Occupational Therapy IWK & AVH
Deskwork - Proper Positioning
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A strong and steady trunk provides the base
of support needed for successful fine motor
tasks
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Important to focus on the activity, not focus
on staying upright
Positioning - The Perfect Fit
 Proper Chair Size
 feet flat on floor
 ankles, knees and hips at 90 degrees
 make sure chair is not too deep
 back should be supported
 two fingers’ space between back of knee and seat
Positioning - The Perfect Fit
 Proper Chair Position
 should be able to sit back comfortably and bend slightly
forward at the waist
 the arm should be at least at a 30 degree angle from the
trunk
 Proper Desk Size
 height of the top of the desk or table should be about 2”
above the height of the elbow
The Perfect Fit
Sitting at the Desk:
Tips and Tricks…
 It is often a challenge to provide optimal desk position
for each student in the classroom
 If feet don’t reach the ground
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use stool, container, phone book,
block of wood, Jettstep
 If chair is too deep/ too wide
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add phone book/ cushion/
foam to back of chair, smaller chair
add foam/ cushion to sides if too wide
 If child slides in seat
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Anti-slip material
Seating Trend .....
 Many students will need to adjust their positioning or
have the ability to move during the school day
 Allow students to stand at their desks
 Dynamic seating options: Hokki stool, Move N’ Sit
cushion, disco disc etc.
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“Writing refers to the expression of ideas and information for the
purposes of communicating. Handwriting on the other hand, refers
to the fine-motor skill of writing letters in order to communicate
those ideas and information.”
Not being able to form letters easily constrains writing
Students need to work on handwriting as a foundation before they
can be expected to concentrate on the message they are writing.
When student is not struggling with letter formation, he/she is freer
to write fluently
Department of Education, English Language Arts Primary-3, April 2013
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Practice 20 minutes, three to five times
week is recommended.
Printing practice should be done as a
separate activity. Focusing only on learning
to print.
Structured teaching will help prevent or
correct bad habits.
Printing Like a Pro, Sunny Hill Centre for Children Therapy Department, 2013
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“ However ten minutes several days of week
devoted to teaching handwriting is justifiable
and necessary, especially in the lower
grades.”
◦ Department of Education: Handwriting P-3 ELA
document April 2013
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Discussion…….
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The development of grasping skills starts at
birth
Grasping skills are important building
blocks for more refined manipulation
Experiencing grasping activities helps to
develop these skills
Grasping is necessary for functional skills
such as crayon use, feeding self and playing
with toys
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Poor muscle development
Poor attention
Limited exposure to fine motor activities
Lack of interest in coloring activities
Not teaching early hand development
skills….lack of awareness of their
importance
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Being able to hold a crayon correctly is a readiness
skill for handwriting
Teach pencil grasp to your students. When children
are young, it is worthwhile encouraging an efficient
type of grasp.
Pencil Grip Song
Pencil Grasp…..
 Adapting it when needed i.e. provide a pencil grip
(eg. Cross Over, CLAW, Grotto)
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Research has shown that having a good
pencil grasp does not ensure legible
handwriting; nor does having a poor pencil
grasp doom one to illegible handwriting.
There are other factors that may contribute
to a student having difficulty with
handwriting other than pencil grasp…
Developmental progression of skills….
A child would learn to:
 Trace
 Imitate
 Copy
 Draw
Prewriting Lines and Shapes
Horizontal Line (2 years)
Vertical Line (2 years)
Circle (3 years)
Cross (4 years)
Right diagonal (4-5 yrs)
Square (4.6 yrs)
Left diagonal (4-5 yrs)
Triangle (5.3 years)
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l
o
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Please keep these milestones in mind when you are teaching primary
students how to print. Expectations need to match their development.
Readiness for Formal
Writing Instruction
 Hand dominance
 Knowledge of simple size and shape concepts (big
line/little line, big curve/little curve)
 Ability to hold a crayon with fingers place correctly (for
their age)
 Satisfactory level of attention, cognitive skills and
cooperation
 Imitation of a vertical line, horizontal line, circle and cross
Olsen, Jan Z. & Knapton, Emily. Handwriting
Without Tears Pre-K Teachers’s Guide (2008)
Cabin John MD, Handwriting Without Tears
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Line development
Print letters easily and automatically
Work on simple words
At first do not worry about staying on the lines
As you see improvements, focus on proper positioning on
the lines and consistent letter sizing
Progress to having student to print entire sentences
Encourage student to focus on spacing between letters and
within words
Proper use of punctuation
Tips and Tricks
 Follow the developmental sequence of tracing,
imitation and copying
 Don’t forget to practice lines and shapes
(drawing/art/multi-sensory) in addition to
handwriting
 Be sure to supervise your student to ensure they follow
the correct steps and not just end up with a good end
product e.g. start your letter a the top , proper letter
formation
Tips and Tricks …
 Continue to teach letter formation to your primary
classroom but be aware that your 4 year old
students may need extra attention to handwriting
later in the year
 Use a multi-sensory handwriting approach
 Practice handwriting or cutting with an object
held in palm by ring and baby finger (stabilization
of the hand)
Teaching Strategies for
Handwriting
Step One:
 Modeling: Show the student a few times how to form
each letter using a chalkboard or white board. Include
numbered arrows that show correct letter formation as
this provides a good visual cue. Having a letter strip with
arrows showing letter formation on the student’s desk is
also suggested for classroom work times.
Step Two
 Self-Talk: Encourage repetitive talking out loud of
directions of proper letter formation, i.e., self-talk
of direction of movement (e.g., “i= down , lift,
dot”). Verbally model the self-talk and prompt the
student to talk out loud, repeating the same set of
directions each time. Using the same self-talk
phrase each time is important for best learning.
Step Three
 Self Evaluation: It is important for the student to
look at their work to see how closely their letter
formation matches the target letter. Selfevaluation can also be in the form of circling their
best-formed letters. Discuss with the student why
they chose those letters.
 Use “Check Your Work” cards to remind students
of self evaluation
Step Four
 Practice: Use a wide variety of writing tools. In
addition to using a pencil for practicing, have the
child write with chalk on a chalkboard or with felt
markers on a white board.
Handwriting Expectations in Each Grade Level
(© N. Pollock, J. Lockhart, B. Blowes, K. Semple, M. Webster, L. Farhat, J.
Jacobson, J. Bradley & S. Brunetti, 2009})
Primary
􀂉Correct letter formation
􀂉 minimal eraser marks or smudging
􀂉Smooth lines
􀂉Consistent pressure i.e. markings are not too light or too dark
Grade 1
􀂉 Consistent spacing between letters and words
􀂉Consistent size of letters
Grades 2/3
􀂉 Correct letter placement e.g. hanging letters, such as “g”
hang below baseline
􀂉Appropriate orientation to baseline
􀂉Appropriate use of margins
􀂉Good organization on page
do
Grades 4/5/6
􀂉 Text clear and easy to read
􀂉 Precise letter formation e.g. good closure and finish of
strokes
􀂉Regular spacing between letters and words
􀂉No crowding
(© N. Pollock, J. Lockhart, B. Blowes, K. Semple, M. Webster, L.
Farhat, J. Jacobson, J. Bradley & S. Brunetti, 2009})
Tips and Tricks…
 Do not use upper case letters when teaching
children to recognize or write their name
 Emphasize starting all letters at the top to
discourage bad habits that are difficult to change
later
 If a child has not chosen a hand dominance,
always be careful to place the crayon/marker at
midline
 Use broken crayons to promote pincer grasp
 Avoid dot-to-dot when working on letters, use
yellow marker instead
Technology
Despite the dramatic rise in available technology for
students to produce written work, printing remains
an essential functional skill to express thoughts,
ideas and knowledge in the classroom and beyond.
Never completely give up on handwriting because it
is a life skills. There are many times in your life that
you need to handwrite (writing your signature, filling
out a job application, or completing a questionnaire).
However, technology certainly plays an important
role for the success of many students.
Why Keyboard ?
 When students have mechanical and organizational
writing difficulties, keyboarding may be their primary
means of written communication expression
 Keyboarding is becoming a life skill, research indicates
it should be taught in 3rd or 4th grade
Advantages of Keyboarding
 Less distal finger control
 improved legibility
 improved accuracy
 improved efficiency
 easier to correct typing and spelling errors
 improves word finding abilities
 less hesitant to reevaluate and edit written work
 improved quality and productivity
Disadvantages of Keyboarding
 More difficult in certain environments
 Computers not always available in classroom
 child may not be familiar with keyboard
arrangement, therefore keyboarding may decrease
speed
 children may become frustrated and composition
may become affected
Consider technology when…
 Legibility is poor at a grade 3 to 4 level- can
sometimes start earlier
 A student’s handwriting begins to hold them back
 A student is resistant to handwriting
 Poor organization within writing
Tips and tricks…
 Ensure students that need technology have
opportunities to become familiar with the
keyboard and its functions
 Engagement in meaningful keyboarding activities
is the best way to learn keyboarding; young people
learn to keyboard through doing activities such as
writing stories, playing computer games, doing
schoolwork and writing letters or emails. (NilesCampbell, Tam, Mays &Skidmore)
 What grade do you start……
Ergonomic Considerations
 Proper positioning
 Eye gaze should be at top third of monitor
 Wrist should be in a neutral position
 Consider finger isolation
 Desk, mouse, keyboard, chair and monitor
considerations
 The tips of the thumb and middle finger are in the
holes of the handles of the scissors. The index finger is
on the outside of the handle to stabilize the scissors,
and the ring and little finger are curled into the palm.
The wrist of the cutting hand should be bent up
(Benbow, 1991).
 Thumbs up!!
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Poor scissor grasp
Switches hands or uses two hands
Scissors in palm instead of in fingers
Scissors on joint
Jagged cutting
Tears paper instead of cuts
Poor control of opening and closing scissors
Paper and scissors rest on desk throughout the
cutting task
Child has difficulty controlling paper and scissors
at the same time
Child doesn’t know where to start first cut
Child cuts without ever turning paper
thumb down
Tips & Tricks to Support Thumbs Up
•Playing card games, especially being the dealer
•Hole punch
•Squirt bottle for watering plants
•Snapping fingers
•Games with small pieces to manipulate (Tricky Fingers or
Tiddlywinks)
•Turning a key in a lock or on a wind-up toy
• Put a sticker on student’s thumb, they always need to see
the sticker when cutting
on joint
Tips & Tricks that Support
Finger Control For Holding
Scissors
•Eye droppers
•Tongs
•Clothes pins
•Pennies in bank
•Pegs
•Unifix cubes
•Opening bottles, jars
•Tweezer games
Two hands
fingers splayed
Tips & Tricks for
Stabilization of the Hand
•Ring and Little Finger Anchors: Curl the ring and little
finger into the palm by holding a small object against the
palm (e.g. pom-pom, play-doh ball, marble…) while cutting
•Play other games or pick up objects with thumb, index and
middle finger with the ring and little finger against their palm.
• For example, place coins in slots or play connect four, cube
twirl etc.
•This activity can be practiced at other times during the
school day such as snack time.
Or this?
Tips & Tricks
•Thumbs up for
both Encourage
tucking elbows
hands
•against body
•Pull chair away
from table during
cutting activity
Tips & Tricks
•Keeps scissors pointed
forward and rotates paper
with helping hand when
turning corners or curves
•Takes smaller snips (i.e,
when turning corners)
Child cuts without ever letting go of the
paper. Notice that both hands are at the
right of midline.
Right-handed: cut in a
counter-clockwise direction
around shape.
Left-handed: cut in a
clockwise direction around
shape.
Child cannot figure
out how to get
scissors to the shape.
Tips & Tricks
• This may indicate poor motor planning
• Provide specific instruction on how to approach and execute cutting
task
• Provide increased opportunities with specific instruction
• If the child is unable to figure out how to get to the shape with the
scissors, the child can draw a line to the shape from the edge of the
paper
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Child demonstrates interest in scissors
Child experiments with opening and closing scissors, not
necessarily cutting paper(hand position may vary)
Child orients scissor blades to paper to begin snipping
(hands do not rest on table)
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Child gains more finger control with the scissors
positioned toward fingertips
Child begins to cut in a forward motion across a 4-inch
strip of paper without adjusting holding hand
Progression for developing control of scissors
Part 3
• Child uses one hand to adjust paper while
the other hand controls the scissors, cutting
across an 8-inch wide piece of paper
• Move holding hand forward as the scissors
pass
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Child cuts forward on a line
Child cuts turning corner(s)
◦ Cutting past the shape/line to the edge of the paper before
rotating object (Note: We don’t teach this, they just do it…
however, we will sometimes structure a project this way to teach
those that can’t break down the steps for organizing the sequence
on their own.)
◦ Rotate object (the paper, not the scissors) to cut around the
corner
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Child cuts out straight-line shapes (square, triangle)
Child cuts out curved-line shapes (circle, oval)
Child cuts out simple shapes (heart, moon)
Child cuts out complex shapes (star, hand)
Notice that the two hands must shift between the tasks of moving and holding.
For example, one hand holds while the other opens and closes the scissors
blades, then the scissors hand must hold while the holding hand shifts position
on the paper.
 Klein, Marsha, Pre-Scissor Skills, Therapy Skill Builders,
1987
 Knight and Gilpin Decker, Hands at Work and Play, Therapy
Skill Builders, 1994 (activities only)
Web pages
 http://www.neelb.org.uk/cass/earlyyears/downloads/Developing
Scissor Skills.pdf
Questions?