• Hannah OT

The Importance of Core Strength and Posture in Handwriting

As an OT I'm often asked about handwriting and two of my current groups are centred around difficulties in this area. My firm belief is that handwriting programmes that focus on practise and hand-eye coordination are ineffective unless a child possesses the gross motor skills to inform their fine motor practise. All of my work with children centres around improving their core strength whilst practising some form of fine motor practise - be that in pre-writing drawing or fun with dough.

In March I had the privilege to be involved in a study by Dr Lyn Haynes (Educationalist) and Helen Terentjev (Osteopath) looking at whether improving core strength through practising an individualised exercise regime would reduce pain experienced while writing. A previous pilot study had been carried out in a secondary setting with promising results. Hearing about Helen's work really rang true to me in my observations of children displaying difficulties with handwriting and I was very keen to learn more about Helen's approach!

Helen, Lyn and I worked with six children across three weeks. All six children were very different in stature, learning needs and character, but one thing they all had in common was that they all lacked core strength and they all experienced some level of pain while writing. The sample was taken from across primary years with two in year 2, one in year 3, one in year 5 and two in year 6. All were boys, and two had a diagnosis of autism, but presented very differently.

It was incredible to see how the boys progressed week on week. The improvements were seen not only in posture and strength, but also in confidence and engagement. It was also great to see how the parents who attended the sessions became more interested and engaged week on week - seemingly to click with the idea when an obvious improvement had been noted.

Two moments that really stood out for me:

The first when one of the boys who always appeared quite anxious and shy lay down on the mat and Helen facilitated him to breath out fully - he began to tear up in relief, as it was clear that this little boy had been holding on to so much tension in his body that this might have been the first time he was ever able to fully relax and listen to what his body was telling him. Over the weeks, he appeared more confident, less anxious and improved in his accuracy of movement and duration of hold for each of the three exercises his was asked to do.

The second moment was when one of the boys who has autism and appears very under aroused was asked to step up onto a wobble board. His eyes lit up and he began to smile! This type of movement is exactly what he needs to stimulate his nervous system to engage in learning. He again improved in his posture and became far more confident - although he still avoids eye contact, his whole body is not twisted away, he now stands correctly and averts only his eyes when he needs to.

The final results have not been observed nor published, but the qualitative difference to me as a therapist is obvious!

I have taken the learning I gathered from Helen into one of the classrooms that I teach in and the results were astounding:

When asked to raise their hand if they experienced any pain while writing, the whole of the year 4 class (30) raised their hand! All kept their hand up for pain after 1.5 pages, and gradually reduced at 1, 0.5 pages and a paragraph. There was still at least 5 left who said they experienced pain after a four sentence paragraph. On speaking with the class teacher, he expressed as much shock as me! What was great is that the class teacher also acknowledged my observations, and Helen's before me, of children for whom the tables were the wrong size and has agreed to do something about this.

So in what took me 15 minutes, could well improve a whole class handwriting and hopefully reduce pain and discomfort! So why do we not ask children if they are experiencing any pain? Why do we assume that children know how to sit when writing? And why is this not a priority in teacher training?

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