Date Presented 04/22/2023

Handwriting development is a major area of concern for many school-age children and is a primary intervention area for OT practitioners. As we continue to navigate the effects of the COVID-19 pandemic, creative approaches to service provision continue to be in demand. In particular, telehealth service provisions by OT practitioners continue to expand. This mixed-methods study describes the effectiveness of a community-based telehealth camp to improve handwriting legibility in school-age children (ages 5–9 years).

Primary Author and Speaker: Lauren Stone Kelly

Contributing Authors: Abigail Wright

Handwriting development is a major area of concern for many school-aged children & is a primary intervention area for OTPs. As we continue to navigate the effects of the COVID-19 pandemic, creative approaches to service provision are in demand, particularly in the area of telehealth services. This study aims to build on current evidence to support ongoing use of & to expand access to OT telehealth services with pediatric populations. This mixed-methods pre-experimental study describes the effectiveness of community-based telehealth camps on handwriting legibility in school-aged children (ages 5-9 years). Recruitment & participation in camps occurred in two phases: 1) summer 2021 & 2) spring 2022. Participants were recruited in the Chicagoland area through word-of-mouth & electronic flyers. Once registered for the camp, they were invited to join the study, though participation was not required to receive camp services. There were no geographic, socioeconomic, gender, or needs based inclusion criteria for participation in the camp & participation was on a first-come, first-serve basis. The camp was provided free-of-charge with all materials provided by institutional funding. In total, 25 of 27 registered children attended the camps . Of those, 20 consented to participate. Children participated in a 6-week 6-session camp led by an OTR with 9 years of clinical pediatric experience with handwriting certification through the Handwriting Without Tears® (HWT) program. Camp activities utilized HWT workbooks & manipulatives & was supported by undergraduate & graduate students trained in research ethics & use of the curriculum by the camp lead. A pretest-posttest pre-experimental design was used to evaluate the effectiveness of the camp on handwriting legibility. The Print Tool® was used to assess handwriting legibility at pre- & post-test, & a draw-a-person task was also administered to further assess motor control & perceptual skills. An anonymous parent survey was also sent at the conclusion of the camp to gather parent perceptions of the camp & its effectiveness. For scoring of non-survey data, forms were de-identified & blindly scored by a licensed OTR with over a decade of pediatric clinical experience & handwriting certification. This OTR had no other involvement in camp & was blinded to all demographics & pre- or post- test status at the time of scoring. Preliminary data from phase 1 showed significant changes in some areas. Significant improvements were observed in capital orientation, lowercase letter memory, & overall number of lowercase letters attempted, as well as higher scores for gross detail on the draw-a-person task (p < 0.05). Results trending towards significant (p <0.1) include total number of capital letters attempted & clothing detail, proportion & profile scores on the draw-a-person test. Parental survey results indicated overall positive perception of the camp (8.29/10 rating). Most parents reported some improvement (7/10 rating) with the most reported improvements being line placement, sizing, spacing, & overall legibility. This research report will also include pending results from phase 2 of the study. Based on preliminary findings, a telehealth group model of handwriting intervention is beneficial to some children. Phase 2 data is expected to support current findings & further bolster support for this model of handwriting intervention. While more research is warranted, this study supports evidence-informed practice of school, community & clinic based pediatric OTPs in utilizing telehealth group models to provide handwriting intervention to children in rural or isolated communities or who are homebound due to pandemic or similar societal restrictions that may occur in the future.


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