Occupational Therapy provides helping hand for writing redevelopment

By Mike O'Kelly

Allison and Lily

Occupational therapist Allison works with Lily during a session.

In the age of technology, handwriting is somewhat of a lost art. Expansive cursive loops and sharp pen strokes are more commonly replaced by fingers flying across keyboards, phones and other mobile devices. Still, there’s beauty and a sense of individuality in the craft, which for many St. Jude Children’s Research Hospital patients is often a tremendous undertaking due to the effects of cancer, treatment or medications.

Fundamental techniques such as seeing the page clearly or gripping a pen can offer initial challenges, which can also include shaky hands or learning to write with a non-dominant hand. St. Jude School Program and Rehabilitation Services staff members incorporate handwriting skills into their lessons and sessions. Occupational therapist Allison Smith works with patients who need a more focused approach, which involves first identifying the complications that can limit a child’s handwriting ability.

“Handwriting is still an important activity in our everyday lives, and we want to get these patients back to doing activities that are normal and familiar to them,” Smith said.

Originating as a summer handwriting camp a few years ago, the handwriting sessions are now individual appointments structured to recreate the optimal writing experience—a steady chair at a desk with feet flat on the floor.

Smith’s approaches vary with each patient—a 4-year-old who hasn’t had a chance to learn handwriting fundamentals will be shown techniques to begin writing while an older patient may need to learn to write with his left hand due to a left-hemisphere brain tumor that has affected his dominant right hand.

Patients with limited vision learn to write by using visual cues on special highlighter paper. If the children can see shadows and differentiate between colors, occupational therapists teach them how to sign their names, even if the patients are not reading and writing in full sentences.

“Handwriting isn’t always fun, but we try to make it fun by starting with coordination activities that are going to get them engaged,” Smith said.

Instead of 60-minute sessions of handwriting only, patients begin their visits with gross and fine motor activities such as picking up small objects with tweezers and clothespins before moving on to writing.

Some of the more common difficulties for patients include letter reversals such as those in lowercase B’s and D’s, forming correct diagonal lines in A’s and K’s and producing oversized letters. The handwriting program includes booklets and lessons for the patients. Modernity is not ignored, however, as lessons can include keyboarding sessions.

Portions of the program can also be completed at home—through booklets or free apps on mobile tablets that reinforce handwriting fundamentals. Occupational therapists provide monthly progress reports. The most valuable moments, Smith said, are seeing a child’s confidence grow with improvement.

“Each patient is different, and there are so many different components that can affect a child’s ability to write well,” Smith said. “Finding the right approach for each patient and seeing them improve is our ultimate goal.”