| Author: | Cheang, Pang |
| Title: | The effectiveness of a sensory-motor intervention program for Chinese primary students with handwriting difficulties |
| Advisors: | Chien, Will (RS) |
| Degree: | DHSc |
| Year: | 2024 |
| Subject: | Penmanship, Chinese Children -- Writing Occupational therapy for children Sensorimotor integration Hong Kong Polytechnic University -- Dissertations |
| Department: | Faculty of Health and Social Sciences |
| Pages: | xviii, 117 pages : color illustrations |
| Language: | English |
| Abstract: | Introduction. Handwriting is a crucial component as a fundamental aspect of academic performance and serves as a prominent indicator of any students’ academic success within the educational system. Handwriting difficulties (HWD) refer to specific learning disabilities in the production of written language. Approximately 10-30% of school-age students experienced different types of HWD. Within the context of Chinese language and culture, Chinese is a logographic language which is composed of different characters, wherein each character is formulated by one or several radicals, and each radical is the combination of one or more strokes. Previous research has indicated that a significant portion of students in Macau may exhibit difficulties with their Chinese handwriting. Students with Chinese HWD may have poor academic performance, particularly when they attempt tests or examinations that require fast and accurate Chinese handwriting. Therefore, it is crucial to identify students who struggle with Chinese HWD particularly during Primary One and Primary Two when they are still in the early stages of learning and development. Appropriate intervention, support and training can be subsequently provided to them to enhance their Chinese handwriting abilities. In occupational therapy, the interventions with children who have handwriting difficulties are often based on the connection between sensorimotor foundation components and handwriting performance. That is, if children with HWD improved their sensorimotor skills, their performance in English and Chinese handwriting would be improved accordingly. Sensorimotor interventions involve combining sensory input and motor activities to facilitate the development of targeted handwriting motor skills. These approaches consider various sensorimotor components, including visual perception, kinesthesia, in-hand manipulation, and visual-motor integration. By incorporating elements of play, games, and targeted exercises, sensorimotor interventions may enhance students’ sensorimotor ability leading to improvement in Chinese handwriting performance. For example, Li-Tsang and her colleagues (2023) achieved positive results with the group-based sensorimotor intervention for P2 to P3 students with Chinese HWD in Hong Kong, and the participants showed improvements in writing speed, air time, ground time, total time, time per character and size. While Hong Kong and Macau share similarities in their education systems and language, it is important to note that the effectiveness of an intervention can vary across different context factors such as individual student ability and character, educational policies, culture and resources may differ between the two regions. In the context of this study, the P1 students were selected for the training as early screening and intervention is believed to facilitate their learning of handwriting. Early identification and intervention during the first year of primary school are emphasised as crucial. By identifying and addressing any potential handwriting difficulties at this early stage, it becomes possible to prevent the development of persistent challenges and promote the acquisition of proper writing skills from the beginning. Therefore, conducting further studies, specifically in the Macau school context, is needed to determine the effectiveness of implementing group-based sensorimotor intervention for Macau P1 to P2 students. Objectives. The aim of this study is to explore the effectiveness of a sensorimotor-based intervention program using a group format in improving Chinese handwriting performance in P1 and P2 students with borderline Chinese HWD. Three objectives are targeted to be investigated, including: First, to assess the efficacy of the sensorimotor-based programme in improving Chinese handwriting performance among P1 and P2 students with borderline Chinese HWD. Secondly, to investigate the sensorimotor skills in students with borderline Chinese HWD after attending the training programme. Thirdly, to investigate the parent perception toward the sensorimotor-based programme for borderline Chinese HWD students. Methods. A total of eighteen P1 and P2 students who use Chinese as their primary written and spoken languages participated in this study. These children were referred by teachers and were assessed through the Smart Handwriting Assessment and Recognition Platform (SHARP) system. Those students with handwriting speed between minus one to two standard deviations (SD) from the mean or the written errors that were between one to two SD from the mean when compared to normative data in the SHARP were selected to join the training group. The sensorimotor assessments, including the Test of Visual Perceptual Skills – 4th edition (TVPS-4), The Bruininks-Oseretsky Tests of Motor Proficiency, 2nd Edition (BOT-2) and Developmental Eye Movement test (DEM), were also conducted before and after the intervention programme. This study utilised a randomised, single-blind clinical study design, where the assessors were blind to the training group allocation. The participants were randomly divided into two groups, which is Immediate Sensorimotor-based intervention Group (ISMG, n=9) and Delayed Sensorimotor-based intervention Group (DSMG, n=9). A ten session group-based sensorimotor intervention was implemented, each lasting for 60 minutes. In phase one, the ISMG received the sensorimotor intervention during the designated sessions, while the DSMG did not receive any intervention at the time and served as the delayed sensorimotor group. In phase two, the intervention conditions were reversed, that is, the DSMG received the sensorimotor intervention, while the ISMG did not receive any intervention during the phase. Additionally, the participants were divided into the intervention group and control group, the intervention group (n=18) combined the ISMG Testing Session one (TS1) to Testing Session two (TS2) and DSMG Testing Session three (TS3) to TS2, and the control group (n=9) consisting of the DSMG in TS1 to TS2. In each session, a registered Occupational Therapist (OT) worked with one or two research assistants to organise the intervention for students. The intervention programme integrated key sensorimotor components: kinesthetic perception, fine motor, ocular motor, visual perception, and visual motor integration activities. To enhance students’ motivation and engagement in the intervention activities, the programme was designed around four different themes: Transportation, Food, Animals, and Sport, through play and games. These themes were carefully chosen to create an engaging and stimulating environment for the students during the sensorimotor intervention sessions. For data analysis, IBM SPSS 26 (SPSS Inc., Chicago, USA) was employed. Difference between the ISMG and DSMG in terms of demographic variables and baseline assessments were compared using t test. An analysis of variance (ANOVA) with repeated measures, specifically a 2 (groups) x 3 (assessment sessions) design, was performed on SHARP measure. To compare the pretest-posttest differences in SHARP, TVPS-4, BOT-2 and DEM within the ISMG and DSMG before and after the intervention, a paired t-test was used. Additionally, to compare the scores of SHARP, TVPS-4, BOT-2 and DEM between the intervention group and control group, as well as the parent feedback form between the ISMG and DSMG, an independent t-test was employed. Results. No significant differences in the baseline assessments of SHARP process, SHARP product, TVPS-4, BOT-2 and DEM between the ISMG and DSMG were found. The standard deviation (SD) pen pressure (P = 0.024) revealed a main effect of the test sessions, and there were significant differences across the different test sessions. The results of this study showed that a main effect of the test sessions on the writing speed (P = 0.003), AG ratio (P = 0.026), out grid (P < 0.05), standard deviation (SD) pen pressure (P = 0.024), missing stroke percentage (P = 0.017) and reversed stroke percentage (P = 0.009). Additionally, a group x test session interaction was observed, for only the SD pen pressure (P = 0.03). Students demonstrated improvement in the writing speed and AG ratio from pre-training to post-training and could sustain the improvement after one month of the training. The pre-post intervention had a significant effect on the writing speed (P = 0.036), total time (P = 0.019), air time (P = 0.02) and SD time per character (P = 0.027) in the SHARP; Visual Discrimination (VD) scaled score (P = 0.022) and Visual Memory (VM) scaled score (P = 0.014) in the TVPS-4; as well as the Upper Limb Coordination (ULC) scaled score (P = 0.047) and Motor Coordination (MC) scaled score (P = 0.033) in the BOT-2. The comparison between the control group (n = 8) and the intervention group (n = 18) showed significant difference in the writing speed (P = 0.022), total time (P = 0.015), air time (P = 0.048), wrong sequence percentage (P = 0.045), and additional stroke percentage (P = 0.025) in the SHARP, and adjusted horizontal time (P = 0.01) in the Developmental Eye Movement test (DEM). Furthermore, parents of the participants had a good perception of their children’s handwriting problems (mean score: 2.88 out of 4.00) and would recommend the SHARP assessment and intervention program to the school and other students. In comparison between the P1 students’ class ranking and academic results, there was a significant improvement in Chinese subjects (P = 0.04). Discussion. This study revealed three findings related to the Chinese handwriting process. First, we found SD pen pressure revealed a main effect, and a group x test session interaction. This finding indicates that a more consistent and controlled application of pressure on the pen during writing may lead to smoother and more uniform writing strokes. Second, we found that the children in the DSMG group demonstrated developmental progress in the writing speed and A/G ratio. It is possible that the parents started to pay closer attention to their children’s handwriting performance before the intervention commenced. Third, when comparing the intervention and control groups in the present study, the mean difference in the writing speed, total time and air time revealed a significant difference, with the control group exhibiting a higher mean difference than the intervention group. This suggests that the control group wrote at a faster speed and took less time in total and air time compared to the intervention group, it is possible that students in the intervention group may have exhibited neater handwriting following the intervention. They also demonstrated significant improvement in wrong stroke sequence and additional strokes. This improvement in the SHARP handwriting product may have contributed to a decrease in the writing speed and an increase in total time and air time during the writing tasks. This study also revealed three findings related to Chinese handwriting product in SHARP. First, higher out of grid problems were present after the intervention for both groups, and this might be attributed to the fact that the students were not as attentive during the second assessment compared to the first SHARP assessment. Although abstract problems do not directly impact students’ academic achievement, this problem should still be considered as important for P1 to P2 students because tidiness and neatness play a crucial role in this early learning stage of handwriting. Second, the intervention had a positive impact on the students’ ability to accurately write strokes in stroke sequence during handwriting. Sequencing is an important component of handwriting as it refers to the proper order and arrangement of strokes required to form characters. This improvement suggests that the sensorimotor-based intervention programme may provide opportunities for students to practise organising and executing the appropriate sequence of steps in the therapeutic activities, further transferring to the improved sequence of the strokes for each word or character. Third, it was observed that there was a trend for decrease in the percentage of wrong strokes, missing strokes and concatenated strokes in the post-test. It is important to acknowledge that the small sample size may have affected the results. The statistical power of the analysis may have been reduced and had been less able to detect significant changes between the groups. This study also revealed two findings related to children’s improvements in sensorimotor skills. From the start, the students demonstrated improvements in sensorimotor areas, including visual perception skills, eye movement and motor coordination. These findings suggest the relevance and effectiveness of sensorimotor training for improvement of handwriting performance. Additionally, the present study findings indicate that students in the intervention group demonstrated better performance in improving adjusted horizontal time in the DEM compared to the control group. This may imply that eye movement skills facilitate the development of the handwriting process and potentially lead to improvements in handwriting performance. Conclusion. This study found that the group-based sensorimotor intervention improved the handwriting performance of students with Chinese HWD in both the handwriting and sensorimotor aspects. In terms of handwriting, the intervention led to significant improvements on the writing speed, total time, air time and SD time per character. Regarding sensorimotor abilities, the intervention was found to enhance students’ visual perception and motor coordination skills. Parents expressed satisfaction with the identification and subsequent intervention provided to their children. This study provides implications for professionals to involve caregivers in the intervention of students with Chinese HWD. Occupational Therapists can incorporate sensorimotor interventions in their practice and utilise the strategies and activities outlined in the study to address the difficulties in the areas of specific sensorimotor components and, in turn, to enhance Chinese handwriting skills. Parents can also be informed about the intervention methods used in the study, allowing them to provide additional support and practice opportunities at home. |
| Rights: | All rights reserved |
| Access: | restricted access |
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