Visual-Perceptual Training for Handwriting Legibility and Speed in Children with Handwriting Difficulties: A Single-Arm Interventional Study.

Background: Empirical evidence relating motor-free visual-perception (VP) skills and handwriting (HW) legibility and speed is sparse, despite the theoretical belief that VP is necessary for letter recognition and is an essential component of HW. Therefore, the study was carried out to investigate the effect of VP training on scanning skills, motor-free VP skills, and HW legibility and speed. Objectives: The main objective is to study the effect of VP training on HW legibility and speed; motor-free VP skills and scanning skills. Study Design: This was a single-arm interventional study design was chosen for the research. Methods: Single arm of 10 children of either gender between 6 and 10 years of age, with HW difficulties meeting the inclusion and exclusion criteria, was recruited by convenience sampling. They were assessed pre- and post-training (6th and 12th week) using the letter cancellation test (LCT), Test of VP Skills-3rd Edition (TVPS-3) and Evaluation Tool of Children's Handwriting (ETCH). The intervention included individualized VP training weekly twice along with home program. Results: The mean scores of LCT, TVPS-3, and Evaluation Tool of Children's Handwriting-Manuscript (ETCH-M) of n = 10 were analyzed. Post 12-week intervention, statistically significant improvement were found in mean scores of LCT (P < 0.05, 95% confidence interval [CI] [0.411,0.699]) and on TVPS- 3 subtests (P < 0.05, 95% CIs [13.14, 17.46], [11.60, 15.60], [11.46, 14.14], 11.73, 15.87], [11.33, 15.27], [11.66, 15.44] and [11.56, 15.44] sequentially) and on overall mean scores (P < 0.05, 95% CI [12.67, 16.13]). Statistically significant improvements were calculated on ETCH-M subtests- total letter, number, and word legibility scores (P < 0.05, 95% CIs [88.91, 95.69] [100,100] and [79.01, 93.19] respectively); and on near-point copying speed (P < 0.05, 95% CI [35.98, 55.42]) but non-significant improvement was seen on far-point copying speed (FPS) (P = 0.103, 95% CI [23.69, 36.31]). Conclusion: VP training, without HW practice, has an effect in improving scanning skills, motor-free VP skills, and HW legibility and speed (except FPS). Thus, VP training may influence HW legibility and speed. [ABSTRACT FROM AUTHOR]