[OTlist] Evidence
Just to interject about the handwriting requests. I remember a saying that, Proximal stability allows distal control. Perhaps a fancy way of saying that scapular/shoulder weakness prevents a solid foundation for stability to allow greater fine motor control with the writing utensil. The joint laxity, poor endurance, poor posture, etc., are all things that contribute to poor penmanship. Sorry if this is redundant, but hopeful it helps. Michael Holmes OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Evidence
Hi, I have been trying to remediate handwriting issues in the middle school population as well. I would agree with Michael that proximal stability is key. Using this principal in conjunction with some of the core concepts and astronaut protocol by Mary Kawar have also been useful in preping the ocular-vestibular systems and following through with functional tasks. I have had some progress with spacing and sizing difficulties. Using the visual therapy literature and Kawar's Eye sight to insight I try to move kids using scanning from peripheral to focal vision. You can also do this by practicing saccades and pursuits, or scanning, copying and visual discrimination tasks. A great web sight to look at is http://www.eyecansee.com , and www.abcjesuslovesme.com. They both have free printable visual/perception worksheets and games. Good luck. Andrea Houtras, MS,OTR/L -Original Message- From: Michael Holmes o...@nvhospital.org To: otl...@otnow.com. Sent: Thu, Mar 11, 2010 1:03 pm Subject: [OTlist] Evidence Just to interject about the handwriting requests. I remember a saying that, Proximal stability allows distal control. Perhaps a fancy way of saying that scapular/shoulder weakness prevents a solid foundation for stability to allow greater fine motor control with the writing utensil. The joint laxity, poor endurance, poor posture, etc., are all things that contribute to poor penmanship. Sorry if this is redundant, but hopeful it helps. Michael Holmes OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Evidence?
Hi, I am going to be the devils advocate, and say that this child may very well have skipped a few crucial developmental stages most possibly contributing to the problem. We are trained in dissecting these problems and intervening at these levels to re mediate the problem. In a school based model, we are asked to create adaptations, or when possible treat children using school related functional strategies that may serve to best support their academics in or out of class. I have seen kids receive years of therapy with little gains for various reasons. Poor follow through, limited family involvement, limited intensity and the list goes on. My dilemma rests with Renee. The restrictions we are up against in the schools often limits our ability to make real progress. This child's true underlying issues are thereafter never met, yet services continue for years. If in fact, this child has true shoulder girdle instability, and probably postural instability, among other issues, can one time weekly help re mediate these issues or consultation + a home exercise program? I recently took a course with Mary Kawar Eye Sight To Insight It was a wonderful course with a wealth of strategies backed up with theory and some research. She did respond to a question related to frequency and intensity of services in her school based practice. She recommended 1x weekly with parent involvement and a strong home exercise program to be completed 2x daily. Her Research and theory was not backed by any evidence, however the vision therapy literature is beginning to demonstrate some strong evidence when coupled with occupational therapy. Andrea Houtras MSOTR/L-Hamilton Pediatric Therapy LLC -Origi From: Joan Riches jric...@telusplanet.net To: OTlist@OTnow.com Sent: Fri, Feb 19, 2010 2:37 pm Subject: Re: [OTlist] Evidence? Renee What did you suss out regarding the reason that he grips his pen or pencil so hard that his hand gets tired?-or was that your conclusion? In my experience and this is not research evidence or even particularly large handwriting problems can go back to atypical development of the shoulder girdle in infancy so that the child was unable to hold up his hands to explore the movements of his fingers. This can be a result of treatment for congenitally dislocated hips among other things - anything that prevents pushing up from the prone position. By the time the shoulder girdle strengthens there are more interesting things to do than be fascinated with fingers so they remain undifferentiated. I'm sure your recommendations are designed to remedy this. It might help the mother to understand if she thinks back and realizes that this developmental step was skipped for one reason or another and that meaningful activities will be more effective than exercises. How does he do with activities that require him to manipulate very small pieces - Lego model building etc? Joan Riches B.Sc.O.T., OT(C) Specialist in Cognitive Disability High River, Alberta, Canada -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Renee Lowrey Sent: February 19, 2010 5:19 AM To: otlist@otnow.com Subject: [OTlist] Evidence? I am working in a school district where we provide ‘hands-on’ consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesn’t get tired when he writes (He’s in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesn’t want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.435 / Virus Database: 271.1.1/2691 - Release Date: 02/19/10 07:34:00 No virus found in this outgoing message. Checked by AVG - www.avg.com Version: 8.5.435 / Virus Database: 271.1.1/2691 - Release Date: 02
Re: [OTlist] Evidence?
Sounds the school could have been referred Mom to the clinic for what attention to a concern that only happens at home. (tongue in cheek). Why can parents make referrals to you in the school setting? Sounds like a dicey situation of the expectation of professional courtesy. I'd suggest that you involve refer up to your management at least to the level of a 'heads up'. Good luck, Joan Joan Riches B.Sc.O.T., OT(C) Specialist in Cognitive Disability High River, Alberta, Canada 403 652 7928 -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Renee Lowrey Sent: February 21, 2010 5:57 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Evidence? Joan, In the context of his school environment he is able to successfully manipulate all materials. When I completed the assessment (about 45 min of writing activities), he did not appear to fatigue and I even asked him if his hands were tired, to which he responded they were not. He is able to keep up with taking notes in class, and other than some issues with spacing between words, his writing is 100% legible. With these things in mind, I provided the recommendations of modified paper and keyboarding. My job is to assist him in meeting his needs to promote success in his educational setting through acc/mods, not provide 'treatment' to address decreased strength. I also work in a pediatric clinic and often have difficulty separating the two models. The challenge is to provide the appropriate services in each individual setting per regulations and scope of practice. I think sometimes it's hard for parents to understand the difference between the two models. It doesn't help that not all districts provide services in the same way, making it more difficult for parents to understand. Thanks so much for your input!! -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Joan Riches Sent: Friday, February 19, 2010 1:38 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Evidence? Renee What did you suss out regarding the reason that he grips his pen or pencil so hard that his hand gets tired?-or was that your conclusion? In my experience and this is not research evidence or even particularly large handwriting problems can go back to atypical development of the shoulder girdle in infancy so that the child was unable to hold up his hands to explore the movements of his fingers. This can be a result of treatment for congenitally dislocated hips among other things - anything that prevents pushing up from the prone position. By the time the shoulder girdle strengthens there are more interesting things to do than be fascinated with fingers so they remain undifferentiated. I'm sure your recommendations are designed to remedy this. It might help the mother to understand if she thinks back and realizes that this developmental step was skipped for one reason or another and that meaningful activities will be more effective than exercises. How does he do with activities that require him to manipulate very small pieces - Lego model building etc? Joan Riches B.Sc.O.T., OT(C) Specialist in Cognitive Disability High River, Alberta, Canada -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Renee Lowrey Sent: February 19, 2010 5:19 AM To: otlist@otnow.com Subject: [OTlist] Evidence? I am working in a school district where we provide hands-on consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesnt get tired when he writes (Hes in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesnt want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.435 / Virus Database: 271.1.1/2691 - Release
Re: [OTlist] Evidence?
Davis, Actually, keyboarding was one of the accommodations I recommended! Since the student has legible writing and mom was complaining of fatigue, I recommended keyboarding for longer, more intense writing activities. Unfortunately, mom sees accommodations as a way out of her son doing what the other students are doing, which will result in him depending on them. I tried explaining the difference in the educational vs. medical model, but she is determined we provide 'treatment' to address her concerns about hand strengthening. She has requested an outside OT eval, which the district will have to pay for. The principal of the school explained that even if the 'clinic' OT recommends strengthening exercise, does not mean we are obligated to provide them. I guess we'll see what happens. Thanks for your input! -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of David Harraway Sent: Friday, February 19, 2010 7:47 PM To: OTlist@otnow.com Subject: Re: [OTlist] Evidence? Hi, just coming at this from another angle - interested in learning from those therapists who work with school aged population when they might consider it appropriate to recommend to move from a handwriting based means of text production towards primarily keyboard generated text for class and homework? If it's just plain hard slog for a kid to get through the demands of class and school work using pen and pencil; and so much so that their capacity to keep up with peers in terms of literacy and language development; and given that the broader culture is jumping across to work with digital media and the potential efficiency gains to be had by doing so (not needing to double handle hard crafted sentences and paragraphs)it seems that recommending that the student be working smarter might be preferred in setting them up for life/work. Can appreciate that there are potentially all kinds of cultural and logistical constraints in this kind of recommendation; but in my experience when a kid can use a keyboard to produce text at 30 wpm neatly and only12wpm with pencil/ paper, the choice about which way to go is fairly apparent. As always though, it's a lot about the types and blend of tasks the student is doing; and for sure work on handwriting for signatures etc; but for the grunt work, if a keyboard is an possible accommdation; and allows the focus to be redirected away from what is physically demanding to what is really important - learning and language acquisition and the social experiences gained from being with peers, then I say go for it. David Harraway OT working in AT ComTEC cmnahrw...@aol.com wrote: Some conflicing evidence, but from my brief lit review it looks like practice is the major factor. In the second study the intervention was only to meet with the student twice a week for 30 minutes lasting 10 weeks. The intervention consisted of biomechanical, sensorimotor, and teaching learning strategies (practice and feedback?). In the first study provided it states that they compared sensorimotor (strength, coordination, sensory training?) versus practice and the practice intervention was more effective, in fact the sensorimotor group declined in their ability. 1) The effects of sensorimotor-based intervention versus therapeutic practice on improving handwriting performance in 6- to 11-year-old children P. L. Denton, S. Cope and C. Moser (2006) Journal Title: American Journal of Occupational Therapy Volume 60; Issue 1; Pages 16-27 Abstract OBJECTIVE: The aim of this study was to investigate the effects of two interventions (sensorimotor and therapeutic practice) on handwriting and selected sensorimotor components in elementary-age children. METHOD: Thirty-eight children 6 to 11 years of age with handwriting dysfunction but no identified educational need were randomly assigned to one of the two intervention groups or a control group. Intervention groups met four times per week over 5 weeks. Handwriting was measured pre- and postintervention using the Test of Handwriting Skills. Visual perception (motor-reduced), visual-motor integration, proprioception, and in-hand manipulation were also measured. RESULTS: Children receiving therapeutic practice moderately improved handwriting whereas children receiving sensorimotor intervention declined in handwriting performance. The control group did not change significantly. Sensorimotor impairment was noted at pretest in three or four components and selected sensorimotor component function improved with intervention. CONCLUSION: Therapeutic practice was more effective than sensorimotor-based intervention at improving handwriting performance. Children who received sensorimotor intervention improved in some sensorimotor components but also experienced a clinically meaningful decline in handwriting performance. 2) Effect
Re: [OTlist] Evidence?
Sue, Thanks, I will! -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Sue Doyle Sent: Friday, February 19, 2010 7:37 PM To: otlist@otnow.com Subject: Re: [OTlist] Evidence? I would recommend directing this question to Dianne Long at dl...@ithaca.edu. She did an extensive look at consultation programs etc. Sue D From: renee.low...@mmsean.com To: otlist@otnow.com Date: Fri, 19 Feb 2010 06:18:46 -0600 Subject: [OTlist] Evidence? I am working in a school district where we provide hands-on consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesnt get tired when he writes (Hes in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesnt want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Evidence?
I really appreciate your input. I have found a few articles about the effectiveness of the consultation model as well as 'clinic' vs. natural environment. I think the biggest challenge seems to be educating parents on educational model vs. medical model of therapy services. Thanks so much for your input : ) -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Carolyn Sent: Friday, February 19, 2010 2:52 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Evidence? Hello, As the mother of a learning disabled child, although I do not have evidence in writing to support this, I agree with your approach based on my personal experience. My child strongly resents having to leave his classroom to go to the resource room. He has been receiving special ed services since preschool. They miss out on activities in the classroom when pulled out and feel different. I strongly feel the less time they are singled out and pulled out of the class the better off they are. As they get older they don't want to be pulled out even more. What his resource room teacher does (although she is not an OT but I think this method would work) is push in to the classroom to help him and any student that might be struggling. She even helps students who do not have an IEP. Lastly, his speech teacher gives him homework for articulation exercises along with a calendar to check off each day he does it. When he brings it in she gives him rewards. I feel it is a great way for him to take responsibility for his exercises and making him independent. As a parent that is my goal, to make him independent and to be responsible for his work. He will begin middle school next year and the demands for him to be independent and responsible for his work will only increase. Care --- On Fri, 2/19/10, Renee Lowrey renee.low...@mmsean.com wrote: From: Renee Lowrey renee.low...@mmsean.com Subject: [OTlist] Evidence? To: otlist@otnow.com Date: Friday, February 19, 2010, 7:18 AM I am working in a school district where we provide ‘hands-on’ consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesn’t get tired when he writes (He’s in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesn’t want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Evidence?
Chris, Thanks for the info. I found those in my original search, but was hoping there was something out there I hadn't seen yet. Thanks for taking the time!! -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of cmnahrw...@aol.com Sent: Friday, February 19, 2010 6:04 PM To: OTlist@OTnow.com Subject: Re: [OTlist] Evidence? Some conflicing evidence, but from my brief lit review it looks like practice is the major factor. In the second study the intervention was only to meet with the student twice a week for 30 minutes lasting 10 weeks. The intervention consisted of biomechanical, sensorimotor, and teaching learning strategies (practice and feedback?). In the first study provided it states that they compared sensorimotor (strength, coordination, sensory training?) versus practice and the practice intervention was more effective, in fact the sensorimotor group declined in their ability. 1) The effects of sensorimotor-based intervention versus therapeutic practice on improving handwriting performance in 6- to 11-year-old children P. L. Denton, S. Cope and C. Moser (2006) Journal Title: American Journal of Occupational Therapy Volume 60; Issue 1; Pages 16-27 Abstract OBJECTIVE: The aim of this study was to investigate the effects of two interventions (sensorimotor and therapeutic practice) on handwriting and selected sensorimotor components in elementary-age children. METHOD: Thirty-eight children 6 to 11 years of age with handwriting dysfunction but no identified educational need were randomly assigned to one of the two intervention groups or a control group. Intervention groups met four times per week over 5 weeks. Handwriting was measured pre- and postintervention using the Test of Handwriting Skills. Visual perception (motor-reduced), visual-motor integration, proprioception, and in-hand manipulation were also measured. RESULTS: Children receiving therapeutic practice moderately improved handwriting whereas children receiving sensorimotor intervention declined in handwriting performance. The control group did not change significantly. Sensorimotor impairment was noted at pretest in three or four components and selected sensorimotor component function improved with intervention. CONCLUSION: Therapeutic practice was more effective than sensorimotor-based intervention at improving handwriting performance. Children who received sensorimotor intervention improved in some sensorimotor components but also experienced a clinically meaningful decline in handwriting performance. 2) Effect of an occupational intervention on printing in children with economic disadvantages C. Q. Peterson and D. L. Nelson (2003) Journal Title: American Journal of Occupational Therapy Volume 57; Issue 2; Pages 152-60 Abstract OBJECTIVE: The purpose of this study was to evaluate whether an occupational therapy intervention improved an academic outcome (D'Nealian printing) in a school setting. The study specifically examined improvement in printing skills in economically disadvantaged first graders who were at risk academically and socially. The intervention was based on an occupational framework including biomechanical, sensorimotor, and teaching-learning strategies. METHOD: The final sample consisted of 59 first-grade children from a low socioeconomic urban elementary school-based health center who were randomly assigned to an occupational therapy intervention or a control condition. In addition to regular academic instruction, the intervention group received 10 weeks of training twice a week for 30-minute sessions. The control group received only regular academic instruction. Subjects were pretested and posttested on the Minnesota Handwriting Test, which assesses legibility, space, line, si ze, and form (the main variables in this study) as well as speed. RESULTS: Multivariate analysis of variance confirmed that the gain scores in the occupational therapy intervention group were significantly greater than those in the control group. The Hotelling-Lawley Trace value was 0.606, with F(5, 53) = 6.43, p .0001). The estimated effect size (eta2) was .378, with an observed power of .994. Largest gains for the intervention group were in the areas of space, line, and size. CONCLUSION: The intervention group demonstrated a significant increase in scores on the posttest of the Minnesota Handwriting Test when compared to the scores of the control group. Occupational intervention was effective in improving the academic outcome of printing in children who are economically disadvantaged Chris Nahrwold -Original Message- From: Renee Lowrey renee.low...@mmsean.com To: otlist@otnow.com Sent: Fri, Feb 19, 2010 7:18 am Subject: [OTlist] Evidence? I am working in a school district where we provide ‘hands-on’ consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work
Re: [OTlist] Evidence?
instruction. Subjects were pretested and posttested on the Minnesota Handwriting Test, which assesses legibility, space, line, si ze, and form (the main variables in this study) as well as speed. RESULTS: Multivariate analysis of variance confirmed that the gain scores in the occupational therapy intervention group were significantly greater than those in the control group. The Hotelling-Lawley Trace value was 0.606, with F(5, 53) = 6.43, p .0001). The estimated effect size (eta2) was .378, with an observed power of .994. Largest gains for the intervention group were in the areas of space, line, and size. CONCLUSION: The intervention group demonstrated a significant increase in scores on the posttest of the Minnesota Handwriting Test when compared to the scores of the control group. Occupational intervention was effective in improving the academic outcome of printing in children who are economically disadvantaged Chris Nahrwold -Original Message- From: Renee Lowrey renee.low...@mmsean.com To: otlist@otnow.com Sent: Fri, Feb 19, 2010 7:18 am Subject: [OTlist] Evidence? I am working in a school district where we provide ‘hands-on’ consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesn’t get tired when he writes (He’s in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesn’t want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com __ NOD32 4881 (20100219) Information __ This message was checked by NOD32 antivirus system. http://www.eset.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Evidence?
Hi Renee, I work in the schools. I feel your recommendations are appropriate. Strategies for the student to work on in the classroom means that he is receiving intervention everyday instead 1x/weekly. Could you provide details of your findings. There are many reasons besides hand strength that can lead to poor penmanship. In our county FM/poor handwriting is the number one request that leads to an OT referral for assessment. Looking forward to your response. As for research, you might try AOTA website. Talk to you soon. Wayne --- On Fri, 2/19/10, Renee Lowrey renee.low...@mmsean.com wrote: From: Renee Lowrey renee.low...@mmsean.com Subject: [OTlist] Evidence? To: otlist@otnow.com Date: Friday, February 19, 2010, 4:18 AM I am working in a school district where we provide ‘hands-on’ consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesn’t get tired when he writes (He’s in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesn’t want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Evidence?
Renee What did you suss out regarding the reason that he grips his pen or pencil so hard that his hand gets tired?-or was that your conclusion? In my experience and this is not research evidence or even particularly large handwriting problems can go back to atypical development of the shoulder girdle in infancy so that the child was unable to hold up his hands to explore the movements of his fingers. This can be a result of treatment for congenitally dislocated hips among other things - anything that prevents pushing up from the prone position. By the time the shoulder girdle strengthens there are more interesting things to do than be fascinated with fingers so they remain undifferentiated. I'm sure your recommendations are designed to remedy this. It might help the mother to understand if she thinks back and realizes that this developmental step was skipped for one reason or another and that meaningful activities will be more effective than exercises. How does he do with activities that require him to manipulate very small pieces - Lego model building etc? Joan Riches B.Sc.O.T., OT(C) Specialist in Cognitive Disability High River, Alberta, Canada -Original Message- From: otlist-boun...@otnow.com [mailto:otlist-boun...@otnow.com] On Behalf Of Renee Lowrey Sent: February 19, 2010 5:19 AM To: otlist@otnow.com Subject: [OTlist] Evidence? I am working in a school district where we provide hands-on consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesnt get tired when he writes (Hes in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesnt want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.435 / Virus Database: 271.1.1/2691 - Release Date: 02/19/10 07:34:00 No virus found in this outgoing message. Checked by AVG - www.avg.com Version: 8.5.435 / Virus Database: 271.1.1/2691 - Release Date: 02/19/10 07:34:00 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Evidence?
I would recommend directing this question to Dianne Long at dl...@ithaca.edu. She did an extensive look at consultation programs etc. Sue D From: renee.low...@mmsean.com To: otlist@otnow.com Date: Fri, 19 Feb 2010 06:18:46 -0600 Subject: [OTlist] Evidence? I am working in a school district where we provide ‘hands-on’ consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesn’t get tired when he writes (He’s in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesn’t want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
[OTlist] Evidence?
I am working in a school district where we provide hands-on consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied with these recommendations. She wants us to work on hand strengthening (like in the a clinic) setting so his hand doesnt get tired when he writes (Hes in 3rd grade now). No matter how I explain how services are better provided in the context of the classroom and how the acc/mods will allow him to participate in his education, she is not satisfied. She doesnt want him to depend on the acc/mods, which she thinks will result in decreased hand strength and therefore illegible handwriting. Does anyone know of any research regarding the efficacy, or lack thereof, of hand strengthening exercises and improved hand writing; or of the benefits of a consultation model rather than an direct, pull-out model in school systems? Any info will be most appreciated. Thanks, Renée L., OTR/L -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
Re: [OTlist] Evidence?
Some conflicing evidence, but from my brief lit review it looks like practice is the major factor. In the second study the intervention was only to meet with the student twice a week for 30 minutes lasting 10 weeks. The intervention consisted of biomechanical, sensorimotor, and teaching learning strategies (practice and feedback?). In the first study provided it states that they compared sensorimotor (strength, coordination, sensory training?) versus practice and the practice intervention was more effective, in fact the sensorimotor group declined in their ability. 1) The effects of sensorimotor-based intervention versus therapeutic practice on improving handwriting performance in 6- to 11-year-old children P. L. Denton, S. Cope and C. Moser (2006) Journal Title: American Journal of Occupational Therapy Volume 60; Issue 1; Pages 16-27 Abstract OBJECTIVE: The aim of this study was to investigate the effects of two interventions (sensorimotor and therapeutic practice) on handwriting and selected sensorimotor components in elementary-age children. METHOD: Thirty-eight children 6 to 11 years of age with handwriting dysfunction but no identified educational need were randomly assigned to one of the two intervention groups or a control group. Intervention groups met four times per week over 5 weeks. Handwriting was measured pre- and postintervention using the Test of Handwriting Skills. Visual perception (motor-reduced), visual-motor integration, proprioception, and in-hand manipulation were also measured. RESULTS: Children receiving therapeutic practice moderately improved handwriting whereas children receiving sensorimotor intervention declined in handwriting performance. The control group did not change significantly. Sensorimotor impairment was noted at pretest in three or four components and selected sensorimotor component function improved with intervention. CONCLUSION: Therapeutic practice was more effective than sensorimotor-based intervention at improving handwriting performance. Children who received sensorimotor intervention improved in some sensorimotor components but also experienced a clinically meaningful decline in handwriting performance. 2) Effect of an occupational intervention on printing in children with economic disadvantages C. Q. Peterson and D. L. Nelson (2003) Journal Title: American Journal of Occupational Therapy Volume 57; Issue 2; Pages 152-60 Abstract OBJECTIVE: The purpose of this study was to evaluate whether an occupational therapy intervention improved an academic outcome (D'Nealian printing) in a school setting. The study specifically examined improvement in printing skills in economically disadvantaged first graders who were at risk academically and socially. The intervention was based on an occupational framework including biomechanical, sensorimotor, and teaching-learning strategies. METHOD: The final sample consisted of 59 first-grade children from a low socioeconomic urban elementary school-based health center who were randomly assigned to an occupational therapy intervention or a control condition. In addition to regular academic instruction, the intervention group received 10 weeks of training twice a week for 30-minute sessions. The control group received only regular academic instruction. Subjects were pretested and posttested on the Minnesota Handwriting Test, which assesses legibility, space, line, si ze, and form (the main variables in this study) as well as speed. RESULTS: Multivariate analysis of variance confirmed that the gain scores in the occupational therapy intervention group were significantly greater than those in the control group. The Hotelling-Lawley Trace value was 0.606, with F(5, 53) = 6.43, p .0001). The estimated effect size (eta2) was .378, with an observed power of .994. Largest gains for the intervention group were in the areas of space, line, and size. CONCLUSION: The intervention group demonstrated a significant increase in scores on the posttest of the Minnesota Handwriting Test when compared to the scores of the control group. Occupational intervention was effective in improving the academic outcome of printing in children who are economically disadvantaged Chris Nahrwold -Original Message- From: Renee Lowrey renee.low...@mmsean.com To: otlist@otnow.com Sent: Fri, Feb 19, 2010 7:18 am Subject: [OTlist] Evidence? I am working in a school district where we provide ‘hands-on’ consultation. I work with a student to see which intervention strategies (accommodations/modifications) will work best and then education teachers on how to use and follow through with the recommendations. I recently completed an eval on a student for handwriting legibility (per mom). I recommended acc/mods for home school and provided some strengthening activities that could be incorporated into the natural context of his school day. Unfortunately, but mom was not satisfied
