Sensory Motor Lateralization as Handwriting Intervention in School-Based OT

Study Overview
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Brief Summary
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Children who attend School-Based Occupational Therapy (SBOT) show mixed dominance and a liable decreased in the structural and functional differentiation between the two hemispheres. The lack of right-left disparity has been found to link to mirror invariance, poor spatial organization, fragmentary reversals, and handwriting difficulty. This study intends to find out, whether, Sensory Motor Lateralization (SML), With a rightward bias, profits handwriting more than the conventional (CON) Without.

Detailed Description
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10 to 30% of school children suffer handwriting difficulty. Many of them are eventually referred to SBOT for remedial intervention. Among these children, 70% show mixed dominance in their hand and/or leg use, and a likely functional and structural interhemispherical asymmetry reduction. This would make them right-left symmetrical. Learning, thus, may be challenged, because people who are right-left balanced would not have a consistent reference point to process the learning materials regularly in any pre-determined directions. They are, thus, prone to suffer mirror invariance, fragmentary reversal errors, and handwriting difficulty, especially with the fast and accurate construction of asymmetrical letters from memory. To enhance right-left disparity, dispel mirror invariance, and facilitate the automatized handwriting, SML preferentially belabors one's right eye, ear, hand and leg in therapy, that would greater engage the left hemisphere for its acclaimed vantages over learning. This study investigates, whether SML, wielding such a rightward bias, profits handwriting greater than CON.

Official Title
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Handwriting Intervention, With vs. Without a Rightward Bias, in a Junior High School-A Randomized Controlled Study

Conditions
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Developmental Dysgraphia

Intervention / Treatment
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* Behavioral: SML
* Behavioral: CON


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Any Special or Regular Education students with Individualized Education Plans (IEPs), OT mandates, and handwriting goals. Has Intelligence Quotient (IQ) equal to or above 60. Ambulatory. Proficient in English, and fluent in naming, identifying, and accessing the sequence of letters in the alphabet. The students who attend Physical Therapy (PT), Adaptive Physical Education (PE), and any other programs are included, if the programs being provided are skill-, theme-, or task-oriented, not involving any muscle strengthening activities. Exclusion Criteria: All are excluded, if the study candidates have any medical condition(s) that would prohibit them from the full physical participation in school.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Sensory Motor Lateralization (SML)<br>This was a group of 8 junior high school students who received SML in school for handwriting difficulty during the 2012-13 School Year. The participants received left eye-and-ear occlusion, fitness exercises, fine motor speed training, and handwriting practice on their right hand only. | Behavioral: SML<br>* SML consists of supervised handwriting practice, fitness exercises, and fine motor speed drills that preferentially belabor a participant's right eye, ear, hand and leg during therapy.<br>* Other names: Cerebral Lateralization Intervention;|
| Active Comparator: Conventional School-Based OT (CON)<br>This was a group of 8 junior high school students who received conventional school-based Occupational Therapy service for handwriting difficulty during the 2012-13 School Year. The participants received a like fitness exercises, fine motor speed training, and handwriting practice on their dominant hand instead. | Behavioral: CON<br>* CON consists of supervised handwriting practice, fitness exercises, and fine motor speed drills on the participant's dominant hand.<br>* Other names: Conventional School-Based OT;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| SML excels CON in manuscript letter legibility | Assess by the percent accuracy score of manuscript letter legibility derived from the Wold Sentence Copying Test (WSCT). TThe letter legibility score was calculated by counting the total number of letters the participant wrote minus the writing errors per THS-R criteria, divided by the total number of characters written, and multiplied by 100. The minimum is 0, and the maximum is 100. The higher values represent better treatment outcome. | Change from Baseline percent accuracy score at 3 months | 
| SML excels CON in script letter legibility | Assess by the percent accuracy score of script letter legibility derived from the Wold Sentence Copying Test (WSCT). The letter legibility score was calculated by counting the total number of letters the participant wrote minus the writing errors per THS-R criteria, divided by the total number of characters written, and multiplied by 100. The minimum is 0, and the maximum is 100. The higher values represent better treatment outcome. | Change from Baseline percent accuracy score at 3 months | 
| SML excels CON in manuscript transcription speed | Assess by WSCT.Speed was derived from the total number of letters written timed 60, divided by the total number of seconds used, and recorded as number of letters per minute. The minimum is 0, and there is no maximum. The higher values represent better treatment outcome. | Change from Baseline letters per minute at 3 months | 
| SML excels CON in script transcription speed | Assess by WSCT. Speed was derived from the total number of letters written timed 60, divided by the total number of seconds used, and recorded as number of letters per minute. The minimum is 0, and there is no maximum. The higher values represent better treatment outcome. | Change from Baseline letters per minute at 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Developmental Dysgraphia, Ambidexterity, Outcome study