Peer Reviewed Articles Using Pencil Grips to Improve Handwriting

• Periodical Listing
• Am J Occup Ther
• PMC3722657

Am J Occup Ther. 2013 Mar-April; 67(ii): 218–227.

Writing Forces Associated With Four Pencil Grasp Patterns in Class 4 Children

Heidi Schwellnus

Heidi Schwellnus, PhD, is Postdoctoral Young man in Cerebral Palsy, Bloorview Research Institute, Toronto, Ontario, and Centre for Interdisciplinary Enquiry in Rehabilitation and Social Integration, Quebec, Quebec, Canada

Heather Carnahan

Heather Carnahan, PhD, is Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada

Azadeh Kushki

Azadeh Kushki, PhD, is Postdoctoral Swain, Bloorview Research Constitute, Toronto, Ontario, Canada

Helene Polatajko

Helene Polatajko, PhD, is Professor, Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada

Cheryl Missiuna

Cheryl Missiuna, PhD, is Professor, School of Rehabilitation Scientific discipline, and Director, CanChild, Heart for Childhood Disability Enquiry, McMaster Academy, Hamilton, Ontario, Canada

Tom Chau

Tom Chau, PhD, is Senior Scientist, Canada Enquiry Chair in Rehabilitation Engineering, Bloorview Inquiry Institute, 150 Kilgour Road, Toronto, Ontario M4G 1R8 Canada; and Professor, Institute of Biomaterials and Biomedical Engineering science, University of Toronto, Toronto, Ontario, Canada; ac.otnorotu@uahc.mot

Abstract

OBJECTIVE. We investigated differences in handwriting kinetics, speed, and legibility among four pencil grasps later a 10-min copy task.

METHOD. Seventy-four Grade iv students completed a handwriting assessment earlier and subsequently a copy job. Grip and centric forces were measured with an instrumented stylus and forcefulness-sensitive tablet. We used multiple linear regression to analyze the human relationship between grasp design and grip and axial forces.

RESULTS. We found no kinetic differences amongst grasps, whether considered individually or grouped by the number of fingers on the barrel. However, when grasps were grouped co-ordinate to the thumb position, the adducted grasps exhibited higher mean grip and axial forces.

Conclusion. Grip forces were generally similar across the different grasps. Kinetic differences resulting from thumb position seemed to have no bearing on speed and legibility. Interventions for handwriting difficulties should focus more on speed and letter formation than on grasp pattern.

MeSH TERMS: hand strength, handwriting, kinetics, task operation and analysis

Handwriting is a skill that school-age children are required to master (Smits-Engelsman, Niemeijer, & van Galen, 2001). Even with the increased use of computers and tablets, handwriting remains an important skill, because the motor action of creating letters on paper has been found to increment the retentivity of messages beyond that attainable with keyboarding lone (Longcamp et al., 2008). James (2010) institute that the cosmos of letterforms augmented the visual processing of letters in preschool children. Thus, the importance of learning to manually class letters cannot exist underestimated.

The production of functional handwriting depends on the circuitous interplay of a number of abilities including proficient fine motor coordination and precise forcefulness regulation as well as cognitive, perceptual, and language skills (Van Galen, 1991). Understandably, given the demand for this complex integration of skills, learning to write can be challenging for children.

Dysgraphia

When a child has handwriting difficulties without a diagnosis of a neurological or intellectual disability, the handwriting difficulties are often termed dysgraphia (Feder & Majnemer, 2007). Dysgraphia is characterized by difficulty in the production of legible writing, in maintaining the quantity and speed of writing demanded in class, or both. The number of typically developing children who struggle with handwriting varies, with reported prevalence worldwide ranging from 6% to 34% (Graham, Weintraub, & Berninger, 1998; Overvelde & Hulstijn, 2011; Smits-Engelsman et al., 2001).

Pencil Grasp Fence

Pencil grasps are commonly classified co-ordinate to the position of the thumb, the number of fingers on the barrel of the pencil, and finger joint positions. In dynamic grasps, the thumb is positioned in opposition to the fingers; the thumb and fingers are placed on opposite sides of the pencil. In lateral grasps, the thumb crosses over the pencil, stabilizing it confronting the other fingers. Nonetheless, the pad of the pollex tends to contact the lateral edge of the index finger instead of the shaft of the pencil. Iii fingers contact the barrel in a tripod grasp and 4 in a quadrupod grasp.

Although a child's pencil grasp pattern is usually implicated in handwriting problems, this implication is non testify based (Graham et al., 2008; Rigby & Schwellnus, 1999; Rosenblum, Dvorkin, & Weiss, 2006). Historically, the dynamic tripod (DT) pencil grip has been promoted every bit the optimal grasp pattern because information technology allows for the fine dexterous movements of the fingers to create letters (Elliott & Connolly, 1984). Therapists and teachers unremarkably recommend that children, peculiarly those with handwriting difficulties, utilize the DT pencil grasp (Schneck & Henderson, 1990). Three other pencil grasp patterns—namely, the dynamic quadrupod (DQ), the lateral tripod (LT), and the lateral quadrupod (LQ) pencil grasps—are suggested to be mature grasps that are functional in terms of speed or legibility for writing (Dennis & Swinth, 2001; Koziatek & Powell, 2003). The prevalence of each of these grasp patterns in children is comparable to that of the DT grasp (Koziatek & Powell, 2003; Schwellnus et al., 2012). In mature pencil grasps, the intrinsic muscles of the paw are responsible for the movement of the pencil inside the hand (Elliott & Connolly, 1984). In dissimilarity, with young pencil grasp patterns, the pencil is held with the fingers, only the movement is controlled past the extrinsic muscles (Elliott & Connolly, 1984).

A desirable feature of the DT pencil grasp is the facilitation of fluid and fine movements of the iii fingers as they flex and extend to form vertical and curved alphabetic character strokes (Elliott & Connolly, 1984; Tseng, 1993). In add-on, the ring and the fifth fingers provide stabilization against the palm and support the metacarpal phalangeal arch of the hand (Benbow, 2002; Ziviani & Wallen, 2006). The increased surface expanse of grasps other than the DT could subtract the dynamic motility of the pencil (Dennis & Swinth, 2001). With the lateral grasps, the thumb is adducted and the web space is closed more than tightly around the barrel of the pencil, which restricts the pencil's motility, eliminates thumb opposition, and farther compromises residual (Dennis & Swinth, 2001). Likewise, with the DQ grasp, the ring finger is in contact with the pencil barrel, thereby eliminating the radial–ulnar dissociation of the fingers. In turn, stabilization normally provided by the band and fifth fingers against the palm of the manus is lost (Ziviani & Wallen, 2006). The vertical movements of the pen are therefore provided solely by the motility of the index, middle, and ring fingers, and the pollex is minimally involved in the movement of the pencil. The aforementioned movement restrictions may reduce the variability of grip strength. Indeed, previous research has found that when grip strength has a depression amount of variability, handwriting quality is decreased (Falk, Tam, Schwellnus, & Chau, 2010).

For a pencil grasp to be functional for writing, information technology must offer the user the power to efficiently create a legible written product for the required duration. Children must exist able to write long enough to go along up with class work and to complete assignments and examinations equally they progress through schoolhouse. Stevens (2008) found that people who used the LT grasp produced the same quantity of work but stopped writing before than those using other grasps and therefore wrote faster. The dynamics of the LT grasp were suggested to cause earlier fatigue (Stevens, 2008), which may exist the result of inefficient movements that are controlled proximally (Summers, 2001). Clearly, much argue still exists in the literature effectually the relative functional merits of the various pencil grasps. A closer expect at the kinetic characteristics of different grasps may assistance to explain functional similarities and differences among grasps.

Grip and Axial Forces

Grip force is understood to be the forces exerted by the pollex and fingers on the butt of the writing implement. The dynamic grasps with the opposed positioning are deemed to exist balanced grasps considering the forces exerted by the three (or iv) digits intersect at a common bespeak and therefore require minimal forcefulness to maintain (Soechting & Flanders, 2008). Grasps take also been categorized by the amount of hyperextension of the distal finger joints of the alphabetize finger (Selin, 2003; Ziviani, 1983) as a proxy for grip force. Recent inquiry has indicated that grip strength variability is a potent indicator of handwriting legibility (Falk, Tam, Schwellnus, & Chau, 2011) and that students with writing difficulties exhibit more static grip force patterns (Falk et al., 2010). Paired with the growing evidence that the unlike pencil grasps are functionally equivalent, these findings beg the question of whether the kinetic characteristics of different grasps are in fact like.

The amount of surface contact with the pencil barrel varies with the dissimilar finger and thumb positions. In the quadrupod gasps, an additional finger is in contact with the barrel; in the lateral grasps, the adduction of the pollex reorients the pencil within the grasp and increases the barrel-to-finger contact area (Figure 1). The impact of this greater surface contact expanse on grasp part is unknown. Grasps other than the DT have been hypothesized to subtract the corporeality of force exerted by each digit by distributing the requisite force over a larger surface expanse. Alternatively, the broadened surface contact may increase the total grip force, rendering the grip more static, and in turn diminish the engagement of the intrinsic hand muscles (Dennis & Swinth, 2001).

4 grasp patterns: (A) Dynamic tripod, (B) dynamic quadrupod, (C) lateral tripod, and (D) lateral quadrupod.

Although the onetime hypothesis suggests that the grasp with more contact points would exist more stable and may reduce fatigue, the increased stability has non been proven to exist advantageous for writing (Wu & Luo, 2006). The broader surface expanse hypothesis suggests that grasp patterns with increased contact and pressure level could exist less functional than the DT grasp; the elevated force per unit area over time could increase the effort required to maintain the grasp, inducing premature fatigue, which could, in turn, decrease motor control and the legibility of writing (Dennis & Swinth, 2001; Engel-Yeger & Rosenblum, 2010). In fact, the LT grasp has been linked to earlier fatigue (Stevens, 2008). Patently, grip forces may potentially modulate pencil grasp endurance, besides every bit the speed and legibility of the writing.

Centric force may also vary with pencil grasp blueprint. Axial forcefulness, also termed indicate pressure level, is the force practical down from the writing utensil onto the writing surface (Harris & Rarick, 1957). The bear on of greater barrel surface contact area on axial force is unknown; information technology may remain the same, increase, or decrease, depending on the number of digits involved and their orientation with respect to the barrel of the writing utensil. Final, the variability of axial force has been associated with decreased legibility of writing (Baur et al., 2006; Harris & Rarick, 1959), simply again, the relationship between pencil grasp pattern and kinetic variability is unknown.

In lite of the preceding, in this written report we aimed to answer the following main question: What are the kinetic differences, if any, among the four pencil grasp patterns, earlier and after an extended writing job? 2nd, nosotros explored whether kinetic differences were related to functional differences in terms of speed and legibility.

Method

Participants

One hundred twenty Grade 4 students were recruited equally a volunteer sample from four schools within a metropolitan school board. Previous grip force studies accept suggested that a sample size between 9 and 16 per group is required to find a large effect on various force parameters with 80% power (Chau, Ji, Tam, & Schwellnus, 2006; Falk et al., 2010). The Statistics Canada (http://statcan.gc.ca) data on the schools' postal codes indicated that the average household income for the school catchment areas was in the heart- and upper-middle-class range. Both the school board'south and the university's research ideals boards approved the report. Written consent from each parent was obtained, and each child assented to participate at the time of data collection.

Handwriting is relatively well developed past Form 4, and the quality of writing has stabilized (Overvelde & Hulstijn, 2011). The students had been introduced to cursive writing and were quondam enough to write for a minimum of x min (Dennis & Swinth, 2001; Parush, Pindak, Hahn-Markowitz, & Mazor-Karsenty, 1998). Data drove was conducted in the spring for near of the students; however, to accomplish the desired sample size of 120 students, an additional xvi students were recruited in the subsequent schoolhouse year. These new recruits were derived from a new cohort of Grade 4 students and were assessed in the fall (thus, they were younger and less experienced writers than the spring cohort at the fourth dimension of testing).

Instruments

To evaluate the grip and the axial forces, the students wrote with an instrumented pen on an electronically inking and digitizing tablet (Wacom Cintiq 12WX, Wacom, Vancouver, WA). The dimensions (width × elevation × thickness) of the tablet were 10.3 × half dozen.4 × 0.67 in. (261.vi mm × 162.half-dozen mm × 11 mm). In the landscape orientation, the writing surface was like in width to a regular alphabetic character-sized sheet of newspaper. The tablet was positioned in forepart of the children on a tabletop. The pen's construction is described in detail in Chau et al. (2006). The pen barrel was 0.43 in. (11 mm) in diameter, comparable to that of a primary school pencil. The high-friction tip of the pen simulated the pencil-on-newspaper writing experience. TekScan paper-thin sensors (Model 9811, Tekscan, Boston) were adhered to the circumference of the barrel to capture the grip force. The sensor strips were replaced 6 times throughout data collection sessions as a result of wear and tear. Recordings of the axial and grip forces were synchronized and stored on a laptop computer. The sampling periods for axial and grip forces were vii ms and iv ms, respectively. The centric information were linearly interpolated to match the sampling menstruation of the grip data before analysis.

Handwriting Assessment

We used the Children'south Handwriting Evaluation Scale (CHES; Phelps & Stempel, 1987). The CHES has both a manuscript version (CHES–M for Grades 1 and ii) and a cursive version (CHES for Grades three and beyond). We chose this assessment because it requires merely 2 min to complete; in comparison, the Evaluation Tool of Children'south Handwriting (Amundson, 1995) requires 15–20 min to complete. The selection of a brief assessment was necessary to minimize time out of the classroom. Students copy a standard text (two sentences in the CHES–M and five in the CHES). Both versions accept scoring criteria to evaluate handwriting speed and legibility. The psychometric properties of the CHES–Thousand and the CHES are intrarater reliability of .82 and interrater reliability of .95 (Phelps & Stempel, 1987). The CHES can be administered in two min. Either the quality or the speed score or both can be used to identify students with handwriting difficulties or dysgraphia.

Children are expected to employ cursive writing by Class 4 in Due north America (Dennis & Swinth, 2001; Graham et al., 1998); nonetheless, all the children in the study elected to utilize manuscript writing. All children had been taught cursive in school, only their teachers did not require its use in class, so a hybrid assessment was required. The children were former enough to copy the longer passage of the CHES, but because of their use of manuscript, we applied the CHES–M quality criteria. The quality score quantifies the legibility of the letters in the sample. The CHES–Grand has a total score of 100, with 10-point increments. A score of 80–100 indicates adept legibility; 50–70, satisfactory; and ≤40, poor. Given that the sample historic period exceeded that of the normative data, the quality scores were plotted and the 15th percentile was selected as the cutoff (Graham, Struck, Santoro, & Berninger, 2006); therefore, children who scored ≤thirty were identified equally having writing difficulties. The CHES has twice equally many words as the CHES–Thou and therefore has more than take a chance of errors, then the lower score cutoff is justified. Writing speed was estimated in messages per minute (LPM). Neither the CHES–M nor CHES rate norms could exist used considering the age and writing format criteria were not met. The children were thus identified as dysgraphic solely on the basis of their quality scores.

Protocol

The participants were assessed in a serenity room in their ain school during school hours. The children saturday on a Stokke height-adjustable chair (Stokke LLC, Stamford, CT) facing a regular school table. A digital camcorder recorded a shoulder-to-articulatio genus sagittal view of the child'southward pencil grasp and the position of the torso. The chair was initially positioned to support the children's feet to allow for the recommended 90° sitting posture (Parush, Levanon-Erez, & Weintraub, 1998); withal, posture was recorded only not controlled during the study, allowing the children to assume their own comfortable writing positions. The primary author (Tom Chau), an experienced occupational therapist, conducted all the assessments. All children completed the CHES twice, once before a ten-min re-create task (CHES 1) and once after the re-create task (CHES 2). A x-min-long copy job was previously institute to be sufficient to fatigue Grade iii students (Parush, Pindak, et al., 1998), and this duration of writing did significantly alter scores for perceived attempt in Class four students (Schwellnus et al., 2012).

To familiarize the children with writing on a tablet, they proficient writing ane or 2 sentences on the tablet for 1 min before performing the CHES. The children then copied every bit much of a story equally possible for 10 min. The story was selected from a literacy text for Form 4 students. The primary author observed the pencil grasp patterns during the assessment. Each pencil grasp was identified as one of the iv grasp patterns in Figure 1. If a grasp pattern differed from ane of the four mature grasp patterns, it was described in terms of number and positioning of digits on the pencil barrel and labeled as other. 3 children's pencil grasps were identified equally other. The primary author also recorded whether the children switched grasp patterns during the assessment.

Data Handling and Analysis

All identifying information was removed from the writing samples, which were scored in random order for speed and quality by the chief author. A subset of samples was scored twice by the get-go rater to ascertain intrarater reliability for the quality of the writing samples. Intrarater agreement was 80% for quality scores. A second experienced rater completed grasp pattern categorization for a quarter of the sample and scored ten% of the samples for quality. The scores for quality were compared with those obtained by the principal author, and the percent of understanding was determined. Interrater percentage of agreement was 80% for both quality scores and grasp classification.

Information analysis was completed using Matlab Version seven.nine.0 (Mathworks, Natick, MA) and Statistical Analysis Software nine.2 programs (SAS Institute Inc., Cary, NC). Descriptive statistics on grasp distribution were completed. Only the sensors contacted by the fingers were used in the analysis. The sensor information were filtered with a low-laissez passer Butterworth filter with a cutoff frequency of fifteen Hz to eliminate the noise in the point. The data from the pen and tablet were and then calibrated separately. The following force parameters were derived from the calibrated information: hateful grip and mean axial strength, coefficient of variation (CV) of grip and centric forces (degree of variability in the grip forces), and change in means and CVs of both forces from CHES 1 to CHES 2 (δ).

To answer the primary question (i.east., Are in that location kinetic differences amid grasps?), we performed three distinct analyses using multiple linear regression (MLR; Armitage, Beery, & Matthews, 2008) to examine the relationship between force parameters and (1) grasp design (DT, DQ, LT, LQ), (ii) the number of fingers involved (tripod vs. quadrupod), and (3) the position of the pollex (lateral vs. dynamic). The MLR model controlled for handedness and gender because they may have an impact on handwriting performance. Because the sensors were replaced several times during the study, we besides controlled for the pen. To address the second question (i.e., Is there a linkage betwixt kinetic and functional differences?), nosotros replicated these analyses for speed and legibility scores whenever pregnant effects of grasp, finger multiplicity, or thumb position were constitute.

Results

Participant Demographics and Distribution of Grasps

A sample of 120 children participated in the study. Information from 26 children were discarded considering of technical issues with the sensors. An additional 17 children who switched between a lateral and a dynamic grasp design were also eliminated because they crossed groupings in the analysis. The 3 participants with young, other grasp patterns were also removed. The terminal sample consisted of 74 children (boilerplate historic period = 9 yr, eleven mo), equally divided between boys and girls. The grasp distribution for the sample was DT, n = 22 (30%); DQ, due north = 12 (sixteen%); LT, n =19 (26%); and LQ, n = 21 (28%).

Legibility of Writing and Speed

The CHES one boilerplate quality score was 56.89, and the average speed of writing was 54.six LPM. Of the sample, xx% had CHES quality scores on the offset administration of the assessment that were beneath the cutoff of thirty. This fraction increased to 32% of CHES two quality scores after the 10-min re-create task. The boilerplate quality score on CHES ii was 43.10, which was statistically different from that of CHES 1, t(73) = vii.44, p < .0001. When the scores for the starting time and second assessments for individuals were compared, 10 children (13.five%) increased their quality scores after the ii-min copy task, an interesting result; all the same, the remainder of the children's scores decreased. The writing speeds on the CHES 2 and CHES 1 were not significantly unlike, t(73) = −0.73, p = .467; CHES i = 54.vi LPM, CHES two = 55.43 LPM.

Result of Grasp on Force Parameters

Neither grasp pattern (DQ, DT, LT, LQ) nor the number of fingers on the pencil (tripod or quadrupod) had a significant issue on the force parameters for CHES 1, CHES ii, or alter in force parameters betwixt CHES 1 and CHES 2, F(iii, 63) ≤ 2.57, p ≥ .063 for grasp blueprint and F(1, 63) ≤ 0.64, p ≥ .43 for number of fingers on the pencil (Figures 2 and ​ 3). Only thumb position (lateral or dynamic) had a meaning relationship with mean grip force, mean axial force, and CV of axial force for CHES 1 (Figure four). The mean grip force during CHES 1 was significantly higher for the lateral thumb position than for the dynamic thumb position, F(i, 65) = six.88, lateral = 5.62 newtons (N), dynamic = iv.23 Due north, p = .011. The same was truthful for the mean axial forces, F(1, 65) = 5.51, lateral = 0.96 N, dynamic = 0.65 N, p = .022, and the CV of axial force was significantly unlike, F(1, 65) = half-dozen.24, dynamic = 0.77 N, lateral = 0.70 Due north, p = .015. For CHES 2, thumb position had a significant effect merely on mean axial force (run across Figure 4), which differed significantly between the lateral and dynamic grasp patterns, F(one, 65) = 6.43, lateral = one.23 N, dynamic = 0.88 N, p = .014.

The effect of grasp on force for four grasp patterns.

Note. CV = coefficient of variation; DQ = dynamic quadrupod; DT = dynamic tripod; light gray = Children'due south Handwriting Evaluation Scale one; nighttime greyness = Children'south Handwriting Evaluation Scale 2; LT = lateral tripod; LQ = lateral quadrupod.

The effect of grasp on force: Quadrupod versus tripod.

Annotation. CV = coefficient of variation; light grayness = Children'southward Handwriting Evaluation Scale i; night gray = Children's Handwriting Evaluation Scale 2.

The outcome of grasp on force: Dynamic versus lateral grasp.

Note. CV = coefficient of variation; dynamic = fingers in opposition; lateral = fingers adducted; light gray = Children's Handwriting Evaluation Calibration 1; dark gray = Children'south Handwriting Evaluation Calibration 2.

Thumb position did not have a significant effect on speed or legibility scores for both CHES 1 speed, F(ane, 65) = 0.90, p = .346, and legibility, F(1, 65) = 0.03, p = .866, and CHES ii speed, F(i, 65) = 0.06, p = .800, and legibility, F(1, 65) = 0.06, p = .812. In other words, kinetic differences were non associated with corresponding functional differences.

Effect of Grasp on Change in Mean Force From CHES ane to CHES 2

We found no pregnant effects of grasp on the modify in mean of grip and axial forces from CHES 1 to CHES two for whatever of the analyses: change in mean grip force, F(3, 63) = 0.29, p = .831; modify in mean centric force, F(iii, 63) = 0.37, p = .774; modify in CV grip force, F(iii, 63) = 0.31, p = .815; and modify in CV centric forcefulness, F(3, 63) = 0.64, p = .593. This finding indicates that the effort involved in writing for >10 min affected the grasp patterns equally (see Figures 2–4).

Discussion

Distribution of Grasp Patterns

Three of the grasp patterns (DT, LT, and LQ) were almost equally prevalent; the DQ had the lowest prevalence in the sample. Other enquiry has institute similar results (Dennis & Swinth, 2001; Koziatek & Powell, 2003; Schwellnus et al., 2012), which further supports the demand to determine whether these grasp patterns tin can be treated every bit kinetically equivalent.

Legibility and Speed of Writing

The legibility scores for CHES ane indicated that 20% of the sample had dysgraphic writing, which is higher than that institute by Overvelde and Hulstijn (2011) but is in line with other previous research findings (Graham et al., 1998; Smits-Engelsman et al., 2001). After the x-min copy job, the percentage of children with dysgraphic writing increased to 32%, a issue indicating that the task did fulfill its purpose of increasing the participants' effort. Interestingly, 10 participants (13%) increased their legibility score for CHES two; iv dysgraphic writers actually increased sufficiently to reclassify themselves as proficient. These children may have needed a considerably longer copy task to affect the quality of their writing to the same degree. An alternative explanation from a motor learning perspective is that these children institute writing on the tablet to be an unfamiliar task and had some difficulty controlling the pencil during CHES one, and that after the copy job, they became more familiar with the feel and could improve control the quality of their writing (Engel-Yeger & Rosenblum, 2010). A 3rd caption is that instead of classifying children as dysgraphic solely on legibility criteria, rate information is needed to reduce Type 1 error.

Grip and Axial Forces

The grip and axial forces were not significantly different among the four grasp patterns when compared with each other individually or when compared by the number of fingers on the barrel of the pencil. The differences in the mean grip force and the mean and variability of the axial forces of the four grasp patterns were but significant when the grasps were classified past pollex position. A larger amount of forcefulness was exerted on the barrel of the pencil when the pollex was adducted and placed over rather than in opposition to the index finger only during CHES 1; this difference did not occur during CHES 2. The difference may be the result of the need to increase digit strength to compensate for the lack of thumb opposition when the tripod or quadrupod is lost (Soechting & Flanders, 2008). That beingness said, the departure in mean grip force occurred only during CHES 1, which, considering no difference was found in legibility or speed of writing amid the four grasp patterns, corroborates previous results of similarity in function of grasp patterns (Koziatek & Powell, 2003; Schwellnus et al., 2012). Further inquiry could investigate a like protocol with an even longer copy task to determine whether these results concord for older students who may be required to write >14 min.

The variability of grip forces was not significantly different among any of the grasp patterns in any of the comparisons, suggesting that although the lateral grasps may announced to have lesser degrees of small-scale movements than the dynamic grasps at the distal finger joints, the variability of the forces is not different for any of the grasp patterns. A higher variability of grip force has been found to exist linked to greater legibility (Falk et al., 2010). The variability of the centric force was significantly different for CHES i but not for CHES 2. Engel-Yeger and Rosenblum (2010) found that with increased writing speed, which occurred in CHES 2, distal musculus variability decreased, indicating fixing of the joints to write faster. Consistent with this finding, the CV of the grip forces in this study did not change from CHES one to CHES ii; withal, axial forcefulness varied more during CHES 1. Fatigue may peradventure have decreased the motor coordination and therefore movement coordination, and to compensate for this lack of control, the participants may have decreased the variability of the grip force past fixing the distal joints (Aune, Ingvaldsen, & Ettema, 2008) and potentially writing with greater hateful centric pressure. Some other possible caption is that the CHES 1 results may have been transient as the children accommodated to writing on the tablet. This caption is supported by the results of a 2010 written report that found that children used previous knowledge of a handwriting task to improve their performance (Engel-Yeger & Rosenblum, 2010).

Grip and axial forces were not significantly different betwixt CHES 1 and CHES 2, suggesting that the forces involved in the four grasp patterns are equally affected by the extended copy chore. The children did write faster on CHES two, and an increment in speed has been institute when writing for longer periods (Dennis & Swinth, 2001; Kushki, Schwellnus, Ilyas, & Chau, 2011). When writing faster, children may employ increased forcefulness or accept increased variability in axial forcefulness, behaviors that take previously had the affect of reducing legibility (Engel-Yeger & Rosenblum, 2010; Harris & Rarick, 1957, 1959); withal, nosotros did not observe this reduction of legibility in the current study.

Implications for Occupational Therapy Exercise

The iv commonly occurring pencil grasps seem to be more equivalent than different in terms of grip kinetics. Fifty-fifty with increasing use of engineering science, the connected teaching and mastery of handwritten piece of work has been found to be benign for dissociation of reversals and improved reading. As a result, it is important to continue to refer children with handwriting difficulties to occupational therapists to assist with the mastery of this cardinal skill; however, referrals for children solely for an "incorrect" pencil grasp blueprint may not be necessary if the child has grade-appropriate functional writing. The focus of intervention should shift to improving the speed and formation of letters to enhance legibility rather than to modify the grasp pattern.

Limitations, Future Work, and Conclusions

Our findings farther support the equivalence of the four mature pencil grasps for functional writing, even after an extended copy task. The kinetics, speed, and legibility of writing were not dissimilar among children who used 4 different types of grasp later on ten min of writing. Merely when the grasps were grouped according to the thumb position did any significant differences in hateful grip and axial forces ascend; however, these changes in force did not affect the speed or legibility of the writing.

I limitation of the study is that the volunteer sample was recruited from middle- to upper-middle-class neighborhoods of a metropolitan city and thus may not have been representative of the general population. In addition, the final sample size was a small-scale 74. With the students all using manuscript writing, a nonnormative scoring cutoff for legibility was derived and rendered the speed data usable but as raw scores. Thus, our demarcation of the sample ought to be interpreted with caution. The protocol involved writing on the tablet, which may have been unfamiliar to some participants; however, the initial exercise fourth dimension and the proliferation of pen-enabled gaming devices would accept reduced the novelty of tablet-based writing. Terminal, the 10-min copy task may non accept been sufficient to fatigue all participants. All the same, this extended writing task did alter perceived endeavour scores.

At the fourth dimension of this study, no standardized handwriting assessment for manuscript writing for Class 4 children was available. If the use of manuscript in higher grades is indeed a prevalent do, the development of an appropriate handwriting assessment would be necessary. Futurity inquiry should also further report the kinetics of static or young grasps to decide whether the writing forces are afflicted past the loss of dynamic movement.

Acknowledgments

We give thanks A. Dupuis and S. Klejman for their help with the statistical analysis as well as the staff, students, and parents who took function in the study. The projection was funded past the Home Care Enquiry Doctoral Training Award; National Grants Plan; SickKids Foundation; Canada Research Chairs Program; the Natural Sciences and Applied science Research Quango of Canada; the Graduate Department of Rehabilitation Science, University of Toronto; and the Children'southward Rehabilitation Research Network.

Contributor Information

Heidi Schwellnus, Heidi Schwellnus, PhD, is Postdoctoral Fellow in Cerebral Palsy, Bloorview Research Institute, Toronto, Ontario, and Centre for Interdisciplinary Enquiry in Rehabilitation and Social Integration, Quebec, Quebec, Canada.

Heather Carnahan, Heather Carnahan, PhD, is Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.

Azadeh Kushki, Azadeh Kushki, PhD, is Postdoctoral Fellow, Bloorview Research Institute, Toronto, Ontario, Canada.

Helene Polatajko, Helene Polatajko, PhD, is Professor, Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada.

Cheryl Missiuna, Cheryl Missiuna, PhD, is Professor, School of Rehabilitation Science, and Director, CanChild, Middle for Childhood Inability Research, McMaster University, Hamilton, Ontario, Canada.

Tom Chau, Tom Chau, PhD, is Senior Scientist, Canada Enquiry Chair in Rehabilitation Engineering, Bloorview Inquiry Plant, 150 Kilgour Road, Toronto, Ontario M4G 1R8 Canada; and Professor, Institute of Biomaterials and Biomedical Engineering science, University of Toronto, Toronto, Ontario, Canada; ac.otnorotu@uahc.mot.

References

• Amundson S. J. Evaluation Tool of Children'southward Handwriting. Homer, AK: OT Kids; 1995. [Google Scholar]
• Armitage P., Beery One thousand., Matthews J. N. S. Statistical methods in medical inquiry. 4th ed. Malden, MA: Blackwell Scientific discipline; 2008. [Google Scholar]
• Aune T. K., Ingvaldsen R. P., Ettema 1000. J. Issue of concrete fatigue on motor command at different skill levels. Perceptual and Motor Skills. 2008;106:371–386. http://dx.doi.org/10.2466/pms.106.2.371-386 . [PubMed] [Google Scholar]
• Baur B., Schenk T., Fürholzer West., Scheuerecker J., Marquardt C., Kerkhoff G., Hermsdörfer J. Modified pen grip in the handling of writer's balk. Human Motion Science. 2006;25:464–473. http://dx.doi.org/10.1016/j.humov.2006.05.007 . [PubMed] [Google Scholar]
• Benbow M. Paw skills and handwriting. In S. A. Cermak & D. Larkin (Eds.), Developmental coordination disorder (pp. 140–156). Albany, NY: Delmar/Thompson Learning. [Google Scholar]
• Chau T., Ji J., Tam C., Schwellnus H. A novel instrument for quantifying grip activity during handwriting. Archives of Physical Medicine and Rehabilitation. 2006;87:1542–1547. http://dx.doi.org/10.1016/j.apmr.2006.08.328 . [PubMed] [Google Scholar]
• Dennis J. L., Swinth Y. Pencil grasp and children'southward handwriting legibility during different-length writing tasks. American Periodical of Occupational Therapy. 2001;55:175–183. http://dx.doi.org/10.5014/ajot.55.2.175 . [PubMed] [Google Scholar]
• Elliott J. K., Connolly K. J. A classification of manipulative hand movements. Developmental Medicine and Child Neurology. 1984;26:283–296. http://dx.doi.org/10.1111/j.1469-8749.1984.tb04445.x . [PubMed] [Google Scholar]
• Engel-Yeger B., Rosenblum Southward. The effects of protracted graphomotor tasks on tripod pinch strength and handwriting performance in children with dysgraphia. Inability and Rehabilitation. 2010;32:1749–1757. http://dx.doi.org/10.3109/09638281003734375 . [PubMed] [Google Scholar]
• Falk T. H., Tam C., Schwellnus H., Chau T. Grip force variability and its effects on children's handwriting legibility, class, and strokes. Periodical of Biomechanical Technology. 2010;132:114504. http://dx.doi.org/10.1115/1.4002611 . [PubMed] [Google Scholar]
• Falk T. H., Tam C., Schwellnus H., Chau T. On the development of a calculator-based handwriting assessment tool to objectively quantify handwriting proficiency in children. Estimator Methods and Programs in Biomedicine. 2011;104:e102–e111. http://dx.doi.org/x.1016/j.cmpb.2010.12.010 . [PubMed] [Google Scholar]
• Feder 1000. P., Majnemer A. Handwriting evolution, competency, and intervention. Developmental Medicine and Child Neurology. 2007;49:312–317. http://dx.doi.org/x.1111/j.1469-8749.2007.00312.10 . [PubMed] [Google Scholar]
• Graham Southward., Harris K. R., Bricklayer 50., Fink-Chorzempa B., Moran S., Saddler B. How do primary class teachers teach handwriting? A national survey. Reading and Writing. 2008;21:49–69. http://dx.doi.org/x.1007/s11145-007-9064-z . [Google Scholar]
• Graham Southward., Struck M., Santoro J., Berninger V. Westward. Dimensions of good and poor handwriting legibility in first and 2d graders: Motor programs, visual–spatial organization, and letter of the alphabet formation parameter setting. Developmental Neuropsychology. 2006;29:43–60. http://dx.doi.org/10.1207/s15326942dn2901_4 . [PubMed] [Google Scholar]
• Graham S., Weintraub N., Berninger V. W. The relationship between handwriting style and speed and legibility. Periodical of Educational Research. 1998;91:290–297. http://dx.doi.org/10.1080/00220679809597556 . [Google Scholar]
• Harris T. 50., Rarick G. L. The trouble of pressure in handwriting. Periodical of Experimental Teaching. 1957;26:151–178. [Google Scholar]
• Harris T. L., Rarick Thou. L. The relationship between handwriting pressure level and legibility of handwriting in children and adolescents. Journal of Experimental Education. 1959;28:65–84. [Google Scholar]
• James Thousand. H. Sensori-motor experience leads to changes in visual processing in the developing brain. Developmental Scientific discipline. 2010;thirteen:279–288. http://dx.doi.org/ten.1111/j.1467-7687.2009.00883.x . [PMC gratuitous article] [PubMed] [Google Scholar]
• Koziatek S. Grand., Powell N. J. Pencil grips, legibility, and speed of fourth-graders' writing in cursive. American Journal of Occupational Therapy. 2003;57:284–288. http://dx.doi.org/10.5014/ajot.57.iii.284 . [PubMed] [Google Scholar]
• Kushki A., Schwellnus H., Ilyas F., Chau T. Changes in kinetics and kinematics of handwriting during a prolonged writing task in children with and without dysgraphia. Research in Developmental Disabilities. 2011;32:1058–1064. http://dx.doi.org/10.1016/j.ridd.2011.01.026 . [PubMed] [Google Scholar]
• Longcamp Thou., Boucard C., Gilhodes J. C., Anton J. L., Roth 1000., Nazarian B., Velay J. L. Learning through hand- or typewriting influences visual recognition of new graphic shapes: Behavioral and functional imaging testify. Periodical of Cerebral Neuroscience. 2008;20:802–815. http://dx.doi.org/10.1162/jocn.2008.20504 . [PubMed] [Google Scholar]
• Overvelde A., Hulstijn West. Handwriting development in form 2 and form 3 master school children with normal, at risk, or dysgraphic characteristics. Research in Developmental Disabilities. 2011;32:540–548. http://dx.doi.org/10.1016/j.ridd.2010.12.027 . [PubMed] [Google Scholar]
• Parush S., Levanon-Erez Due north., Weintraub Due north. Ergonomic factors influencing handwriting performance. Piece of work. 1998;11:295–305. [PubMed] [Google Scholar]
• Parush Southward., Pindak 5., Hahn-Markowitz J., Mazor-Karsenty T. Does fatigue influence children'south handwriting operation? Work. 1998;11:307–313. [PubMed] [Google Scholar]
• Phelps J., Stempel L. Handwriting: Development and evaluation. Annals of Dyslexia. 1987;37:228–239. http://dx.doi.org/x.1007/BF02648069 . [PubMed] [Google Scholar]
• Rigby P., Schwellnus H. Occupational therapy conclusion making guidelines for problems in written productivity. Physical and Occupational Therapy in Pediatrics. 1999;19:v–27. http://dx.doi.org/10.1080/J006v19n01_02 . [Google Scholar]
• Rosenblum Due south., Dvorkin A. Y., Weiss P. 50. Automated segmentation equally a tool for examining the handwriting process of children with dysgraphic and proficient handwriting. Human Move Scientific discipline. 2006;25:608–621. http://dx.doi.org/10.1016/j.humov.2006.07.005 . [PubMed] [Google Scholar]
• Schneck C. Thou., Henderson A. Descriptive analysis of the developmental progression of grip position for pencil and crayon control in nondysfunctional children. American Journal of Occupational Therapy. 1990;44:893–900. http://dx.doi.org/10.5014/ajot.44.10.893 . [PubMed] [Google Scholar]
• Schwellnus H., Carnahan H., Kushki A., Missiuna C., Polatajko H., Chau T. Outcome of pencil grasp on the speed and legibility of handwriting in children. American Journal of Occupational Therapy. 2012;66:718–726. http://dx.doi.org/ten.5014/ajot.2012.004515 . [PubMed] [Google Scholar]
• Selin A.-South. Pencil grip—A descriptive model and 4 empirical studies. Main's thesis, Åbo Akademi University, Turku, Finland. Retrieved from world wide web.doria.fi/bitstream/handle/10024/4108/TMP.objres.23.pdf?sequence=two.
• Smits-Engelsman B. C., Niemeijer A. Due south., van Galen G. P. Fine motor deficiencies in children diagnosed as DCD based on poor grapho-motor ability. Human Move Science. 2001;xx:161–182. http://dx.doi.org/x.1016/S0167-9457(01)00033-ane . [PubMed] [Google Scholar]
• Soechting J. F., Flanders Yard. Sensorimotor control of contact strength. Current Opinion in Neurobiology. 2008;eighteen:565–572. http://dx.doi.org/10.1016/j.conb.2008.11.006 . [PMC free article] [PubMed] [Google Scholar]
• Stevens A. C. The furnishings of typical and singular grasps on endurance and fatigue in handwriting. Master's thesis, Texas Woman'southward University, Denton. Retrieved from http://gradworks.umi.com/14/62/1462906.html.
• Summers J. Joint laxity in the index finger and thumb and its relation to pencil grasps used by children. Australian Occupational Therapy Journal. 2001;48:132–141. http://dx.doi.org/10.1046/j.0045-0766.2001.00247.x . [Google Scholar]
• Tseng M. Factorial validity of the Tseng handwriting problem checklist. Journal of the Occupational Therapy Clan of the Republic of China. 1993;xi:13–26. [Google Scholar]
• Van Galen G. P. Handwriting: Issues for a psychomotor theory. Human Movement Science. 1991;10:165–191. http://dx.doi.org/10.1016/0167-9457(91)90003-G . [Google Scholar]
• Wu F. M., Luo Due south. Design and evaluation approach for increasing stability and operation of touch pens in screen handwriting tasks. Practical Ergonomics. 2006;37:319–327. http://dx.doi.org/10.1016/j.apergo.2005.06.010 . [PubMed] [Google Scholar]
• Ziviani J. Qualitative changes in dynamic tripod grip between 7 and xiv years of historic period. Developmental Medicine and Child Neurology. 1983;25:778–782. http://dx.doi.org/10.1111/j.1469-8749.1983.tb13846.x . [PubMed] [Google Scholar]
• Ziviani J., Wallen M. The development of graphomotor skills. In: Henderson A., Pehoski C., editors. Hand function in the child: Foundations for remediation. 2d ed. Philadelphia: Mosby/Elsevier; 2006. pp. 217–236. [Google Scholar]

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722657/

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