On the development of a computer-based handwriting assessment tool to objectively quantify handwriting proficiency in children.

Standardized writing assessments such as the Minnesota Handwriting Assessment (MHA) can inform interventions for handwriting difficulties, which are prevalent among school-aged children. However, these tests usually involve the laborious task of subjectively rating the legibility of the written product, precluding their practical use in some clinical and educational settings. This study describes a portable computer-based handwriting assessment tool to objectively measure MHA quality scores and to detect handwriting difficulties in children. Several measures are proposed based on spatial, temporal, and grip force measurements obtained from a custom-built handwriting instrument. Thirty-five first and second grade students participated in the study, nine of whom exhibited handwriting difficulties. Students performed the MHA test and were subjectively scored based on speed and handwriting quality using five primitives: legibility, form, alignment, size, and space. Several spatial parameters are shown to correlate significantly (p<0.001) with subjective scores obtained for alignment, size, space, and form. Grip force and temporal measures, in turn, serve as useful indicators of handwriting legibility and speed, respectively. Using only size and space parameters, promising discrimination between proficient and non-proficient handwriting can be achieved.

Evaluation of an occupational therapy mentorship program: effects on therapists' skills and family-centered behavior.

There is growing interest in understanding the usefulness of mentorship programs for children's rehabilitation service providers. This evaluation study examined the effects of an occupational therapy mentorship program on the skills and behaviors of 8 new and 17 experienced occupational therapists practicing at a regional children's rehabilitation center. Self- and peer-report measures of family-centered behavior, critical thinking ability, listening/interactive communication skill, and clinical behavior were collected before and after an 11-month facilitated, collaborative group mentorship intervention. Significant pre-post changes associated with intervention were found on 9 of 12 outcome measures, including information provision, respectful treatment, self-confidence, and listening and clinical skill. Changes were not found on the more trait-like variables of open-mindedness, interpersonal sensitivity, and interpersonal skill. Experienced therapists had higher scores than new therapists on most variables, including family-centered behavior, listening skill, and clinical skill. Implications regarding the utility of mentorship programs in children's rehabilitation centers are discussed.

Grip force variability and its effects on children's handwriting legibility, form, and strokes.

A comprehensive understanding of the underlying biomechanical processes during handwriting is needed to accurately guide clinical interventions. To date, quantitative measurement of such biomechanical processes has largely excluded measurements of the forces exerted radially on the barrel of the writing utensil (grip forces) and how they vary over time during a handwriting task. An instrumented writing utensil was deployed for a direct measurement of kinematic and temporal information during a writing task, as well as forces exerted on the writing surface and on the barrel of the pen. The writing utensil was used by a cohort of 35 students (19 males), 16 in first grade and 19 in second grade, as they performed the Minnesota Handwriting Assessment (MHA) test. Quantitative grip force variability measures were computed and tested as correlates of handwriting legibility, form, and strokes. Grip force variability was shown to correlate strongly with handwriting quality, in particular for students classified by the MHA as nonproficient writers. More specifically, static grip force patterns were shown to result in poor handwriting quality and in greater variation in handwriting stroke durations. Grip force variability throughout the writing task was shown to be significantly lower for nonproficient writers (t-test, p<0.01) while the number of strokes and per-stroke durations were shown to be higher (p<0.03). The results suggest that grip force dynamics play a key role in determining handwriting quality and stroke characteristics. In particular, students with writing difficulties exhibited more static grip force patterns, lower legibility and form scores, as well as increased variation in stroke durations. These findings shed light on the underlying processes of handwriting and grip force modulation and may help to improve intervention planning.

Perceptions of writing and communication aid use among children with a physical disability.

Children with physical disabilities (CPD) often experience decreased opportunities to participate in daily occupations. Occupational therapists (OTs) prescribe writing and communication aids; however, little is known about this population's perceptions of the technology. This qualitative study explored the perceptions that CPD had regarding their writing and communication aids. Children were interviewed; a focus group of one parent and two OTs provided context to the children's comments. Enablers and barriers to using communication aids were found. Participants reported a greater sense of pride, more self-confidence, and a greater sense of autonomy and productivity with the technology. Analysis of the interviews, focus group, and reflective notes resulted in a model showing how enablers and barriers of on-screen technology usage relates to occupational enhancement or occupational detriment. This study contributes to an understanding of the meaning that CPD associate with writing technology and the factors associated with usage.

Evaluating the benefits of displaying word prediction lists on a personal digital assistant at the keyboard level.

Visual-cognitive loads influence the effectiveness of word prediction technology. Adjusting parameters of word prediction programs can lessen visual-cognitive loads. This study evaluated the benefits of WordQ word prediction software for users' performance when the prediction window was moved to a personal digital assistant (PDA) device placed at the keyboard level. Twenty-one young people aged 11-14 (11 new users and 10 experienced users) participated in the study. The Canadian Occupational Performance Measure was used to measure users' self-ratings of performance and satisfaction. Results of two-tailed paired t-tests reveal significantly (p < .05) higher performance and satisfaction ratings when the word prediction list was displayed on the PDA. Users reported that it was easier to look for the words at the keyboard level and to select words directly from the PDA. Visual comparisons of the users' typing speed and accuracy show that experienced users had faster typing rates and new users appeared to have better accuracy when they typed with WordQon the PDA display. Further studies with larger samples of individuals with different diagnoses and ages are required to confirm the benefit of using a PDA display in enhancing typing rate and accuracy.

Rater reliability of the adapted scoring criteria of the Minnesota Handwriting Assessment for children with cerebral palsy.

BACKGROUND/AIM: Current handwriting assessment tools are standardised mostly on typically developing students. This study estimated the intrarater and interrater reliabilities of the adapted scoring criteria, titled the Minnesota Handwriting Assessment-Cerebral Palsy (MHA-CP), for evaluating the effectiveness of handwriting interventions for children with cerebral palsy. METHODS: We scored two batches of 20 random samples each from 80 handwriting samples produced by 30 children with cerebral palsy using the MHA-CP to estimate the intrarater and interrater reliabilities, respectively. RESULTS: Intraclass correlation coefficients exceeded 0.95 for both intrarater and interrater reliabilities for all quality subscales of the MHA-CP. CONCLUSIONS: The MHA-CP is shown to be a reliable measure of the manuscript handwriting performance of children with cerebral palsy who are in Grades 1 and 2. Further empirical testing is recommended to confirm its validity as an outcome measure for this population.

Developing a support group for families with children with disabilities in a Canadian Chinese church community.

This article presents an overview of the difficulties families face when raising a child with disability. With language barriers and limited support, immigrant families have difficulties in locating necessary resources for their children. The experience of a support group for parents with children with disabilities in a Canadian Chinese immigrant church is reported and discussed.

Movement-to-music computer technology: a developmental play experience for children with severe physical disabilities.

Children with severe physical disabilities often lack the physical skills to explore their environment independently, and to play with toys or musical instruments. The movement-to-music (MTM) system is an affordable computer system that allows children with limited movements to play and create music. The present study explored parents' experiences of using the MTM system with their children. A qualitative methodology employing in-depth interview techniques was used with six mothers and their children. The themes extracted from the data were organized under two main concepts of the International Classification of Functioning, Disability, and Health (ICF) (WHO, 2001) framework. The results showed that the MTM expanded horizons for the child along the ICF health dimensions and the MTM had a positive impact on ICF environmental determinants of health. The small sample size should be noted as a limitation of this study. Further research should be carried out with a larger sample of children with restricted mobility to obtain a better understanding of the impact of MTM technology on children's psychosocial development.

A novel instrument for quantifying grip activity during handwriting.

OBJECTIVE: To describe and exemplify a noninvasive instrumentation system that uniquely records grip forces exerted on the barrel of the writing utensil along with typical temporal and kinematic parameters. DESIGN: Exploratory case series. SETTING: A tertiary care, pediatric rehabilitation hospital. PARTICIPANTS: Convenience sample of 6 primary school children with spastic hemiplegic cerebral palsy (CP) with documented fine motor difficulties and 6 children with no known handwriting difficulties. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Grip and normal forces during handwriting. RESULTS: The instrumentation revealed nontrivial correlations between normal and grip forces (0.55 +/- 0.16), a temporal delay between normal and grip forces (97.7 +/- 16 ms), and a consistent grip-to-normal force ratio (4.3 +/- 1.5), across all participants. Grip force distributions agreed intuitively with qualitative observations of individual grasps of the writing utensil. Further, 5 new parameters derived from grip force measures statistically differentiated between able-bodied children and those with hemiplegic CP. CONCLUSIONS: The proposed instrumentation provides new insight into grip and normal force coordination and has the potential to uncover discriminatory grip force characteristics between writers with and without handwriting difficulties. Further study with larger populations is required to define functional ranges for the new grip measures.

Measuring the outcomes of word cueing technology.

BACKGROUND: Measurement of assistive technology outcomes is complex because many factors (e.g., environment and model of service delivery) influence the successful use of the technology. PURPOSE: Using the example of measuring the outcomes of word cueing technology, this paper presents an approach for measuring assistive technology outcomes. METHOD: The Canadian Occupational Performance Measure (COPM) was administered to 29 children with physical and learning disabilities, between the ages of 3.9 and 19 years. Participants were provided with WordQ, a software program designed to assist the development of writing skills. Follow-up data were collected through telephone interviews. RESULTS: The COPM findings supported the effectiveness of WordQ Version 1 to enhance written productivity, with a mean performance change score of 3.5 (SD = 1.5). The COPM was an effective tool for measuring clients' perceived outcome of word cueing technology. Telephone interview was considered a successful method for collecting outcome data. PRACTICE IMPLICATIONS: A mix of tools and methodologies should be used to gain a comprehensive understanding of the impact of assistive technology.

Perceived benefits of word prediction intervention on written productivity in children with spina bifida and hydrocephalus.

Word prediction has been commonly used as a tool to enhance written productivity. However, the effectiveness of word prediction as a strategy to meet this targeted outcome has not been established. Using a single-subject alternating treatments design, this study evaluated the effect of word prediction on written productivity from the users' perspectives. Three girls and one boy aged 10-12 with spina bifida and hydrocephalus participated in the study over a period of 20 days. The Canadian Occupational Performance Measure (COPM) was used to measure changes in perception of written productivity. Analysis of individual participant data showed that participants perceived word prediction to have the potential to influence written productivity on some writing tasks. Quantitative analysis using a randomization test did not reveal any significant changes in COPM scores after using word prediction. The varied abilities of the participants in the study and the small sample size may be the reasons why statistical analysis did not show any changes. The limitations of this study included use of a copy task, lack of a supporting measure to COPM and limited generalizability. Further studies with a larger sample are necessary to explore the skills required for successful use of word prediction and the impact of word prediction on specific tasks.