Date Presented 04/20/2023

Because of the utility of the prone position in OT as a handwriting intervention and the lack of data supporting it, data were collected using a pretest–posttest control group design to determine whether lying in prone affects the handwriting legibility of kindergarteners.

Primary Author and Speaker: Magdalene M. Pearl

Additional Authors and Speakers: Julie A. Duckart

This study was conducted to answer the question: ‘Does writing in prone result in more legible handwriting?’ due to the prevalence of the prone position used in occupational therapy as a handwriting intervention and the lack of data supporting it. The quasi-experimental design of the study is due to the nonrandomized nature of the participants. Participants included 43 kindergarteners in 2 classrooms without recommendations for occupational therapy and between the ages of 5-7, divided into an intervention group and control group based on classroom enrollment. The intervention group did at least three handwriting activities in prone a week for three weeks while the control group followed their normal handwriting curriculum. A pre-posttest of each group was performed using the Handwriting Without Tears Screener of Handwriting Proficiency for Kindergartners. Paired t-tests and pre-post difference independent t-tests were performed to compare data. Additionally, an informal interview was conducted with the intervention group instructor for further insight into the attitudes of the students towards activities in prone. Based on the pre-posttest paired t-tests for each group, both groups had a significant improvement in memory, and just the prone group displayed a significant increase in placement, sentence, and total scores. The results of the prone minus control pre-post difference independent t-test showed that the prone group had a significant improvement in placement, sentence, and total scores. Despite the results displaying a positive relationship between writing in prone and legibility, these results cannot be generalized to a larger population based on the studies limitations in its evaluations, intervention, and participant populations. However, this study opens the door for further research into the effects of prone on handwriting as well as other activities and provides data for evidence-based practice using prone positioning as a handwriting intervention.


Chang, S.-H., & Yu, N.-Y. (2013). Handwriting movement analyses comparing first and second graders with normal or dysgraphic characteristics. Research in Developmental Disabilities, 34(9), 2433–2441.

Chung, P. J., Patel, D. R., & Nizami, I. (2020). Disorder of written expression and dysgraphia: definition, diagnosis, and management. Translational pediatrics, 9(Suppl 1), S46–S54.

Parush, S., Lifshitz, N., Yochman, A., & Weintraub, N. (2010). Relationships between handwriting components and underlying perceptual-motor functions among students during copying and dictation tasks. OTJR: Occupation, Participation & Health, 30(1), 39–48.

Learning Without Tears. (2018). Kindergarten Beginning Print Screener Admin Packet. . Retrieved April 7, 2022, from