The Effect of a Combined Visual Efficiency and Perceptual- Motor Training Programme on the Handwriting Performance of Children with Handwriting Difficulties: A Pilot Study

Background: The purpose of this study was to investigate the effect of a combined visual efficiency and perceptual-motor training programme on the handwriting performance of Chinese children aged 6 to 9 years with handwriting difficulties (HWD). Methods: Twenty-six children with HWD were assigned randomly and equally into two groups. The training programme was provided over eight consecutive weeks with one session per week. The perceptual-motor group received training only on perceptual-motor functions, including visual spatial relationship, visual sequential memory, visual constancy, visual closure, graphomotor control and grip control. The combined training group received additional training components on visual efficiency, including accommodation, ocular motility, and binocular fusion. Visual efficiency, visual perceptual skills, and Chinese handwriting performance were assessed before and after the training programme. Results: The results showed statistically significant improvement in handwriting speed after the training in both groups. However, the combined training gave no additional benefit on improving handwriting speed (ANCOVA: F=0.43, p=0.52). In terms of visual efficiency, participants in the combined training group showed greater improvement in amplitude of accommodation measured with right eye (F=4.34, p<0.05), left eye (F=5.77, p<0.05) and both eyes (F=11.08, p<0.01). Conclusions: Although the additional visual efficiency training did not provide further improvement in the handwriting speed of children with HWD, children showed improvement in their accommodation amplitude. As accommodative function is important for providing sustainable and clear near vision in the process of reading and word recognition for writing, the effect of the combined training on handwriting performance should be further investigated.