considered as essential. This frame of reference assumes that functional visual perceptual skills are prerequisite skills for good handwriting. The ability to perceive letters as a set of distinct features is the main concern in the component of visual perception. Writing tools, including paper and erasers, needed to be positioned and stabilized effectively are prerequisite for legible handwriting. Functional grasp is necessary to manipulate writing tools effectively. At the end, writing should also be readable and completed with an appropriate time interval. In evaluation, therapists look at the overall legibility, subskills of alignment, spacing, and size of both in-class handwriting and homework. There are numbers of assessments on visual-perceptual and/or fine motor skills for occupational therapists to assess the underlying causes. Clinical observations can also be made during handwriting. The treatment plan within this frame of reference includes various interventions including working in the classroom with the child and cooperating with the teacher on environmental and/or curricular adaptations. The aim of the interventions is that the child will be able to generalize skills into more complex fine motor skills, and eventually be able to participate in age-appropriate occupation as a student.
Frame of reference
Domain of occupation
Collaboration with classroom teachers is required
Roston, K. (2010). A frame of reference for the development of handwriting skills. In P. Kramer & J. Hinojosa (Eds.), Frames of reference for pediatric occupational therapy (3rd ed., pp. 425-460). Philadelphia: Lippincott Williams & Wilkins.
The Conceptual Model for Performance in Handwriting views that handwriting is important for one’s work and/or education domains of occupations. It considers the performance components, performance areas (functional performance), performance contexts, and the interactive relationship among them. Prerequisites to handwriting include performance components in sensory, perceptual, motor cognitive, and language functions, as well as integrations of these components.
The Biomechanical frame of reference for positioning children for function is applied to individuals who are unable to maintain posture from appropriate automatic muscle activity caused by neuromuscular or musculoskeletal dysfunction. The goals of this frame of reference are (1) to enhance development of postural reactions, which can be done by reducing the demands of gravity and aligning the body, and (2) to improve functional performance by providing external support for proximal stability to improve distal function.
The Sensory Integration (SI) frame of reference focuses on how the interaction between the sensory systems including auditory, vestibular, proprioceptive, tactile, and visual systems, provides integrated information that contributes to a child’s learning and adaptive behaviors. The key consideration is that children have the abilities to make adaptive responses to constantly changing sensory environments. The sensory integrative abilities include sensory modulation, sensory discrimination, postural-ocular control, praxis, bilateral integration, and sequencing.
This frame of reference adapts a top-down approach to identify visual perceptual factors that limit an individual’s daily participation, and adaptive and compensation approaches are used to facilitate engagement in meaningful occupation. It uses theories from cognition, developmental psychology, education, and Warren’s developmental hierarchy of visual perceptual skills. Visual Perceptual skill development is viewed to be developed from a hierarchy, starting from oculomotor control, visual fields, visual acuity.
The Neuro-Developmental Treatment (NDT) frame of reference is used to analyze and treat posture and movement impairments based on kinesiology and biomechanics. To identify difficulties and plan for intervention, the following concepts are to be considered in NDT, including planes of movement, alignment, range of motion, base of support, muscle strength, postural control, weight shifts, and mobility. NDT assumes that posture and movement impairments are changeable. Thus, it utilizes movement analysis to identify missing or atypical elements.