Systematic review of interventions to improve or augment handwriting ability in adult clients.

This systematic review examined research related to interventions that addressed handwriting deficits in adults with impaired upper limb motor coordination resulting from central and peripheral nervous system injury or illness. The clinical question was, "Based on current research, what is/are the recommended intervention(s) to improve, augment, or replace handwriting skills among adult clients with upper limb motor deficits?" A research protocol was followed, which was modified to include pediatric literature after an initial search of interventions for adults proved limited. Four studies related to adults and 10 related to pediatrics were included in the review and all were evaluated for quality using standardized procedures. The adult studies addressed the use of voice recognition software and hand dominance transfer training. Available evidence for interventions with children with handwriting deficits centered around these clinical options: Cognition Orientation to Daily Occupational Performance, task-orientated self-instruction, ergonomic modifications to a desk, school-based intervention (emphasis on visual motor skills and practice), sensory diet with therapeutic listening, therapeutic practice, and a graphomotor program. Improvement in handwriting skill emerged from seven of the 10 pediatric studies. Direct practice of handwriting tasks was common to all successful studies and missing in studies that failed to show skill improvement. It may be logical to conclude that intervention strategies should include direct practice of handwriting, whether the client is an adult or a child. Further research on handwriting intervention programs specifically for adult clients and the inclusion of direct practice as intervention is warranted.