Occupational therapy intervention to address handwriting deficit in elementary-aged school children: How to, how much, and how often? A scoping review

Handwriting is a key occupation for school-aged children and one of the common reasons for referral to a school-based occupational therapist. There are many interventions offered by school-based occupational therapists and this scoping review aimed to examine specific intervention approaches and compare their mode of service delivery (i.e., direct and/or indirect), recommended dosage (i.e., frequency and duration), embedded theoretical frameworks, and identify if the intervention caused statistically significant changes in a child's handwriting ability. Eight (8) studies were reviewed (seven Level III; one Level V) identified through a comprehensive database search. Of the eight studies that met the inclusion criteria, five were curriculum-based programs, all of which incorporated task-specific motor learning approaches and showed statistically significant improvement in handwriting (both direct and indirect OT involvement). Two studies reviewed devices (iPad and weighted pencil) and one study did not involve performing handwriting during treatment sessions. The studies reviewing the use of devices and the study where task-specific handwriting was not completed in treatment sessions did not demonstrate statistically significant benefit on improving a child's handwriting ability. Curriculum-based interventions that have an embedded motor learning practice component, with either direct or indirect involvement from occupational therapy, may have a positive impact on a student's handwriting ability; however, more rigorous studies need to be completed. The use of devices (i.e., iPad & weighted pencils) to improve handwriting is not currently supported in the literature.