Loosing hand dominancy after injury or a medical condition is a daunting task after years of developing manipulative skills of one’s preferred hand. A recent assessment of a vocational rehabilitation client in her late twenties who sustained a spinal stroke identified the need for compensatory tools and interventions to overcome barriers due to loss of her preferred hand. With continuing education the vocational goal to retrain her in a profession compatible with her mobility impairment, identifying compensatory tools as well as interventions to support use of her non-dominant hand was required. As a student, producing written communication to support coursework were among the goals identified by the client. In the area of written communication, efficient production of word-processed information as well as hand writing notes were identified client goals.
While several high-tech tools were identified to support access to the computer and written production, handwriting was also a concern for this client. While electronic tools for note taking are readily available, experience with assessing post-secondary students continues to find handwriting the most typical and familiar method of notetaking for students. A survey of students enrolled in Information Science post-secondary program found only 37% used electronic note taking (Fox, 2005) with 63% used hand writing when note taking. In the study, the use of electronic note taking further reduced when drawing figures or numbers were required during note taking (diagramming, math, chemistry, etc.) (Fox, 2005). Identifying compensatory methods of word processing were important for this client as well as low tech tools and interventions for re-training handwriting with her non-dominant hand.
Handwriting for Heroes, a systematic program to learn to write with your non-dominant hand, is a method of instruction for adults who need to “re-learn how to handwrite for individuals sustaining injury and loss of skills in their dominant hand. Written by experienced VA Occupational Therapists working with adults who sustained injuries to their dominant hand, the series of 6 weeks of graded lessons provides practice in development of in hand manipulation skills, visual motor and handwriting practice. Within the sequence of lessons, mindful exercises and positive affirmation embedded in the functional handwriting lessons are also provided to the user. In its 3rd, edition, this user manual provides daily guided practice to regain both cursive and manuscript handwriting skills in the six-week lesson format. For this client being assessed, Handwriting for Heroes seemed to be a great resource given the high interest in learning to handwrite with her non-dominant hand.
Purchase of the Handwriting for Heroes 3rd Edition manual allowed a more thorough review of the program. Over view of the program showed a well-developed manual offering six weeks of lessons and activities with the following writing and fine motor components:
- Warm-ups (visual motor warm-ups)
- Practice writing a sequence of single and series of letters
- Range control, stretches (translation)
- Writing and copying words and sentences with increasing neatness
- Tracing word/letter formation within lines or pathways
- Dot to dot, coloring within lines
- Application of skills to functional tasks (writing lists, personal information, within blanks for sizing, money management tasks, recipes, e.g.)
- Mindful activities
Lessons are functional, varied and progress with repeated practice throughout the program. Tips for therapists are also provided including posture, grasp patterns, lighting, and other positioning suggestions.
Adaptive equipment recommendations, like what pediatric therapists use for handwriting instruction, positioning and tool use are also provided:
- Slant boards for writing
- Clip boards
- Adaptive pens or grips
The Handwriting for Heroes website offers several resources related to their program:
- Handwriting for Heroes Slide Presentation
- One Handed Videos
- Adaptive Grips – EZ Grips
- EZ Grip ResQ gel pen
In addition to the recommended pens identified by the OT’s of Handwriting for Heroes program above, experience with evaluating vocational rehabilitation clients with mobility impairment (arthritis, reduced strength, pain, neurological disorders, Ehlers Danlos, e.g.) have found the following preferred adaptive pens/pencils and grips for handwriting tasks:
The Handwriting for Heroes 3rd Edition program is a well-organized manual providing sequential lessons for individuals interested in retraining handwriting with their non-dominant hand. The program offers lessons in the physical task involved in retraining as well as emotional guidance. The authors of Handwriting for Heroes also offer additional support when using the program including low tech equipment, positioning and intervention strategies. The Handwriting for Heroes website offers additional information on their program.
Regarding the vocational rehabilitation client assessed, she was motivated to use this program to learn to write with her non-dominant hand. After trial of different pens that would aid writing with decreased strength of her non-dominant hand, she chose the Super Big Fat Pens for Arthritis, a frequent low tech writing choice of clients I service with upper extremity strength and pain challenges.
H/T to the Occupational Therapist authors who dedicated their time in creating and publishing Handwriting for Heroes, offering a valuable resource to our OT Tool Kit.
More for your OT Tool Kit!
Carol – OT’s with Apps and Technology
Fox, J. (2005, November). A Survey of Electronic Note-Taking Behavior in Information and Library Science . Chapel Hill, NC, USA.