Editorial

Occupational therapy practitioners have been working in the schools for more than 40years. With the passage of PL94-142, occupational therapy practitioners were identified as related service providers and worked to identify how to best apply their skills and expertise in the schools. With the goal to ensure that occupational therapy services were educationally relevant, many practitioners partnered with teachers to address written communication/handwriting since this skill is critical to successful occupational engagement in the schools. However, in some school systems, handwriting is no longer systematically taught. This can be due to challenges such as the lack of a curriculum in a district; the lack of time teachers have to teach handwriting; and poor client factors such as poor shoulder girdle strength, poor trunk stability, and fine motor challenges. Additionally, children are being asked to write at younger and younger ages and the question emerges; are they developmentally ready to meet the handwriting demands they are facing in their school settings?

The Occupational Therapy Practice Framework (AOTA, 2014) helps define areas to address when promoting good handwriting skills, preventing challenges with handwriting and assess/address as part of intervention when supporting handwriting performance (see Table 1). Additionally, the occupational therapy practitioners’ skills in activity analysis can help inform educational teams regarding contextual and environmental factors that may impact handwriting performance in the educational setting. It is clear that the skills and expertise of an occupational therapy practitioner can support not only handwriting remediation/intervention, but the development of appropriate practices (district wide and in the classroom) that support promotion of handwriting skills and the prevention of poor handwriting skills.

Table 1. The occupational therapy practice framework and handwriting.

Client Factor	Example of Relationship to Handwriting
Mental Function	Efficiency in handwriting requires mental functions such as attention, memory, perception, and sequencing in order to learn and remember letter formations as well as develop automaticity in letter formation.
Sensory Function	Visual, vestibular, proprioceptive and touch functions can all impact handwriting performance. Effective handwriting requires a student to be able to
Neuromuscular Function	Joint mobility and stability is needed in order to manipulate a writing utensil and paper.
Muscle Function	Muscle power, tone and endurance all support engagement and production of handwriting.
Movement Function	Handwriting requires good in-hand manipulation and control of voluntary movement
Body Structures	The production of handwriting requires particularly the body structures related to movement.
Performance Skills	Relationship to Handwriting
Motor Skills	Handwriting requires the ability to coordinate motor skills such as aligns, stabilizes, positions, reaches, grips manipulates, moves, flows, endures and paces
Process Skills	Process skills such as paces, attends, heeds, chooses, uses, handles, inquires, initiates, continues, sequences, terminates, gathers, organizes, adjusts and accommodates all support the development and effectiveness during handwriting performance.
Performance Patters	Relationship to Handwriting
Habits	As an individual develops proficiency in handwriting, it is important that letter formation becomes a habit
Routines	The ability to follow a routine to complete written assignments supports engagement in the occupation of education.
Roles	Handwriting is an important part of the role of student for children in schools.

Vander Hart, Fitzpatrick, and Cortesa (2010) reviewed the current literature and identified eight of the most effective, research-based instructional handwriting practices. These included:

1. Frequent/daily lessons: 50 to 100 minutes of handwriting instruction per week with daily practice is optimal.

2. Direct and Explicit Instruction: Specifically teach how to form upper and lowercase letters in a specific order. This includes emphasizing similarities or differences between letters.

3. Modeling: Components of handwriting such as proper pencil grip, paper position and letter formation need to be modeled consistently by all educators.

4. Guided Practice: Students trace, copy and use visual cues to learn how to form letters. Then they produce the letters from memory.

5. Use of Feedback: Feedback (re: letter formation, legibility, etc….) needs to be provided, not only after the student has finished a paper but also during the process of writing.

6. Independent Practice: Students should be given opportunities to self-evaluate their writing and to practice and review handwriting.

7. Integrated Lessons: Handwriting should be taught within the context of a writing assignment.

8. Writing Materials: Have several types of paper and writing utensils available as the student is learning to write.

When reviewing these data, it is clear that a school-based occupational therapy practitioner cannot be the sole teacher of handwriting. Systems need to be developed where the expertise of the occupational therapist can provide promotion and prevention strategies in addition to direct intervention to support the day-to-day handwriting practices within the classroom. Moving from the role of soley providing one-on-one and/or small group handwriting interventions to district wide, systems-based interventions may result in better outcomes for a larger number of students.

It is my hope that as you read the articles in this special issue that you will think carefully about how these data can be applied within the educational setting. How can the skills and expertise of an occupational therapy practitioner best be used to address promotion and prevention strategies? While it is clear that occupational therapy practitioners have skills and the expertise to address occupational performance, in the schools, by supporting a student’s handwriting performance, based on the research on effective handwriting practices, practitioners must work as part of a team in order to implement the best strategies.