|
Helping children with handwriting difficulties:
Curtis gets to grips with a Dexball
Ann Markee, Senior Community Physiotherapist for Children, Rugby Child
Development Centre, Warwickshire, U.K.
Curtis is just six years old. He lives in the Midlands with his mother,
father and brother. He goes to a local Infant School, has lots of friends and is
often invited round to play or to go to parties. Curtis is a great communicator,
even though his talking is sometimes very difficult to understand.
You see Curtis has Athetoid Cerebral Palsy, affecting his speech as well as
his movement and thus to some extent inhibiting his cognitive development as
well. He has a Statement of Special Educational Needs.
Curtis can't yet walk independently - his postural state and his voluntary
movement are disordered. He looks very wobbly and uncoordinated. He gets around
school using a posture walker, or by crawling where easier. He's good at making
transfers to take up different positions for learning e.g. from stand or with
his posture walker to sitting on a chair, or moving from sitting at a table to
sitting on the floor. He joins in PE, which teachers try very hard to
differentiate to accommodate him. His determination to dress or undress to make
himself ready for this session is remarkable but very hard. However what makes
life extremely problematic for Curtis in the classroom is his difficulty with
manipulation.
Children learn much through using hands in various ways. Visually directed
reaching and conscious control of hands and fingers begins early. Accuracy will
be poor at first but quickly improves until thumb/forefinger opposition is
achieved at around eight to ten months and a child learns object release. Once
this is achieved active manipulation and exploration provide constant practice
and refinement of newly learnt skills. The grasp matures from a crude palmar
grab or scoop to a pincer or dynamic tripod grasp using thumb and first, or
first two fingers. At the same time the child begins to learn about size, weight
and texture of the objects handled. He also learns about using tools and
controlling the force, which are spatial and temporal requirements for any
activity. Finally he learns about fixing one part of the body so that another
may move efficiently e.g. shoulder girdle and/or trunk stability will enable
precision distally of elbow, wrist, hand and fingers. Thus the child eventually
learns the skills for drawing and writing, to control the force of the fingers
on the pencil and its pressure on the paper to make marks within confined
spatial limits.
Hands are used in a vast range of everyday activities. In some tasks one hand
has a primary function, the other a supportive role (e.g. writing with one hand,
the other holding the paper), in others hands co-ordinate by performing two
separate aspects of the same task (e.g. tying shoe laces). In reaching for,
grasping and using tools for example, the whole upper limb and trunk may be
involved and where fine manipulation is required, the object is moved within the
hand itself. Such organisation and co-ordination of finger and hand movement
depends on sensory reception and perception of visual, tactile, proprioceptive
and kinaesthetic feedback, informing motor planning and execution. It is a
combination of power and precision, the ability to pick up and retain and to
handle with skill.
For a child like Curtis who has problems with postural fixation and with
motor execution, manipulative skills are very hard to learn. All new tasks may
need to be attempted first at an earlier developmental level, presented in
exciting ways, which will hold his concentration and allow enough practise to
achieve success.
One of the most important skills that children need in school is recording
their thoughts and ideas (usually handwriting). For Curtis, who already has
difficulty speaking, acquisition of this skill has added significance. He may
find handwriting an impossible task to learn (and may eventually have to rely in
one way or another on I.T.) but he is determined to have a go at mastering the
necessary skills.
Handwriting is a complex perceptual motor skill resulting in the manipulation
of a writing implement to make marks on paper. It also requires the visual
perceptual recognition of shapes and the ability to reproduce them and recognise
them as meaningful. It is also therefore a cognitive skill in that it has rules
which need to be taught and understood i.e. words (in English) are written left
to right, capital and small letters are used differently.
Curtis has problems learning to write for several reasons:
- His sitting balance is not always secure so his stability needs to be
checked as regards chair suitability, table height etc. A delicate balance
has to be struck, however, because he wants to be the same as everyone else.
- When he's attempting to use his hands, Curtis manages in various inventive
ways to fix shoulder girdle or wrist so as to get maximum control. His
hand/wrist and finger control are not yet efficient enough to hold a pencil
or crayon firmly or to make consistently recognisable marks or letter
shapes.
- He has taken longer than some children of his age to recognise letter
shapes.
As indicated earlier, the control of wrist and fingers essential for
manipulation of a writing implement is preceded developmentally by control of
the area as a whole, that is shoulder girdle ? elbow ? wrist? fingers. Imagine a
young child's first efforts at painting and drawing - brush or crayon held
firmly in the whole hand - big movement of the whole arm up, down, round and
round. Curtis draws or tries to write most easily like this.
He fixes the paper with his right forearm (taking weight through his right
shoulder and elbow) using his left to hold the pencil. Ordinary pencils and even
very fat crayons are quite difficult for him to manage.
Recently we came across the Dexball, which uses "a unique method to hold
a pen, pencil or spoon in position. A new and innovative product for all those
who have a gripping problem".
It is in fact a ball made of high density foam (two sizes available) and a
special fixture to take the implement - spoon or pencil) to be held with a whole
hand grasp (rather than a more specialised one involving fingers). It slides
easily on the paper so that the whole arm can make the movement for drawing or
writing. For Curtis this was a breakthrough and he immediately had much greater
control - he was delighted. I'm sure Curtis would want me to say "Thank
you" to Insight Medical Products.
Prices:
Small Dexball (60mm diameter) £6.50
Large Dexball (80mm diameter) £6.00
Pen holder for Dexball £1.50
For further information contact "Wayne" at:
Insight Medical Products
Units 1-4 Silk Mill Studios
2 Charton Road
Tetbury, Gloucestershire, U.K.
Tel: 01666 500055
Email: info@insightmedical.net
Insightmedical
Curtis initially used his right arm both to fix the paper and facilitate
movement of the Dexball in his left hand.
Curtis was encouraged to use his left hand independently.
Curtis then managed to use his left hand independently to control the pencil
Back to Top | 
