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Perceptual-Motor
Function of School-Age
Children With Slow
Handwriting Speed
Mei Hui Tseng, ScD, OTR, is Associate Pro f e s s o r, School of
Occupational T h e r a p y, College of Medicine, National Ta i w a n
Un i ve r s i t y, No. 7, Chung-Shan S. Road, Taipei, Taiwan 10016,
R.O.C.; mhtseng@ha.mc.ntu.edu.tw
Susanna M. K. Chow, BSc, MSc, MA, is Assistant Pro f e s s o r,
De p a rtment of Rehabilitation Sciences, Hong Kong Po l y t e c h n i c
Un i ve r s i t y, Hong Ko n g .
This article was accepted for publication Fe b ru a ry 8, 1999, under the edi -
torship of Elaine Vi s e l t e a r .
Mei Hui Tseng, Susanna M. K. Chow
Key Words: Gross and fine motor skills • psy-
chomotor performance
The American Journal of Occupational Therapy 83
Objectives. This study investigated differences in perceptu-
al-motor measures and sustained attention between chil-
dren with slow and normal handwriting speed and the
relationship between these factors.
Method. Thirty-four slow handwriters and 35 normal
speed handwriters (7 to 11 years of age) attending elemen-
tary schools in Taiwan were given three perceptual-motor
tests and a vigilance task to assess sustained attention.
Performances on these measures were analyzed using multi-
variate analysis of variance and regression analyses.
Results. A significant difference was found between
slow and normal handwriters in upper-limb coordination,
visual memory, spatial relation, form constancy, visual
sequential memory, figure ground, visual-motor integration,
and sustained attention. The three significant predictors of
handwriting speed for the slow handwriters were age, visu-
al sequential memory, and visual-motor integration. For
the normal speed handwriters, age and upper-limb speed
and dexterity were the only two significant predictors.
Conclusions. Slow and normal speed handwriters
responded to handwriting demands through different per-
ceptual-motor systems. Whereas upper-limb speed and dex-
terity seems to play an important role in normal speed
handwriters, slow handwriters seem to rely more on visually
directed processes, including sequence memory and visual-
motor integration.
Tseng, M. H., & Chow, S. M. K. (2000). Pe rceptual-motor func-
tion of school-age children with slow handwriting speed. Am e r i c a n
Jo u rnal of Occupational T h e ra py, 54, 8 3 – 8 8 .
P
roficiency in handwriting is essential if students are
to accomplish an acceptable amount of work in the
c l a s s room and meet the standards of the teacher and
the curriculum. El e m e n t a ry school children typically spend
up to 50% of the school day engaged in paper-and-pencil
tasks (Mc H ale & Cermak, 1992). Many of these tasks,
including most tests and examination papers, are per-
formed under time constraints (Amundson & Weil, 1996).
Un f o rt u n a t e l y, although a traditional instructional ap-
p r oach is sufficient for many children to become compe-
tent handwriters by 6 or 7 years of age, handwriting diffi-
culties are common among children in both regular and
special education classrooms (Bergman & Mc L a u g h - l i n ,
1988). As a result, remediation of handwriting difficulties
is one of the most important areas of school occupational
t h e r a p y.
Handwriting, howe ve r, is a complex skill. It follows that
b e f o r e more systematic ways of teaching children to write
can be developed, the constellation of skills that are neces-
s a ry for efficient writing will need to be better understood.
Competent handwriting depends on the maturation and
integration of cognitive, visual-perceptual, and fine motor
skills (Maeland, 1992; Rubin & Henderson, 1982; Sov i k ,
1975; Tseng & Mu r r a y, 1994; Weil & Amundson, 1994;
Ziviani, Ha y es, & Chant, 1990). Handwriting re q u i re s
finely graded manipulation of pencils to produce letter
forms, in a fluent and ballistical manner, with a specific ori-
entation and size, in a specific serial ord e r, and in specific
positions on a writing surface (van Galen, 1993). Fu rt h e r,
a c c o r ding to Sovik and Arntzen (1991), fluent writing is
p r oduced by an integrated pattern of coordinated move-
ments subject to visual monitoring and sensorimotor feed-
back. In support of this range of re q u i r ements, visual-motor
integration was found to be the best predictor of legibility
for both American and No rwegian children (Sovik, 1975)
and for a group of Chinese school-age children (Tseng &
Mu r r a y, 1994). Vi s u a l - p e rceptual skills, including visual-
spatial perception, visual size discrimination, visual re t r i e va l
and left–right orientation, enable children to distinguish
visually among graphic forms and to judge their corre c t n e s s
( S ovik, 1975; Thomassen & Teulings, 1983). Fine motor
skills are also essential because accurately formed letters can
only be produced by the proper timing and force control of
c o o r dinated arm, hand, and finger movements (Alston &
Ta y l o r, 1987; Thomassen & Teulings, 1983).
Much can also be inferred from the various ways in
which handwriters do not achieve functional competence.
Handwriting can be deficient either in terms of legibility or
in terms of speed. Common handwriting problems such as
i n c o r rect letter formation, poor alignment, re ve r s a l s ,
u n e ven size of letters, irregular spacing between letters and
w o r ds, and slow motor speed (Alston & Ta y l o r, 1987;
Johnson & Carlisle, 1996) do not necessarily arise fro m
identical underlying mechanisms. Most studies to date,
h owe ve r, have focused primarily on the re l a t i o n s h i p
b e t ween illegibility and various visual-perception skills, fine
motor skills, and visual-motor integration (Alston &
Ta y l o r, 1987; Carlson & Cunningham, 1990; Cornhill &
C a s e - S mith, 1996; Johnson & Carlisle, 1996; Ma e l a n d ,
1992; Tseng & Mu r r a y, 1994). Illegible handwriting also
has been investigated in connection with other functional
deficiencies. For example, Levine, Ob e rklaid, and Me l t ze r
(1981) not only found that 72% of 26 children with
“d e v elopmental output failure” (low academic work out-
put) had difficulty with fine motor tasks, they further pos-
tulated that these childre n’s uncoordinated finger move-
ments and diminished pencil control accounted for their
“illegible and/or laborious, hesitant, and slow” (p. 20)
handwriting.
Although slow handwriting speed often affects func-
tional performance because it pre v ents students from meet-
ing the time constraints invo l v ed in schoolwork (Amund-
son & Weil, 1996; Cermak, 1991; Levine et al., 1981;
Ol i ve r, 1990), few investigators have focused on this form
of handwriting deficiency. Previous studies include that of
Berninger and Rutberg (1992), who contended that finger
function is the best predictor of handwriting dysfunction
in that fine motor skill accounted for 52.5% of the va r i a n c e
in handwriting speed. Sovik, Arntzen, and Teulings (1982)
found that poor coordination in the form of poor dissocia-
tion (e.g., exaggerated wrist and thumb movement) was
i n versely correlated with writing speed. Cu r i o u s l y, al-
though Ha n m s t r a - Bletz and Blote (1993) found no re l a-
tionship between slow handwriting and dysgraphia, chil-
d ren with dyslexia we re found to write more slowly than
c h i l d r en without reading disabilities (Ma rt l ew, 1992). T h i s
suggests that visual-perception or cognitive skills might also
affect handwriting speed.
In this article, we attempt to identify more clearly the
factors associated with slow handwriting in the hope that
this may help to elucidate the underlying mechanisms.
Because inadequate attention span also has been clinically
o b s e rved to impair handwriting proficiency (cf. Levine et
al., 1981, who found that 60% of their 26 low - p ro d u c t i v -
ity subjects also had serious difficulty concentrating), a vig-
ilance test was included in the present study. We hypothe-
s i zed that children with slow handwriting would obtain
l ower scores on a series of standard visual-perc e p t i o n ,
m o t o r, visual-motor integration, and attention tests than
did children with normal handwriting speeds.
Method
Participants
Teachers at two elementary schools in the greater Ta i p e i
a r ea nominated 110 children from Grade 2 to Grade 6 to
p a rticipate in the study. On the basis of between 6 and 18
months of classroom observations, the teachers eva l u a t e d
71 children as slow handwriters and the other 39 as having
normal handwriting speed.
To ensure the accuracy of these groupings, the 110
referrals we re each given the Chinese Handwriting Sp e e d
Test (CHAST; Tseng & Hsueh, 1997). In this test, chil-
d r en copy a text in pencil from a previously studied
Chinese textbook, and handwriting speed is expressed as
the number of Chinese characters written per minute.
Incompletely written characters (three or more stro k e s
omitted) are not counted. Characters with added stro k e s
a r e counted. The intraclass correlation coefficient (ICC)
for retest reliability was .98 with a 1-week interval. In this
s t u d y, the ICC for interrater reliability was .95.
Using one standard deviation below the norm as the
cutoff point, the children who scored below the cutoff
point for the CHAST we re assigned to the slow handwriter
g r oup (n = 34), and the children who scored above the cut-
off point we re assigned to the normal speed handwriting
g r oup (n = 35). Children whose teachers’ evaluations of
handwriting speed and CHAST scores we re inconsistent (n
= 41) did not take further part in the study.
All participants had been receiving handwriting
i n s t ruction in Chinese characters since Grade 1 and had
normal intellectual function according to their school
re p o rts. The age and handwriting speed of the two gro u p s
of children are shown in Table 1.
84 January/February 2000, Volume 54, Number 1
Instruments
Four measures, including three perceptual or motor tests
and a vigilance test, we re used in the present study. T h e
Upper Limb Speed and Dexterity (ULSD) subtest of the
Bru i n i n k s - Os e retsky Test of Motor Proficiency (BOT M P ;
Bruininks, 1978) was used to measure fine motor function.
The BOTMP has been standard i zed on children ranging
f r om 4.5 to 14.5 years of age. The ULSD subtest consists
of eight items that invo l ve placing pennies, sorting card s ,
stringing beads, displacing pegs, drawing ve rtical lines, and
making dots. The test–retest reliability of the ULSD sub-
test was .89 for Grade 2 and .86 for Grade 6, with an inter-
val of 7 to 12 days. The test–retest reliability ranged fro m
.86 to .89, and the interrater reliability ranged from .79 to
. 9 7 .
The Test of Vi s u a l - Pe rceptual Sk i l l s — No n - Mo t o r
(TVPS; Ga rd n e r, 1982), which measures nonmotor visual
p e r ception in children ranging from 4 years of age to 12
years, 11 months of age, was selected for the study because
it covers a wide age range and examines various aspects of
visual perception, including discrimination, memory, spa-
tial relationships, form constancy, sequential memory, fig-
u r e ground, and figure closure. It is also re l a t i vely easy to
administer and score. The child is shown the test plates and
is asked to point to the correct response from a series of
choices. The TVPS has satisfactory internal consistency,
with Cro n b a c h’s alpha ranging from .66 (visual discrimina-
tion) to .97 (visual closure ) .
The De velopmental Test of Vi s u a l - Motor In t e g r a t i o n
(VMI; Be e ry, 1989), which consists of 24 geometric forms
to be copied in sequence from a test booklet, was designed
for children ranging from 2 to 15 years of age. The geo-
metric forms become pro g re s s i vely more complex, and the
points for each successive, correctly copied form are added
to the child’s score. Scores continue to accumulate either
until all 24 forms have been copied or until three consecu-
t i ve forms are copied incorre c t l y. The interrater re l i a b i l i t y
ranged from .58 to .99, and the test–retest reliability was
.63 for an interval of 7 months and .92 for an interval of 2
we e k s .
The Vigilance Task of the Go rdon Diagnostic Sy s t e m
( Go r don, 1991) was used to test the part i c i p a n t’s ability to
focus and maintain attention over time and in the absence
of feedback. The task presents a series of digits at a rate of
one per second. The child is told to press the response but-
ton whenever a “9” follows a “1.” For the purpose of this
s t u d y, the number of correct responses was totaled. No r m s
h a ve been established on youngsters without hyperactivity
who are 4 to 16 years of age (n = 1,300). Te s t – retest re l i a-
bility was .68 to .85 with a 3-week interva l .
Procedure
All children we r e tested one at a time in a separate, quiet
room in the child’s own school. The perceptual or motor
tests and the Vigilance Task (Go rdon, 1991) we re adminis-
t e red consecutive l y, with a 3-min break between each.
Testing took approximately 40 min to 50 min for each child.
Data Analysis
Because many of the tests or subtests used in the current study
h a v e not been normed on Chinese children, raw scores we re
used for analysis. A multivariate analysis of variance (MANO-
VA) was performed to compare the scores of the slow and
normal speed handwriting groups using the perceptual or
motor measures and the Vigilance Task, and Pearson pro d u c t -
moment correlation was used to analyze the overall corre l a -
tions. St e pwise re g ression analyses we re performed to identi-
fy the best set of predictors, with handwriting speed entere d
as the dependent variable and the perceptual or motor mea-
s u r es and the Vigilance Task as predictor variables. Be c a u s e
the participants we re drawn from Grade 2 to Grade 6, age
was also entered as a predictor in the re g r ession analyses.
Results
Group Differences
The normal speed handwriting group (n = 35) scored high-
er than the slow handwriting group (n = 34) on all measure s
(see Table 2). MANOVA re vealed a significant differe n c e
b e t w een the two groups on all measures using Wi l k s’s lamb-
da [.59905, F(10, 58) = 3.88193, p < .001]. Except on the
Visual Closure and Visual Discrimination subtests, all of the
u n i v ariate F test values we re significant at the .05 level.
Correlation Among Handwriting Speed, Age, and Test
Results
Tables 3 and 4 present the overall correlation matrixes for the
s l o w and normal speed handwriting groups, re s p e c t i ve l y.
Age, the ULSD, visual memory, and visual sequential mem-
o r y we r e the only four measures that correlated significantly
with handwriting speed for both groups of handwriters.
Regression Analysis
St e pwise re g r ession was used to identify the strongest pre-
The American Journal of Occupational Therapy 85
Table 1
Demographic Data of Slow Handwriters and Normal
Speed Handwriters
Mean Age Mean Writing Speed
Group n (SD) (SD)
Slow handwriting
Grade 2 4 84.8 (3.1) 3.6 (0.4)
Grade 3 8 101.3 (8.6) 4.5 (1.0)
Grade 4 12 109.1 (2.3) 8.9 (1.4)
Grade 5 5 125.4 (4.2) 9.0 (1.7)
Grade 6 5 135.6 (6.2) 9.3 (2.8)
Normal speed handwriting
Grade 2 7 87.4 (3.1) 7.6 (2.4)
Grade 3 9 103.9 (6.6) 13.3 (2.8)
Grade 4 8 113.6 (3.8) 15.2 (2.2)
Grade 5 5 120.4 (4.6) 18.7 (2.8)
Grade 6 6 133.2 (7.1) 22.0 (2.8)
Note. N = 69, where n = 34 for the slow handwriting group and n = 35 for
the normal speed handwriting group.
dictors of handwriting speed for each handwriting gro u p.
Handwriting speed was selected as the criterion va r i a b l e ;
age, the ULSD, the seven visual-perceptual subtests, V M I ,
and the Vigilance Task we re the predictor variables. Gi ve n
the small number of participants (n = 34 in the slow hand-
writing group; n = 35 in the normal speed handwriting
g r oup) re l a t i ve to the number of predictor variables (n =
11), predictors with negligible correlations (r < .20) with
handwriting speed we r e not included in the stepw i s e
re g ression analysis.
For the slow handwriting gro u p, the best predictors of
handwriting speed we re age, which accounted for 42.4%
variance; visual sequential memory, accounting for 13.1%;
and the VMI, accounting for 6.5% [F(3, 30) = 16.2997, p
< .0001]. For the normal speed handwriting gro u p, only
age and the ULSD we re found to be significant pre d i c t o r s .
Age accounted for 64.4% of the variance, and the ULSD
accounted for 9.95% of the variance in handwriting speed
[F(2, 32) = 46.296, p < .0001].
Discussion
In this study, we found that, as a gro u p , the slow handwrit-
ers performed less well than the normal speed handwriters
on all measures (see Table 2). For the visual discrimination
test and the visual closure test, howe ve r, the differe n c e
b e t w een the groups was not significant. Perhaps the famil-
iarity of the written text to participants—it contained char-
acters that the children had already learned—taxed less
heavily the basic visual processing abilities of discrimination
and closure. Task familiarity has been found to significantly
influence handwriting speed (Di xon, Ku rzman, & Fr i e s e n ,
1993). T h e re f o r e, visual discrimination and visual closure
may play a less important role in copying familiar texts.
Poor coordination or inadequate fine motor skills have
often been invoked to explain slow handwriting speeds
( B erninger & Rutberg, 1992; Levine et al., 1981; Lindsey
& Beck, 1984; Sovik & Arntzen, 1991; Sovik et al., 1982).
In this study as well, fine motor skill as measured by the
ULSD was strongly correlated with handwriting speed in
both groups (see Tables 3 and 4). Howe ve r, the re g re s s i o n
analysis showed that fine motor skill was only an import a n t
p r edictor of handwriting speed for the normal speed hand-
writing group and not for the slow handwriting gro u p. T h i s
suggests that two different mechanisms might underlie the
handwriting performance of the two groups, with the slow
handwriters relying more heavily on visual processing, espe-
cially sequential memory and visual-motor integration, and
the normal speed handwriters’ performance more related to
upper-limb coordination.
The fact that visual sequential memory was the second
best predictor for slow handwriters also might suggest that
when intervention is re q u i r ed for slow handwriters, occupa-
tional therapy should be directed tow a rd enhancing the
m e m o ry for visual form and sequence. Although the pre s e n t
study examined Chinese handwriting, the importance of
visual memory is similar to that re p o rted in two studies on
English written language in children with handwriting dif-
ficulties. W h e reas Myklebust (1973) found these childre n
had difficulties in mentally visualizing letters and word s ,
Levine et al. (1981) noted their impairment in memory
re t r i e v al for visual patterns and sequences. Although it is
possible to speculate on the differences between the pro-
cessing of Chinese (a logographic script) and English (an
alphabetic script), Tzeng, Hung, Chen, Wu, and Hsi (1986)
found ove rwhelming support from both a literature re v i ew
and their own neurological studies of patients with brain
damage that there are more similarities than differences in
the processing of the two scripts. Both of the two scripts, for
example, are processed in the left brain hemisphere on the
basis of their phonological characteristics.
The finding that handwriting speed was strongly cor-
related with age for both slow and normal speed handwrit-
ers is consistent with previous studies (Ha n m s t r a - Bletz &
Blote, 1990; Sovik, 1975; Tseng & Hsueh, 1997; Zi v i a n i
& Elkins, 1984). In c r eased handwriting speed follows nat-
urally from the empirically observed fact that coord i n a t e d
handwriting movements improve with age and schooling
( Me u l e n b roek & van Galen, 1986; Sovik, 1993).
The finding that the slow handwriters performed more
86 January/February 2000, Volume 54, Number 1
Table 2
Means, Standard Deviations, and Results of Univariate
FTests on Perceptual-Motor and Vigilance Tests for
Slow and Normal Speed Handwriters
Tests Slow Normal Speed F (1, 67) p
Upper Limb Speed and 26.71 .0001
Dexterity subtest
(Bruininks, 1978)
M 40.5 48.9
SD 6.5 7.0
Visual discrimination 2.11 .151
M 13.7 14.3
SD 1.9 1.2
Visual memory 12.58 .001
M 9.9 12.2
SD 3.1 2.4
Visual spatial relation 10.86 .002
M 13.8 14.9
SD 1.6 1.2
Visual form constancy 11.28 .001
M 9.5 11.8
SD 3.4 2.4
Visual sequential
memory 9.64 .003
M 11.2 13.3
SD 3.2 2.4
Visual figure ground 9.01 .004
M 10.1 12.6
SD 3.7 3.1
Visual closure 0.92 .342
M 10.2 11.0
SD 3.3 4.0
Visual-motor
integration 10.49 .002
M 22.8 29.9
SD 9.1 9.3
Vigilance 7.87 .007
M 38.5 41.8
SD 5.4 4.4
Note. n = 34 for slow handwriters; n = 35 for normal speed handwriters.
poorly in a laboratory measure of attention than the normal
speed handwriters supports clinical observations of a stro n g
relationship between slow handwriting and teachers’ ratings
of inattention. This finding also suggests that a possible com-
ponent of slow handwriting stems from difficulties with
maintaining vigilance under unstimulating conditions.
Helping parents and teachers to promote an optimal aro u s a l
l e v el in order to facilitate attention span deserves occupa-
tional therapists’ serious consideration when working with
c h i l d r en with slow graphomotor output.
Conclusion
This study was not an attempt to examine the re l a t i o n s h i p
of quality or speed to handwriting performance. Qu a l i t y
and speed are important, and both should be addressed as
valid and independent indicators of handwriting perf o r-
mance. This study is perhaps one of the few that examined
s l o w handwriters and found that these children, as a gro u p,
we re poorer than children with normal speed handwriting
in graphomotor output, in level of perceptual-motor skills
and proficiencies, and in attention.
Results of re g ression analyses showed that the slow
handwriting group was not just slower than the normal
speed handwriting group: They we re qualitatively differe n t
in the way they processed written information. The perf o r-
mance of the slow handwriters seemed to heavily depend
on visual processing, whereas that of the normal speed
handwriters was motor based. Findings of this study sug-
gest that intervention for slow handwriters should focus on
facilitating visual processing, including memory and visu-
al-motor integration, rather than the fine motor training so
often emphasized in occupational therapy programs. ▲
Acknowledgments
We thank those participating teachers and children from To n g - m a n
El e m e n t a ry School and Ji-shin El e m e n t a ry School. This study was sup-
p o rted through funding awarded to the first author by the Na t i o n a l
Science Council, NSC 86-2314-B-002-236.
References
Alston, J., & Ta y l o r, J. (1987). Handwriting: T h e o ry, re s e a rch, and
p ra c t i c e . New Yo rk: Croom He l m .
Amundson, S. J., & Weil, M. (1996). Prewriting and handwriting
The American Journal of Occupational Therapy 87
Table 3
Correlation Matrix of Handwriting Speed, Age, Fine Motor Proficiency, Visual-Perceptual Measures,Visual-Motor
Integration, and Vigilance for Slow Handwriters
Variable 1 2 3 4 5 6 7 8 9 10 11 12
1. Speed —
2. Age .65***
a
—
3. Upper Limb .49**
a
.25 —
Speed and
Dexterity subtest
(Bruininks, 1978)
4. Visual –.05 –.10 –.05 —
discrimination
5. Visual memory .48**
a
.28 .04 .01 —
6. Visual spatial relations .25
a
.04 –.08 .57*** .25 —
7. Visual form constancy .18 .17 –.05 .38* .46** .33 —
8. Visual sequential memory .38*
a
.03 .30 .17 .51** .28 .18 —
9. Figure ground –.12 –.20 .09 .43* .25 .32 .61*** .23 —
10. Visual closure .05 .08 –.14 .39* .45** .32 .58*** .35* .45** —
11. Visual-motor integration .29
a
–.02 .18 .09 .31 .37* .19 .12 .26 .32 —
12. Vigilance .31
a
.09 .34 .16 .43* .24 .37* .31 .55** .11 .23 —
Note: n = 34.
a
Variables with r > .2 were tested as predictor variables in the regression analysis.
*p < .05. **p < .01. ***p < .001.
Table 4
Correlation Matrix of Handwriting Speed, Age, Fine Motor Proficiency,Visual-Perceptual Measures,Visual-Motor
Integration, and Vigilance for Normal Speed Handwriters
Variable 1 2 3 4 5 6 7 8 9 10 11 12
1. Speed —
2. Age .80***
a
—
3. Upper Limb Speed .78***
a
.68*** —
and Dexterity subtest
(Bruininks, 1978)
4. Visual .09 .16 .33 —
discrimination
5. Visual memory .53**
a
.37* .60*** .31 —
6. Visual spatial relations .23
a
.19 .01 .08 .15 —
7. Visual form constancy .33
a
.24 .32 .36* .46** .33 —
8. Visual sequential memory .45**
a
.34* .54** .24 .46** .18 .44** —
9. Figure ground .37*
a
.33* .28 .29 .28 .26 .43* .30 —
10. Visual closure .11 .03 .15 .17 .27 .14 .45** .19 .38* —
11. Visual-motor integration .42*
a
.34* .43** .18 .49** .32 .41* .24 .51** .37* —
12. Vigilance .26
a
.16 .36* –.14 .37* –.24 .04 .26 –.01 .30 .17 —
Note: n = 35.
a
Variables with r > .2 were tested as predictor variables in the regression analysis.
*p < .05. **p < .01. ***p < .001.
s k i l l s . In J. Case-Smith, A. S. Allen, & P. N. Pratt (Eds.), Oc c u p a t i o n a l
therapy for children (pp. 524–541). St. Louis, MO: Mo s b y.
Be e r y, K. E. (1989). The De velopmental Test of Vi s u a l - Mo t o r
In t e g ra t i o n ( 3rd ed.). Cleveland, OH: Modern Curriculum Pre s s .
Bergman, K. E., & McLaughlin, T. F. (1988). Remediating hand-
writing difficulties with learning disabled students: A re v i ew. B. C.
Jo u rnal of Special Education, 12, 1 0 1 – 1 2 0 .
Be r n i n g e r, V. W., & Rutberg, J. (1992). Relationship of finger
function to beginning writing: Application to diagnosis of writing dis-
abilities. De velopmental Medicine and Child Ne u ro l o gy, 34, 1 9 8 – 2 1 5
Bruininks, R.H. (1978). Bru i n i n k s - Os e retsky Test of Mo t o r
Pro f i c i e n c y. C i rcle Pines, MN: American Guidance Se rv i c e .
Carlson, K., & Cunningham, J. (1990). Effect of pencil diameter
on the graphomotor skill of preschoolers. Ea rly Childhood Re s e a rc h
Qu a rt e rl y, 5, 279–293.
Cermak, S. (1991). So m a t o s e n s o ry dyspraxia. In A. Fi s h e r, E. A.
Mu r r a y, & A. C. Bundy (Eds.), Se n s o ry integration: T h e o ry and pra c t i c e
( p p . 138-170). Philadelphia: F. A. Da v i s .
Cornhill, H., & Case-Smith, J. (1996). Factors that relate to good
and poor handwriting. American Jo u rnal of Occupational T h e ra py, 50,
7 3 2 – 7 3 9 .
Di x on, R. A., Ku rzman, D., & Friesen, I. C. (1993). Ha n d w r i t i n g
p e rformance in younger and older adults: Age, familiarity, and practice
effects. Ps yc h o l o gy and Aging, 8, 3 6 0 – 3 7 0 .
Ga rd n e r, M. F. (1982). Test of Visual Pe rceptual Sk i l l s . Seattle, WA :
Special Child Pu b l i c a t i o n s .
Go rdon, M. (1991). In s t ruction Manual for the Go r don Diagnostic
Sy s t e m (GDS). Model III-R. De W itt, New Yo rk: Go rdon Systems, In c .
Ha n m s t r a - Bletz, L., & Blote, A. W. (1990). De velopment of hand-
writing in primary school: A longitudinal study. Pe rceptual and Mo t o r
skills, 70, 7 5 9 – 7 7 0 .
Ha n m s t r a - Bletz, L., & Blote, A. W. (1993). A longitudinal study
on dysgraphic handwriting in primary school. Jo u rnal of Learn i n g
Disabilities, 26, 6 8 9 – 6 9 9 .
Johnson, D. J., & Carlisle, J. F. (1996). A study of handwriting in
written stories of normal and learning disabled children. Reading and
Writing, 8, 4 5 – 5 9 .
Levine, M. D., Ob e rklaid, F., & Me l t ze r, L. (1981). De ve l o p m e n -
tal output failure: A study of low productivity in school-aged childre n .
Pediatrics, 67, 1 8 – 2 5 .
L i n d s e y, J. D., & Beck, F. W. (1984). Handwriting and the class-
room experience: A recapitulation. The Po i n t e r, 29, 2 9 – 3 1 .
Maeland, A. F. (1992). Handwriting and perceptual-motor skills in
c l u m s y, dysgraphic, and “n o r m a l” children. Pe rceptual and Motor Sk i l l s ,
7 5 , 1 2 0 7 – 1 2 1 7 .
Ma rt l ew, M. (1992). Handwriting and spelling: Dyslexic childre n’s
abilities compared with children of the same chronological age and
younger children of the same spelling level. British Jo u rnal of
Educational Ps yc h o l o gy, 62, 3 7 5 – 3 9 0 .
Mc Hale, K. & Cermak, S. (1992). Fine motor activities in ele-
m e n t a r y school: Pre l i m i n a ry findings and provisional implications for
c h i l d ren with fine motor problems. American Jo u rnal of Oc c u p a t i o n a l
T h e ra p y, 46, 8 9 8 – 9 0 3 .
Me u l e n b r oek, R. G. J., & van Galen, G. P. (1986). Move m e n t
analysis of re p e t i t i v e writing behaviour of first, second, and third grade
p r i m a ry school children. In H. S. R. Kao, G. P. van Galen, & R.
Hoosain (Eds.), Computer recognition and human production of hand-
w r i t i n g ( p p . 273–286). Si n g a p o re: World Scientific.
Myklebust, H. R. (1973). De velopment and disorders of written lan-
g u a g e , vol 2. Studies of normal and exceptional children. New Yo rk :
Grune and St r a t t o n .
Ol i ve r, C. E. (1990). A sensorimotor program for improving writ-
ing readiness skills in elementary age children. American Jo u rn a l
Occupational T h e ra py, 44, 1 1 1 – 1 1 6 .
Rubin, N., & Henderson, S. E. (1982). Two sides of the same coin:
Variations in teaching methods and failure to learn to write. Sp e c i a l
Education: Fo rw a rd Trends, 9, 1 7 – 2 4 .
Sovik, N. (1975). De velopmental cybernetics of handwriting and
g r aphic behavior. Oslo, No rway: Un i ve r s i t e t s f o r l a g e t .
Sovik, N. (1993). De velopment of childre n’s writing perf o rm a n c e :
Some educational implications. In A. F. Kalve r b o e r, B. Hopkins, & R.
Ge u ze (Eds.), Motor development in early and later childhood:
Longitudinal appro a c h e s ( p p. 229–246). New Yo rk: Cambridge
Un i versity Pre s s .
Sovik, N., & Arntzen, O. (1991). A developmental study of the
relation between the movement patterns in letter combinations (word s )
and writing. In J. Wann, A. M. Wing, & N. Sovik (Eds.). De ve l o p m e n t
of graphic skills: Re s e a r ch perspective and educational implications ( p p .
77–89). New Yo rk: Academic Pre s s .
Sovik, N., Arntzen, O., & Teulings, H. L. (1982). In t e r a c t i o n s
among ove rt process parameters in handwriting motion and re l a t e d
graphic production. Jo u rnal of Human Movement Studies, 8, 1 0 3 – 1 2 2 .
Thomassen, J. W. M., & Teulings, H. M. (1983). The deve l o p -
ment of handwriting. In M. Ma rt l ew (Ed.), The psyc h o l o gy of written
language: developmental and educational perspectives (pp. 179–213). New
Yo rk: Wi l e y.
Tseng, M. H., & Hsueh, I. P. (1997). Pe rformance of school-aged
c h i l d r en on a Chinese Handwriting Speed Test. Occupational T h e ra py
In t e rnational, 4, 2 9 4 – 3 0 3 .
Tzeng, O. J. L, Hung, D. L., Chen, S., Wu, J., & Hsi, M. S.
(1986). Processing Chinese logographs by Chinese brain damaged
patients. In H. S. R. Kao, G. P. van Galen, & R. Hoosain (Ed s . ) ,
Graphonomics: C o n t e m p o ra ry re s e a rch in handwriting ( p p . 357–374).
A m s t e rdam: No rth Ho l l a n d .
Tseng, M. H., & Mu r r a y, E. A. (1994). Di f f e r ences in perc e p t u a l -
motor measures in children with good and poor handwriting.
Occupational T h e ra py Jo u rnal of Re s e a r ch, 14, 1 9 – 3 6 .
van Galen, G. P. (1993). Handwriting: a developmental perspective .
In A. F. Kalve r b o e r, B. Hopkins, & R. Ge u z e (Eds.), Motor deve l o p m e n t
in early and later childhood: Longitudinal appro a c h e s ( p p. 217–228). New
Yo rk: Cambridge Un i versity Pre s s .
Weil, M. J., & Amundson, S. J. C. (1994). Relationship betwe e n
visuomotor and handwriting skills of children in kindergarten. Am e r i c a n
Jo u rnal of Occupational T h e ra py, 48, 9 8 2 – 9 8 8 .
Ziviani, J., & Elkins, J. (1984). An evaluation of handwriting per-
formance. Educational Re v i e w, 36, 2 4 9 – 2 6 1 .
Ziviani, J., Ha yes, A., & Chant, D. (1990). Handwriting: A per-
ceptual motor disturbance in children with mye l o m e n i n g o c e l e .
Occupational T h e ra py Jo u rnal of Re s e a r ch, 10, 12–26.
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