children spend from 31 to 60% of their school day either 
 writing or performing other fine motor tasks2 . the preparatory skills 
 for writing are coordination of multiple joints , visual perception , vision - motor 
 integration , and proprioception3 . together with stereognosis , 
 proprioception allows smooth joint movement when vision is impaired or absent5 . children with poor proprioception have 
 problems with handwriting legibility because their grip on a pen is too strong or too 
 weak4 . generally , proprioception can be 
 measured with joint position sense ( jps ) and kinesthetic sense ( ks)6 . while there are many studies investigating children s 
 handwriting , quantitative studies on the association between handwriting and proprioception 
 involving jps and ks are lacking7 . the aim of this study was to investigate the association between proprioception , involving 
 jps and ks , and handwriting legibility in children . nineteen healthy children ( 15 boys and 4 girls ) with an average age of 9.7  0.36  years 
 participated in this study . prior to the study , the children and their parents were informed 
 about the purpose of the study and the general procedures to be undertaken . all children and the study was approved by the kaya university of 
 human health science studies committee . the investigator moved the child s right arm passively 
 through 80 of flexion at the elbow ( from 30 to 110 ) . the children were then directed to 
 repeat this motion 10 times following a metronome set at 1  s intervals . their movements were 
 recorded by a compact measuring system ( cms ) 10 for 3d motion analysis ( using the winarm 
 software zebris medical gmbh , germany ) . cms markers were placed at the greater tubercle and 
 lateral epicondyle of the right humerus and at the right wrist . angles of deviation from the 
 targeted range of flexion were analyzed using matlab version 2014a ( the match works inc . , 
 2014 ) . ks was measured by the kinesthesia item in the sensory integration and praxis tests ( sipt , 
 wps , torrance , ca , usa ) . the investigator moved a finger of the subject passively along a line from 
 beginning to end , allowing the child to learn the line direction and distance . then , 
 blindfolded and after one trial , the children were directed to trace five lines for each 
 hand . only the results of the right hand were analyzed in this study . the investigator then 
 measured the distance between the test endpoints and the real endpoints of the lines . legibility was evaluated using 
 form , alignment , space , size , and slope8 . the legibility score was calculated as the ratio of 
 the number of clearly written words to the total number of words ( score for legibility ( % ) = 
 number of letters that received 5 points/30  100 ) . all data were analyzed using ibm spss statistics 20.0 ( ibm corp . , armonk , ny , usa ) . spearman s rank correlation was used to determine the relationships between legibility of 
 handwriting and jps and ks , with significance defined as p<0.05 . values obtained for jps and ks in relation to handwriting legibility are shown in table 1table 1.handwriting legibility and proprioception test results ( n=19)mean  sdjoint position sense 110 ( degree)22.530  10.063joint position sense 30 ( degree)14.256  10.408kinesthetic sense ( cm)2.044  0.703handwriting legibility ( % ) 33.521  15.852*standard deviation . there was no correlation between writing legibility and jps at either 30 or 
 110 of elbow flexion ( p>0.05 ) . a high ks correlated significantly with legible 
 handwriting ( p<0.05 , table 2table 2.correlation between handwriting legibility and proprioception ( n=19)handwriting legibility ( % ) joint position sense 110 ( degree)0.016joint position sense 30 ( degree)0.009kinesthetic sense ( cm)0.370*p<0.05 ) . this study investigated the association between the legibility of handwriting and jps and 
 ks in young children . children aged between 7 and 8  years are expected to be proficient in 
 building up their speed of handwriting , ensuring consistency in size and proportions of 
 letters as well as the spacing between letters and words9 . the average age of the participants in this study was 9.7  years 
 old . our results showed that a highly accurate ks was 
 associated with higher legibility scores . ks provides ongoing error information and memory storage to be recalled when 
 writing is repeated . a high ks leads to programmed error correction , and the upgraded 
 program generates better writing legibility . the results of this study support the 
 hypothesis that ks reinforces the linkage between visual and motor control required for 
 clear handwriting15 . we 
 studies jps at the elbow joint because proprioception at the elbow joint is necessary for 
 performing fine manipulative tasks including handwriting16 . studies have reported that proprioception at the wrist joint17 and finger joints18 influences handwriting legibility . we looked at children within a limited age range  between 9 and 10  years of age . further , we did not control for other factors that affect writing legibility , such as fine 
 motor control and visual - motor integration19,20,21 . finally , although handwriting quality is measured in terms of legibility and speed , this 
 study investigated only writing legibility .
[ purpose ] this study investigated the association between proprioception , including joint 
 position sense and kinetic sense , and handwriting legibility in healthy children . 
 [ subjects and methods ] assessment of joint position sense , kinetic sense , and handwriting 
 legibility was conducted for 19 healthy children . 
 joint position sense was assessed by 
 asking the children to flex their right elbow between 30 to 110 while blindfolded . 
 the 
 range of elbow movement was analyzed with compact measuring system 10 for 3d motion 
 analysis . 
 kinetic sense was assessed using the sensory integration and praxis test . 
 the 
 children were directed to write 30 words from the korean alphabet , and the legibility of 
 their handwriting was scored for form , alignment , space , size , and shape . to analyze the 
 data , descriptive statistics and spearman correlation analysis 
 were conducted using ibm 
 spss statistics 20.0 . 
 [ results ] there was significant negative correlation between 
 handwriting legibility and kinetic sense . a significant correlation between handwriting 
 legibility and joint position sense 
 was not found . 
 [ conclusion ] this study showed that a 
 higher kinetic sense was associated with better legibility of handwriting . 
 further work is 
 needed to determine the association of handwriting legibility and speed with joint 
 position sense of the elbow , wrist , and fingers .