Graphomotor Intervention Program for Handwriting Difficulties Prevention in School-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 quality and speed of handwriting in second-grade children. 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 (1), 30% to 60% of the school day is spent performing tasks involving handwriting. It is also in this period that the formal learning of handwriting begins (2). However, not all children are able to develop proficient handwriting (3-4). According to Alhusaini, Melam and Buragadda (5) 12% to 30% of children present difficulties in handwriting, with negative consequences for school success (6). Children who fail to develop proficient handwriting are entitled to poor writers or dysgraphics (7-8). Dysgraphia refers to a disturbance or difficulty in the production of written language related to the mechanics of writing (9). Ajuriaguerra (8) defines it as a writing whose quality is deficient, without any neurological or intellectual deficit explaining it. Generally, handwriting is less legible and organized, contains more erasures and corrections, and exhibits a slower speed (9). In addition, this is one of the main reasons for referral and consultation in psychomotricity in school-age (10), for this reason it is fundamental to bet on the prevention of them. The need for prevention and early intervention is indisputable (11). Several studies indicate that both the benefits of late intervention are well-known, because the time is often difficult to correct handwriting difficulties (12-13). Most of the existing studies focus on remediation of handwriting (14). There is evidence of its efficacy in handwriting improvement, depending on its duration, frequency and method of treatment (5, 7, 15). There are few studies dedicated to the prevention of handwriting difficulties (14). In addition, 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 (16), who will apply in this study to children in the second grade of elementary school.

Official Title
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The Effects of a Graphomotor Intervention Program According to a Psychomotor Approach on Quality and Speed of Handwriting in School-Age 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 second grade (aged 7 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; Presence of one or more school retentions; 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: 7 Years
Maximum Age: 7 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 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 handwriting performance | Outcome Measure - The Concise Assessment Scale for Children's Handwriting (BHK) to assess quality and speed of handwriting | 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 | 
| Change from Baseline, between and within groups comparison, in Manual Preference | Outcome Measure - Manual Preference Questionnaire to assess manual preference | 0, 4, 10 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Graphomotor intervention program, Second grade children, Prevention and early identification, Process and product of handwriting, Quality and speed of handwriting