Fine Motor and Beyond: How To Support Underlying Skills for Writing

When Dina Weiss comes to K-313, she is immediately joined by a group of kindergartners. Though she is there to provide Occupational Therapy for several students, Dina is inclusive in her practice. As such, all have benefited from our time together (including me!).

During writing workshop, children love to experiment with various writing tools that Dina brings. They watch as she draws lines for each word while a child plans a sentence, then they do the same. As Dina models letter formation, writers around her listen closely and model in the air.

When Dina visits at choice time, all want to join in on fun with sensory play or big easel drawings. Dina meets children where they are, often finding creative ways to provide support while they are engaging in meaningful projects.

While not everyone receives Occupational Therapy in my classroom, all children are developing related skills. Rather than isolating tools for specific children (which can be stigmatizing), Dina helped me transform my practice and classroom environment to promote participation of all.

Dina’s willingness to collaborate has made me a better teacher. Now, she has so generously offered to share her expertise with the Two Writing Teachers community. To do so, I asked her to answer the following questions (and pass along some of her favorite tips and tools!).

1. What makes the physical and visual process of writing challenging?
2. Why do students receive Occupational Therapy?
3. How can teachers provide more support during the writing process?

WHAT MAKES THE PHYSICAL AND VISUAL PROCESS OF WRITING CHALLENGING?

Writing involves many skills. You need smooth coordination of the eyes and hands (fine motor and visual-motor skills), visual spatial relations (i.e. directionality of letters and print, letter placement, and organizing work on paper) a functional grasp (pencil control), adequate strength and stamina, and proper body positioning (upright sitting posture).

Letter recognition is essential to be able to form and write letters. A student should master pre-writing skills such as forming shapes with vertical, horizontal, curved and diagonal lines, which are a foundation to forming letters and numbers. For students with fine motor or visual motor delays, the mechanical aspect of writing can be very cumbersome. We try and teach students to form letters from top-to-bottom to improve speed and legibility.

WHY DO STUDENTS RECEIVE OCCUPATIONAL THERAPY?

In Occupational Therapy (OT), we look at ways to improve a student’s overall functioning, so they can be more independent and successfully engage in academic tasks and daily activities. A student may receive OT due to medical reasons, deficits in visual motor integration and fine motor skills, motor planning and sequencing, sensory/self-regulation, bilateral integration/coordination skills (using both sides of the body), and ADL/Self-care skills (i.e. getting dressed, eating).

HOW CAN TEACHERS PROVIDE MORE SUPPORT DURING THE WRITING PROCESS?

In OT, we look at the child holistically from a whole-child perspective. We work to identify and remove barriers to instruction. We analyze and adapt the task, modify the environment, and remediate underlying skills to help a child be successful in their learning.

One of a child’s most important occupations is play, so we try to work on these skills and provide students with a “just right” challenge. By doing so, they feel a sense of accomplishment while building on essential skills.

We always keep in mind Universal Design for Learning (UDL). The American Occupational Therapy Association (AOTA) states:

“School-based occupational therapy practitioners support the general population of all children, with and without disabilities, by identifying and recommending flexible options for teaching and learning activities.”

Modifying the Environment:

• Preferential seating: it can be helpful to move closer to the teacher, easel, or smart board.
• Flexible seating
• Dimming lights
• Playing quiet music
• Noise-reducing headphones
• Accessibility of tools: consider the organization and portability of tools, as well as the physical layout of classroom.

Adapting the Task:

Writing Utensils:

• Miniature-sized writing utensils (i.e. crayons, markers, and pencils) reinforce a digital grasp instead of a fisted grasp.
• Thick crayons, markers, or pencils can promote better grasp patterns and increased stability for children when writing.
• Broken crayons require finger isolation and strengthens fingers, as coloring requires gradation of pressure.
• Dry erase crayons on a white board give resistance and feedback.
• Markers require less pressure for children with strength and stamina delays; however, crayons work to build these skills. Pip Squeaks have the added bonus of being thick and short.
• Pencil grips reinforce a digital grasp.

Paper Modifications:

• Wikki Stix are a versatile multi-sensory tool that can be used for writing purposes. It can serve as a raised line, create visual boundaries for writing and drawing, and help improve visual focus.
• Raised line paper provides tactile feedback and gives additional visual cues when writing.
• Highlighting the line on paper or drawing lines for words offers visual cues.
• Visual boundaries (for pictures and words) helps with organization and writing on page.
• Paper choices offer a variety of line and spacing sizes.

Positioning Support:

• Slant board or slant table: a slanted surface helps to improve writing and grasping patterns by enabling wrist extension. It also improves body positioning by bringing the paper/pencil closer to the child. This also improves visual focus.
• Leaning on stomach on the floor (AKA writing in prone): weight-bearing through the shoulder and elbows helps to isolate wrist and finger movements to improve grasp. This also provides the student with deep pressure sensory input, which helps improve body awareness skills.

Therapeutic Breaks:

• Theraputty is an amazing modality that is so versatile. Students love to find hidden beads inside putty during a “treasure hunt.” Cut putty into pieces for hand strengthening and scissor skills, and roll putty into letters. These activities work on improving hand strength, which is essential for writing.
• Wikki Stix can be used during multi-sensory activities such as forming shapes, letters, and numbers. Wikki Stix require a lot of in-hand manipulation skill, since they can be rolled into tiny balls and then unravelled into straight lines. Wikki Stix also work on fingertip strength and grading of pressure when children adhere them to a surface.

Strengthening and Coordination Activities

These can be offered to all children as choices during soft starts, indoor and outdoor play times, breaks throughout the day, or shared with families for play at home.

• Theraputty
• Wikki Stix
• Peg boards
• Play dough with cookie cutters
• Water beads (letter beads can be hid within for added literacy practice)
• Instant snow, shaving cream or sand: forming letters using a sensory medium is not only fun for a child, but strengthens letter formation skills.
• Go Noodle: full-body movements, incorporating crossing midline, and integrating right and left sides of body are all prerequisite skills to writing. You have to know where your body is in space to be able to write.
• Bubble wrap: Save bubble wrap from packages. It works the tiny little muscles of the hand.
• Legos
• Stringing beads
• Coloring on vertical surfaces, such as an easel or chalkboard: works on proper posture and muscle strength.
• Animal walks and yoga poses: these exercises address core and upper body strength.
• Puzzles

Dina Weiss is an Occupational Therapist for the NYC Department of Education. She graduated from Columbia University’s Programs in Occupational Therapy, receiving a Masters of Science degree in OT. Since 2011, Dina has been working with the pediatric population in school-based settings. She previously worked for Lighthouse Guild, providing OT services to sighted children, as well as students with blindness and visual impairments. She is fortunate to have such a rewarding profession; helping students maximize their potentials, while collaborating with and constantly learning from dedicated and hardworking teachers and staff.