Graphomotor Intervention Program for Handwriting Difficulties Prevention in Preschool Age

Study Overview
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Brief Summary
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12-30% of children present handwriting difficulties, which has negative repercussions on their school career. For this reason, it is fundamental to bet on their prevention. The aim of present study is to examine the effects of a graphomotor intervention program on graphomotor competences in children in the last year of preschool education. This experimental study is a randomized controlled trial. The program will run for 8 weeks (2 sessions/week of 30 minutes), followed by 6 months of follow-up without intervention. Participants will be assessed 1) at baseline, 2) at the end of the program, and 3) after the follow-up. Participants will be randomly allocated to two groups: experimental group (graphomotor intervention program) and control group.

Detailed Description
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According to estimates, 12 to 30% of children have handwriting difficulties (1), which has negative consequences for school success (2). In addition, this is one of the main reasons for referral and consultation in psychomotricity in school-age (3), which reflects the urgency of acting in this field. The need for prevention and early intervention is indisputable (4). Several studies indicate that both outweigh the benefits of late intervention, because as time goes on it is increasingly difficult to correct handwriting difficulties (5-6). Graphomotor skills include the trait, the drawing and the formal handwriting and are related to long and complex learning, which requires several years of learning (7-9). Today it is known that preschool education represents a very important period for the development of these skills (10). In preschool, children spend 42% of the day on paper and pencil tasks (11) and it is during this period that handwriting readiness skills are developed (12), being a predictor of future school success (12-15). For Beery (16) children are not apt to learn to handwrite without first copying the first nine figures of the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI). It is based on this that intervention programs have been developed with the aim of promoting the development of handwriting readiness skills in preschool age and of preventing possible handwriting difficulties at school age (14, 17). These intervention programs have shown favourable results in improving the graphomotor skills of preschool children (12, 17-18). In most cases only something is done, once the handwriting difficulties are installed. In addition, there are few studies dedicated to intervention in graphomotor skills at preschool age and to my knowledge, there is no study whose intervention is based on a psychomotor approach. Based on this, a graphomotor intervention program with a psychomotor approach was developed, by Matias and Vieira (19), who will apply in this study to children in the last year of preschool education.

Official Title
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The Effects of a Graphomotor Intervention Program According to a Psychomotor Approach on Graphomotor Competences in Preschool Children: A Randomized Controlled Trial

Conditions
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Typical Development, Risk of Dysgraphia, Dysgraphia

Intervention / Treatment
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* Other: Graphomotor intervention program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children in the last year of preschool education (aged 5 years old); Participation agreement. Exclusion Criteria: Diagnosed or suspected of neurological disabilities (e.g., cerebral palsy, epilepsy), psychiatric and/or behavioural disorders; Presence of uncorrected vision and hearing problems; Referenced by Special Education/National Service of Early Intervention in Childhood; Native language is not Portuguese; Children with direct intervention in graphomotor skills or who had a similar intervention to that proposed less than 1 year ago; Participation in the intervention program of less than 80%; Children undergoing drug therapy (e.g., antihistamines) that interfere with the study variables; Do not wish to participate in the study.

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 5 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Graphomotor intervention program<br>The experimental group (EG) intervention comprises a graphomotor intervention program according to a psychomotor approach. The program integrates two group sessions (6-8 children)/week of 30 minutes for 8 weeks (16 sessions). | Other: Graphomotor intervention program<br>* The graphomotor intervention program aims to promote the development and reinforcement, different skills involved in the learning process of handwriting and has a preventive character. It follows a bodily, playful, multisensory, exploratory (sensory integration) and neuromotor task training approach and focuses on the following intervention domains: segmental awareness, passive relaxation, trunk-limb dissociation, interdigital coordination, attention, planning, spatial organization/orientation and perception.<br>|
| No Intervention: Control Group<br>The control group (CG) participants will maintain their normal classroom activities. After the study, control group participants will be offered the opportunity to integrate a similar graphomotor intervention program. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline, between and within groups comparison, in Manual Preference | Outcome Measure - Manual Preference Questionnaire to assess manual preference | 0, 4, 10 months | 
| Change from Baseline, between and within groups comparison, in Motor Performance | Outcome Measure - Movement Assessment Battery for Children - Second Edition to assess manual dexterity, aiming and catching and balance | 0, 4, 10 months | 
| Change from Baseline, between and within groups comparison, in Visual-Motor Integration | Outcome Measure - Beery-Buktenica Developmental Test of Visual-Motor Integration, Sixth Edition to assess visual-motor integration, visual perception and motor coordination | 0, 4, 10 months | 
| Change from Baseline, between and within groups comparison, in Computerized Handwriting Process Measures | Outcome Measure - The MovAlyzeR to assess spatial, temporal and kinematic variables of handwriting | 0, 4, 10 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sociodemographic characteristics | The Sociodemographic Questionnaire collects data on the identification of the child, the parents, the sociodemographic context and the socioeconomic status of the family based on the Graffar Social Classification Scale Adapted | 0 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Graphomotor intervention program, Preschool children, Graphomotor competences, Prevention