The effect of kinesthetic training on handwriting performance in children with kinesthetic impairment

Objective
To investigate whether children who received kinesthetic training would show significant improvements in kinesthesis and handwriting, and whether any improvement in both areas would be significantly greater than those of the children who received either handwriting practice or no treatment.

Design: Randomized-blinded clinical trials

Setting: Regular school in the community

Participants: A convenience sample of 45 grade one children with a mean age of 6.9 years, who had the following characteristics: kinesthetic impairment as indicated by the Kinesthetic Sensitivity test (KST) with scores at or below the 25th centile, demonstrated handwriting difficulties in the classroom setting as indicated by their teachers, functional vision and hearing, normal muscle tone, full range of motion of upper extremities, and appropriate attention span.
Materials and Methods
The participants were randomly assigned to either the Kinesthetic Training (KT) group, the Handwriting Practice (HP) group, or the No Treatment (NT) group. They were evaluated at pre-test and post-test for kinesthesis, handwriting legibility, and writing time. Handwriting legibility was evaluated again four weeks after treatment. All evaluations were performed by evaluators blind to the experimental method.
Intervention: Children in the KT group received kinesthetic acuity, kinesthetic perception, and memory training; children in the HP group received handwriting practice with equal time and attention as those in the KT group; and children in the NT group did not receive any intervention. Training was given in 30-minute daily session for six consecutive school days or, if not possible due to absences or school closures, within 2 weeks.
Measurements and Main Results: Kinesthesis was measured by the KST. Handwriting legibility was measured by the Evaluation of Children's Handwriting (ETCH) and Teacher's questionnaire. Writing time was measured by stop watch. Kinesthesis was significantly improved from pre-test to post-test (p=0.001), with no significant difference in the amount of improvement among the groups (p=0.47). Neither handwriting legibility (p=0.96) as measured by the standardized test (ETCH) nor writing time (p=0.12) was significantly improved in any of the groups. However, handwriting legibility in the classroom setting, as reported by teachers, was significantly improved in all groups at post-test (p=0.0001), with further significant improvement reported at four weeks after training (p=0.04).
Conclusion: Based on the findings, the effectiveness of kinesthetic training to improve handwriting in grade one school children was not established. Further study is needed before the results can be generalized to different grades and/or settings.
Acknowledgement
This project was conducted with partial funding from the National Center for Medical Rehabilitation Research, National Institute of Child Health and Development, National Institutes of Health, grant 5T32HD07462; and the Dudley Allen Sargent Research Fund, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA.
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