[OTlist] Evidence?

2010-02-19 Thread Renee Lowrey
I am working in a school district where we provide ‘hands-on’ consultation.
I work with a student to see which intervention strategies
(accommodations/modifications) will work best and then education teachers on
how to use and follow through with the recommendations.  I recently
completed an eval on a student for handwriting legibility (per mom).  I
recommended acc/mods for home  school and provided some strengthening
activities that could be incorporated into the natural context of his school
day.  Unfortunately, but mom was not satisfied with these recommendations.
She wants us to work on hand strengthening (like in the a clinic) setting so
his hand doesn’t get tired when he writes (He’s in 3rd grade now).  No
matter how I explain how services are better provided in the context of the
classroom and how the acc/mods will allow him to participate in his
education, she is not satisfied.  She doesn’t want him to depend on the
acc/mods, which she thinks will result in decreased hand strength and
therefore illegible handwriting.  Does anyone know of any research regarding
the efficacy, or lack thereof, of hand strengthening exercises and improved
hand writing; or of the benefits of a consultation model rather than an
direct, pull-out model in school systems?  Any info will be most
appreciated.

 

Thanks,

 

Renée L., OTR/L

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[OTlist] Hand strengthening

2010-02-19 Thread Beverly Elkins
Renee,    
    The child may benefit from some hand strengthening through functional task 
(play). I haven't worked with peds for some time now. Given this child's age 
would strengthening be appropriate? 
It sounds as though positioning for postural support/stability would be the 
most appropriate/effective in this case. How is handwriting during your 
sessions with the child utilizing your accommodations/modifications? If it is 
effective, what better outcome study could a parent hope for? Also, how is 
the child's attention to task during handwriting activity and in general 
overall? Another thought, how is his vision? I'm interested in what you 
determine.
Beverly Elkins, OTR/L

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Re: [OTlist] Evidence?

2010-02-19 Thread cmnahrwold
Some conflicing evidence, but from my brief lit review it looks like 
practice is the major factor.  In the second study the intervention was 
only to meet with the student twice a week for 30 minutes lasting 10 
weeks. The intervention consisted of biomechanical, sensorimotor, and 
teaching learning strategies (practice and feedback?).  In the first 
study provided it states that they compared sensorimotor (strength, 
coordination, sensory training?) versus practice and the practice 
intervention was more effective, in fact the sensorimotor group 
declined in their ability.


1) The effects of sensorimotor-based intervention versus therapeutic 
practice on improving handwriting performance in 6- to 11-year-old 
children

P. L. Denton, S. Cope and C. Moser (2006)

Journal Title: American Journal of Occupational Therapy
Volume 60; Issue 1; Pages 16-27

Abstract
OBJECTIVE: The aim of this study was to investigate the effects of two 
interventions (sensorimotor and therapeutic practice) on handwriting 
and selected sensorimotor components in elementary-age children. 
METHOD: Thirty-eight children 6 to 11 years of age with handwriting 
dysfunction but no identified educational need were randomly assigned 
to one of the two intervention groups or a control group. Intervention 
groups met four times per week over 5 weeks. Handwriting was measured 
pre- and postintervention using the Test of Handwriting Skills. Visual 
perception (motor-reduced), visual-motor integration, proprioception, 
and in-hand manipulation were also measured. RESULTS: Children 
receiving therapeutic practice moderately improved handwriting whereas 
children receiving sensorimotor intervention declined in handwriting 
performance. The control group did not change significantly. 
Sensorimotor impairment was noted at pretest in three or four 
components and selected sensorimotor component function improved with 
intervention. CONCLUSION: Therapeutic practice was more effective than 
sensorimotor-based intervention at improving handwriting performance. 
Children who received sensorimotor intervention improved in some 
sensorimotor components but also experienced a clinically meaningful 
decline in handwriting performance.


2) Effect of an occupational intervention on printing in children with 
economic disadvantages

C. Q. Peterson and D. L. Nelson (2003)

Journal Title: American Journal of Occupational Therapy
Volume 57; Issue 2; Pages 152-60

Abstract
OBJECTIVE: The purpose of this study was to evaluate whether an 
occupational therapy intervention improved an academic outcome 
(D'Nealian printing) in a school setting. The study specifically 
examined improvement in printing skills in economically disadvantaged 
first graders who were at risk academically and socially. The 
intervention was based on an occupational framework including 
biomechanical, sensorimotor, and teaching-learning strategies. METHOD: 
The final sample consisted of 59 first-grade children from a low 
socioeconomic urban elementary school-based health center who were 
randomly assigned to an occupational therapy intervention or a control 
condition. In addition to regular academic instruction, the 
intervention group received 10 weeks of training twice a week for 
30-minute sessions. The control group received only regular academic 
instruction. Subjects were pretested and posttested on the Minnesota 
Handwriting Test, which assesses legibility, space, line, si ze, and 
form (the main variables in this study) as well as speed. RESULTS: 
Multivariate analysis of variance confirmed that the gain scores in the 
occupational therapy intervention group were significantly greater than 
those in the control group. The Hotelling-Lawley Trace value was 0.606, 
with F(5, 53) = 6.43, p  .0001). The estimated effect size (eta2) was 
.378, with an observed power of .994. Largest gains for the 
intervention group were in the areas of space, line, and size. 
CONCLUSION: The intervention group demonstrated a significant increase 
in scores on the posttest of the Minnesota Handwriting Test when 
compared to the scores of the control group. Occupational intervention 
was effective in improving the academic outcome of printing in children 
who are economically disadvantaged


Chris Nahrwold

-Original Message-
From: Renee Lowrey renee.low...@mmsean.com
To: otlist@otnow.com
Sent: Fri, Feb 19, 2010 7:18 am
Subject: [OTlist] Evidence?

I am working in a school district where we provide ‘hands-on’ 
consultation.

I work with a student to see which intervention strategies
(accommodations/modifications) will work best and then education 
teachers on

how to use and follow through with the recommendations.  I recently
completed an eval on a student for handwriting legibility (per mom).  I
recommended acc/mods for home  school and provided some strengthening
activities that could be incorporated into the natural context of his 
school
day.  Unfortunately, but mom was not satisfied with