Schoodles Keyboarding Assessment Guide

Introduction

Welcome to the first edition of SCHOODLES School Keyboarding Assessment! Therapists around the world have been using SCHOODLES SFMA for years, and we’re very excited to add this new product.

This assessment tool is an observational approach to evaluating a child’s fine motor skills related to keyboarding. SCHOODLES guides you through a series of tasks that allow you to use and build your observation skills and knowledge to make individualized decisions about a student’s educational needs.

This new tool is the result of many discussions and in depth research regarding how keyboarding fits into the scope of occupational therapy practice and, includes a variety of activities to aide decision making.

Please check our website, www.SCHOODLES.com, for additional helpful information.

We designed this evaluation tool to be fun for kids and therapists. We hope you and your students find enjoyment in all you do together!

- The SCHOODLES Team

The assessment guide is intended to be used as a companion to the student workbook. It was written to help guide therapists’ assessments of fine motor functions and underlying abilities needed to support skilled hand use. Procedures and techniques described in this text are to be used solely for observational purposes; they are not intended to diagnose any condition or disability. Therapists using this observation tool do so entirely at their own discretion. The SFMA is the sole property of SCHOODLES. All rights reserved. Only the workbook is intended to be reproduced for use with students. The assessment guide may not be copied without the authors’ expressed written consent.

© 2017 by Marie Frank OTR/L and Monica Fortunato OTR/L
About the Schoodles Keyboarding Guide and Assessment

School-based occupational therapists often are faced with “what to do next” when a child is unsuccessful producing legible handwritten work, despite skilled intervention. The alternative could be keyboarding. This guide assists with clinical reasoning needed to determine if keyboarding is a viable alternative for students struggling with handwriting.

There are a variety of reasons a student might not produce legible handwriting, such as:

  • Poor strength, poor coordination, increased flexibility, or poor muscle tone; this problem may go hand in hand with diagnoses including Down syndrome, cerebral palsy, or other syndromes and disorders.
  • Low interest or low motivation
  • Poor habits that might be difficult to change
  • Low cognition; a child may not be able to move beyond his developmental age with a task, such as handwriting.
  • Poor proprioception; children with autism sometimes have this challenge.
  • Poor visual perceptual skills


Keyboarding requires many of the same skills as handwriting, but also requires isolation of fingers, memory of key locations, visual scanning, and use of appropriate pressure on keys. (15) Students also need to coordinate both sides of the body, develop motor memory for key strokes, and have adequate strength and coordination if using all ten fingers.

Automation in motor movements also eventually is required for increased speed. Automation in letter formation when writing somewhat correlates with automated finger placement on the keyboard. Both skills must be practiced for a length of time before automation can occur.
Response to Intervention and Keyboarding

Increasingly, occupational therapists are asked to participate in Response to Intervention activities before a student is evaluated for special-education services.

During RTI, occupational therapists may be asked to look at the curriculum and how keyboarding is taught to general-education students.

A thorough examination of handwriting instruction, keyboarding instruction, and overall use of technology in the classroom may reveal areas where an occupational therapist could help - not only the student who is struggling, but the entire group of children. (34)

This SCHOODLES keyboarding assessment is outside the scope of RTI, as it was developed to determine a student’s needs and the need for occupational therapy

intervention. However, portions could be modified to be used as a screen for regular education students if decisions are being made regarding use of pen or pencil vs. keyboard for written outcomes.
When Is a Child Ready for Keyboarding?

A child as young as two years old can learn to use a mouse, or can use a smartphone or tablet with surprising ease. For the purposes of a school-based assessment, we are discussing children who have special needs. We often interact with children at developmentally and physically different levels than their peers, so we need to look at skills needed to keyboard rather than age to assess a child’s readiness
When Should Typing/Keyboarding Be Considered as an Alternative to Handwriting?

If handwriting skills are not functional and not meeting the child’s needs in the classroom, exploring keyboarding as an alternative method of producing written work in third grade and higher is a valid option.

Additionally, if lengthy periods of intervention by an occupational therapist have been provided, and handwritten work continues to be illegible, too laborious, or not automated, consider keyboarding.

It is important to remain within the occupational therapy scope of practice and follow IDEA when making decisions about typing assessment and intervention. Occupational therapists are obligated to ask these questions:

  • What does the child need to be able to do in the classroom?
  • Who is already working on typing with the child?
  • Who can work on typing with the child other than occupational therapists?
  • Which underlying performance components related to fine and visual motor skills, and visual memory are missing or delayed with regard to keyboarding outcomes?
  • Can we give general guidance to regular education, special-education teachers, or paraprofessionals? Would this be sufficient to meet the needs of the student?
  • Does the teacher or paraprofessional have time and resources to adapt classroom learning tasks to keyboard use?
  • When considering intervention, does the intervention require the unique skills of an occupational therapist? What can OT provide that is different from what another service provider might be able to do?
When Is There Justification for Moving from Handwriting to Typing?

The first question should always be: What does the child need to be able to do to succeed in school?

The answer isn’t “The child needs to type.” The answer could be “The child needs to produce legible work”; “The child needs to produce work with more ease and speed”; or “The child needs to feel more motivated, and enjoy the process of writing.” It is important to have a clear educational goal.

What is the gauge for legibility of written work? The gauge should be “Can you and others read your writing?” The gauge is not the percentage of accuracy with letter to line, spacing, and sizing. These measures help determine progress, but shouldn’t be the final determination for legibility. Do not look for perfection.

Fatigue may play a factor in handwriting skills. Can the teacher read what is written after the child produces more than one paragraph? Legibility sometimes drops as fatigue sets in. Asking the teacher for work samples may provide accurate information on endurance while writing. Accommodations may be an appropriate solution for fatigue as keyboarding also requires endurance.

Intervention for typing skills from an occupational therapist can be provided if the student’s handwriting skills are not functional; and if after assessment, it is determined keyboarding may improve a student’s speed, legibility, and volume of work. Students with a variety of impairments may require the unique skills of an OT to learn and be functional with keyboarding.
Benefits of Moving to Keyboarding

Freeman, MacKinnon, and Miller (19) found keyboarding may enable children to focus on content rather than letter production, thus improving the quality of their work. We need to find out what is important to the teacher: content or other components of written work, such as spelling, grammar, or punctuation.

When children labor over letter to line alignment, size, spacing, and letter formation during a handwritten task, content may suffer because of so much mental effort being put into legibility. The reverse can happen as well. When students engage in developing content and reduce their focus on appearance, legibility may suffer.

Students often shorten everything when they can’t create content and handwrite at the same time. They will do anything not to have to write. The student may be able to produce longer writing assignments if he learns to keyboard, and is engaged in it

Keyboarding, as opposed to handwriting, has been found to be helpful when comparing speed, length, and quality of compositions for children with autism (3). However, the result was not statistically significantly different. Meaning, we might not be gaining a lot by moving a child to typing, but it is worth exploring.

Certainly, relieving a student of the burden of lack of automation of letter production can make sense. He merely needs to recognize and find the letter on the keyboard. This would more likely be true for a child with autism, as most children have letter-writing automation by the end of second grade.

Rogers and Case-Smith (44) suggest “most students who were slow at handwriting or had poor legibility increased the quantity and overall legibility of text they produced with a keyboard.” This study also demonstrated that handwriting performance is not predictive of keyboarding performance, because different skills are used. Because of those slightly different skills, one could argue that poor habits, impairments, or lack of letter automation resulting in illegible writing could be overcome by the move to keyboarding.

Keyboarding may hold the attention of children who might otherwise be distractible. This is especially true when using favored keyboarding games to improve typing skills.

Occupational therapists might work with students with physical challenges, who cannot complete the physical task of handwritten work. These students often benefit from keyboarding. The assessment might include a review of challenges and solutions via use of an assistive technology assessment. Assistive technology may include adapted keyboards, onscreen tools, switches, splints, and alternate methods of access. which might allow a student more options for written expression. This type of an assessment often falls on the occupational therapist - but not always. Each school should have access to an AT specialist to guide this portion of an assessment. This type of assessment is not included here.
Drawbacks of Moving to Keyboarding or Formal Keyboarding Instruction

Berninger, Abbott, Augsburger, and Garcia (5) found that production speed changed between handwritten work and keyboarding depending on the grade level of the student, and the level of the task’s complexity.

Overall, speed increased on the keyboard when just letters or words were typed, but decreased when the student wrote essays.

Berninger et al. also suggested students, both with learning disabilities and without, produced longer essays more quickly by pen. They go on to suggest keyboarding is best instructed within the context of producing work in the classroom, rather than in isolation. This is the definition of purposeful activity. Ask: Will the cost/benefit of one-on-one instruction outside the classroom on a typing program result in improvement?

In addition, we must determine if the student is indeed a functional writer or not. If we introduce typing to a student who is a functional hand-writer, we may be interfering with the learning process, as the child is learning a new skill as he tries to complete an assignment.

We also must understand that children with fine-motor difficulties might find touch-typing difficult. (28) They may be physically unable to perform actions required for keyboarding.

The “home row” method of typing instruction may not serve children who have limited endurance, physical limitations or coordination problems. Children often find their own ways to type just as quickly as those who have been taught the home-row method. Consider students whose fingers fly on their smartphones. Teaching ten-finger typing is the gold standard, but may not be motivating or possible for some children. Hunt and peck can be effective, and produce legible results. (38)

Just as it’s difficult to change a pencil grip after a certain age, it might be difficult to change the way a student approaches a keyboard. This might be especially true for an older student who has spent hours typing a certain way.

Additionally, if a child needs to use vision to guide motor movements (needs to visually locate each key) and has poor visual memory (unable to chunk visual information), typing may not be the best option. Poor ability in both areas would lead to slow keyboarding. Typically, this is an issue with cognitively delayed children.
Welcome
Welcome new user! Your entire Schoodles Keyboarding guide is contained below. We will be adding features, videos and supporting research articles to this page. Please check back often to see the results of our tinkering.

Your Schoodles Team

When to Recommend and How to Proceed with Typing as an Alternative to Writing

Alternatives to Keyboarding
First consider accommodations for a student having trouble keeping up with handwritten work or can’t write legibly. Look at what’s going to be most efficient for the student in the classroom, and enhance learning

  • Voice-to-text dictation software, which easily is accessible through Word programs and on smartphones
  • Peer note taker
  • Teacher-supplied notes
  • Photographs of black/whiteboards taken via a smartphone
  • Recordings of lectures to review and take notes from at a later date
  • Scribe in the form of a parent or classroom aide
Skills Needed to Be Successful with Keyboarding

Keyboarding might be a potential functional skill and alternative to handwriting if students can:
  • Recognize letters
  • Formulate sentences
  • Create content with minimal assistance
  • Show motivation
  • Gain access to technology in the school and at home
  • Has the potential to master the visual motor skills needed for keyboarding
Keyboarding Trial and Implementation

Keyboarding could be included in a list of possibilities, with a written outcome being the goal rather than keyboarding itself being the goal; then we are released from the obligation of having to teach keyboarding, and we can focus on what the child needs to be able to do. For example, the goal for the student could be to, ‘produce six lines of self-generated text in five minutes’.

It is prudent to trial keyboarding with the student and his classroom teacher before relegating everyone to a year of keyboarding intervention. Occupational therapists should focus on underlying deficits found during the evaluation. If practice is required, recruit aides to monitor programs, or work with the teacher to provide opportunities in the classroom for the student to build skills. Those who are with the child on a daily basis could follow a program designed by the therapist.
Keyboarding Intervention

With a functional goal written, underlying deficits in mind, a program tailored to the student’s unique needs, and a time table for progress, we can use one of any number of commercial keyboarding programs. Here are some of the many keyboarding programs available:

https://www.hwtears.com/kwt/our-curriculum

http://www.barbarasmithoccupationaltherapist.com/keyboardingresources.html

http://www.bigbrownbear.co.uk/keyboard/

http://www.kidztype.com/

https://www.nitrotype.com/

A few strategies for intervention:

  • Ask the student to draw a picture of what he is trying to write. This creates a place holder the student can go back to when he tries to write content.
  • meaningful activities to teach typing skills has proved to be more motivating to students than the typical drill and practice tutorials. This requires individualized planning. Games, essays, letters, stories, schoolwork, or emails may take the mind off drudgery and on to producing legible written work. Something interactive may be motivating as well.
  • Develop a planned progression of skills for the student, and celebrate when he meets goals.
Keyboarding Assessment

Occupational therapists may determine the need for keyboarding as an intervention by using the SCHOODLES Keyboarding Assessment. The various components review skills and abilities needed to support skilled keyboarding.

We use this to determine whether the student is a good candidate for moving on to keyboarding as an alternative way to produce written work.

Before we start, we also need to determine if the student has access to a tool to fit his needs. Are keyboards and/or tablets available to the student at school? Check with administrators about resources and alternatives before recommending a tool. Make sure the team is involved. Will the student have time to practice keyboarding skills at home and at school?
Assessment Guidelines

SCHOODLES SFMA: Portions of SCHOODLES SFMA are a framework for this assessment, with the addition of items relevant to keyboarding. Read through the entire assessment, and print needed portions before proceeding.

Background Information: Gather and review relevant information, and record it on the information sheet. Review previous testing. BOT scores, especially manual dexterity and bilateral coordination subtests, can indicate areas of deficit that may impact typing skills.

Teacher Interview: Use the teacher interview as a guide to do a face-to-face or phone interview with the student’s primary and special-education teachers.

Student Interview: It is vital to gather information about what is important to the student. If the student is not invested in using keyboarding as an alternative to handwritten work, intervention will not be successful.

Motivation is important. A student needs a reason to develop keyboarding skills. Gather information about the student’s perception of his skill, and where areas of difficulty are most prevalent.

Classroom Skills: The assessment starts by determining if handwriting is a viable method to produce written work when compared to keyboarding. Gather comparative information to determine if making the switch to keyboarding is a valid option with potential for increased success.

Supporting Skills: Assessing supporting skills is a key component of SCHOODLES assessments. By looking at each task in a qualitative way, we can make valuable observations and predictions about the student’s potential as a keyboarder. We also determine intervention focus areas that may be unique to occupational therapy.

Classroom Skills

Handwriting

Look at the student’s current handwriting skills. Check to see if the student recognizes letters using the letter recognition sheet. This skill is paramount if we are to move forward with keyboarding. Ask the student to copy a sentence, write a dictated sentence, then compose a few sentences about a picture.

If a student has poor handwriting, try to determine the reason for it. Is it a motor delay, a visual perceptual delay, a processing problem, or poor motor memory? Is it difficulty with organization?

While the child is writing, observe for starting points, letter formation, speed, ease of recall of individual letters and, most importantly, legibility. This also is a good time to observe if movements for letter and word formation are automated, or if the child has to think about each stroke. This is a motor planning task. Children in kindergarten and first grade rely on visual information to guide their movements to form letters. Internal feedback for letter formation comes at the end of first grade or the beginning of second grade. When this occurs, movements should smooth out, speed up, and become automated. At this time, vision often still guides placement, spacing, and sizing of letters. (32) Gathering this information about legibility and why it’s failing is important to make a case for a switch to keyboarding.

If a student uses cursive letters, take samples of printed work as well. If printing is easier and more legible, make accommodations for him to use printing as the primary means of completing written assignments. An occupational therapist might make a case for keyboarding if the student moved on to cursive handwriting as a trial, to see if it breaks patterns that lead to illegibility, and written work continues to be illegible.

Compare the handwriting sample with work in the student’s backpack and in the classroom. Important! Work done during assessments often looks better. The student may have more time and more support. If this is the case, the best option may be to continue focus on handwriting skills and more practice. Consider accommodations.

While working through the handwriting task, watch for inconsistencies between the copied sample and the dictated, then the self-generated. If the copied sample is legible, and the dictated and/or the self-generated are not, illegibility is not a motor problem. The task becomes more cognitively complex as we decrease supports. We then most likely have a visual memory or processing problem (learning disability). For a child to be able to write a dictated sentence, he must be able to visualize letter formations, and construct words. For a child to write from his own thoughts, he must be able to generate the thoughts, and visualize the letters or words without visual cues. (Adapted with permission from Jill Dalbaka OTR/L’s model.)
Instructions for the Handwriting Portion of Assessment

Find a starting point with the student. Complete each task until it becomes too challenging, then stop. As handwriting task requirements increase, writing quality may break down. The workbook task separates motor and cognitive abilities by asking the student to first copy a sentence, write a short sentence from dictation, and to write a sentence about the picture provided. Asking the child to make his letters the same size as the sea creature at the beginning of each line helps determine if the child has control of this aspect of written work.

  • Ask the child to copy the sentence "I like jellyfish," or something more complex, such as “The ocean contains a vast variety of life forms. They vary in size from microscopic krill to large blue whales.”
  • For dictation, use a simple sentence such as a line from a poem, or “The quick brown fox jumps over the lazy dog.” This sentence includes all twenty-six lower letters. For older students, use some lines of the “Sea Foam” poem in the workbook, or something of interest.
  • Ask the student to self-generate content, and write a sentence or two sentences describing the picture in the SCHOODLES workbook or for older students, use an appropriate picture or photo.
  • Take note of each of these abilities as you move on to the keyboarding portion of the assessment. For keyboarding to be a useful skill, a student must be able to generate content, or have the support of another person to help generate content. If this is not the case, consider accommodations for the student. Question the usefulness of keyboarding if the student is unable to produce written work on his own or with minimal assistance.
Keyboarding Skills

Several skills are needed to successfully keyboard, but the first necessity is access to a computer. Assess keyboard and fingering methods on the device the student would most likely use. Evaluate scanning skills while moving through this portion of the assessment. Take note of approximate time needed to locate access points, locate keys and locate letters, and words on a page. This is recorded in the vision area of the observation sheet.

Turn on/off the computer: Use a computer or device the student typically would be using.

Log on: Check with the teacher to get information about log-on rights for the student.

Right/left/double-click: Check for knowledge and use of a track pad or mouse.

Open a Word document: Make sure the student knows where to go to open a new document in Word.

Keyboard sample: Make sure the student is seated comfortably at a work station suited to his size. To gather information to determine whether keyboarding is a viable alternative to handwritten work, we use three different trials. Use a writing passage that is ability level and relevant for the student, if possible, to increase interest. Time both handwriting and keyboarding. Using the same writing passage for handwritten work and keyboarding may reveal information about speed.

If a student-specific passage is unavailable, use portions of one of our favorite poems we’ve included in the workbook. Observe how the child approaches keyboarding. Handwriting speed correlates with keyboarding speed in children without disabilities. (41)

  • Copy: Ask the student to copy via keyboarding a portion of a poem included. For younger children, use one or two lines of the poem; for older students, use four or more lines. Tell the student you would like him to move as quickly as possible, but you would like correct spelling and punctuation. Cover all content but the sample provided in the SCHOODLES workbook. Take note of the fingers used to press keys; bilateral hand use; visual scanning with location of letters and punctuation on the keyboard; level of automation; and the number of times the student needs to look at the sample. This measures “chunking”: how many letters, words or groups of words a student can copy after one glance. Chunking is a term referring to the process of taking individual pieces of information (chunks), and grouping them into larger units. By grouping each piece into a large whole, you can increase the amount of information you can remember, and the speed of typing. Poor readers might only copy one letter at time, not words. Observe the student while typing to see which methods currently are used, and if they appear functional. Note oral overflow. This might indicate a developmental difficulty with fine motor work. Note loss of place when transferring information. This might indicate poor visual scanning or attention problems. Note if words or portions of the sample are omitted.
  • Self-Generate: Self-generation of content does not require transfer of information, but it requires the ability to create content while performing the complex motor task of typing. Provide the student with a picture and ask him to type two to four sentences based on what he sees. Does the process of letter finding slow after initiation compared to the copy task? Take note of the fingers used to press keys, bilateral hand use, visual scanning with location of letters and punctuation on the keyboard, and level of automation.
  • Timed test: Timed typing tests with accurate results can be completed with online programs. We recommend the following. They are quick and easy tests therapists can use to gather baseline words per minute information and follow up as the student progresses.


Tests for young children: http://www.ducksters.com/games/typingtest.php
Tests for older children: https://www.typing.com/typingtest; http://www.freetypinggame.net/play4.asp; http://www.typingtest.com/

Supporting Skills

Introduction

Supporting skills are the skills needed to support fine motor work. We include them in this portion of the assessment to guide a detailed analysis of why a student may not be performing near the level of his peers. If you have assessed the child using SCHOODLES SFMA, you do not need to complete this portion of the assessment. As always, SCHOODLES is not scored, so the therapist can customize this tool to the student’s identified needs, suspected areas of need, and age.
Visual Observations

Visual feedback is essential to children learning new fine motor tasks. As tasks become automated, the need to use the visual sense diminishes, and body sense takes over. Developed visual perceptual skills are important components of skilled fine motor work. Keyboarding requires a number of visual skills. A variety of standardized tests are available that may be used to further assess a student’s visual perceptual abilities.

Visual attention is the basis from which all other vision skills emerge. This may sound elementary, but it is not uncommon to see children not using their eyes and hands together. They may be smiling at us while they color or draw, and have difficulty maintaining attention on tasks in front of them. Fine motor tasks must be visually guided before they are automated through kinesthetic awareness of the moving body. A student must begin by looking at his hands as he works on the keyboard, before he automates.

Keyboarding has additional visual challenges, as a student needs to look at the location of the letters on the keyboard and type them, while checking the screen to make sure work is being recorded correctly. This requires visual memory skills. Students’ eyes constantly move between planes. Visual scanning has increased importance as the student seeks letters, and locates his place on the screen as he writes. These scanning tasks increase the possibility of losing one’s place, and might slow the copying process for the student.

Visual-perception demands (how the brain processes visual information) increase with keyboarding. The following components of visual perception are factors to consider when assessing a student’s ability to effectively use keyboarding as an alternative to handwritten work:

  • Figure ground: finding the cursor or locating text on a busy screen
  • Visual discrimination and form constancy: changing font, italics, size, and knowing the difference between upper and lowercase letters
  • Visual spatial relationships: understanding where fingers are in relation to the keyboard, how scrolling works, or how the mouse moves the curser
AOA

The American Optometric Association (AOA) recommends that beginning at six months of age, a doctor of optometry should conduct regular eye exams. According to the AOA, 60 percent of students identified as problem learners have undetected vision problems. (12) Taking the time to have a child read (or for younger students, identify a picture) at both close and far ranges may indicate nearsightedness or farsightedness. An occupational therapist can make general vision observations, but a thorough eye exam might be suggested if problems are suspected. If a visual exam already is scheduled, place the assessment on hold until the results of that exam are known. Do not assess a child who is waiting to get glasses, as uncorrected vision problems may affect the testing results.

The AOA says every child needs to have the following vision skills for effective reading and learning. These skills also are required for keyboarding:

  • Visual acuity: the ability to see clearly in the distance for viewing the classroom board, at an intermediate distance for the computer, and up close for reading a book.
  • Eye focusing: the ability to quickly and accurately maintain clear vision as the distance from objects change, such as when looking from a chalkboard to a paper on the desk, and back. Eye focusing allows the child to easily maintain clear vision over time, such as when reading a book or writing a report.
  • Eye tracking: the ability to keep the eyes on target when looking from one object to another, move the eyes along a printed page, or follow a moving object such as a thrown ball
  • Eye teaming: the ability to coordinate and use both eyes together when moving the eyes along a printed page, and to be able to judge distances and see depth for classwork and sports
  • Eye-hand coordination: the ability to use visual information to monitor and direct the hands when drawing a picture or trying to hit a ball
  • Visual perception: the ability to organize images on a printed page into letters, words and ideas, and to understand and remember what was read
Visual Pursuit/Eye Tracking

It is important to check a child’s ability to follow a moving object with his eyes. This can be done during your occupational therapy assessment. Visual pursuit testing is appropriate for children five years and older. (48)

  1. Hold a small object of interest (we often use a pencil-top creature or colorful eraser) approximately 16 inches away from the child’s face.
  2. Do not give instructions as to whether moving the head is appropriate.
  3. Tell the child to watch the object as you move it, and to keep his eyes on the object.
  4. Move the object horizontally, vertically, diagonally (right to left and left to right), clockwise, and counterclockwise (two to three times for each movement).
  5. Move the object horizontally, vertically, diagonally (right to left and left to right), clockwise, and counterclockwise (two to three times for each movement).
  6. Observe range and accuracy of eye movement. (The goal for the child is smooth pursuit, without losing track of the object.) Observe short-term visual attention span and head movement.
  7. If the head moves with the eyes, try the exercise while asking the child to hold his head steady. Watch for the above
  8. Note nystagmus (irregular movements) at ends of eye range or midline, convergence of eye gaze (eyes working together), or difficulty crossing midline. A jerk at midline indicates delayed bilateral integration. (48, 55)


A child approximately six years or older should be able to track with his eyes, and easily follow an object for about sixty seconds without needing to turn his head. The eye movements should be sustained, smooth, and symmetrical. If the child's head has to move side to side while following the object, or if the child's eyes show jerking movements, excessive blinking, or have to refocus every few seconds, then we can infer the child has problems with visual tracking.

If a child cannot move his eyes independently from his head, causes may include immaturity in development, low muscle tone in the trunk (the child needs the stability of neck and trunk to maintain smooth movements), torticollis, or stiff neck.

If a jerk at midline is seen, it may be helpful to complete the portions of this assessment that address crossing midline and bilateral integration. A detectable jump at midline could suggest midline-crossing problems, and may interfere with reading, as a child may often lose his place.
Saccadic Eye Movements (not included in this assessment)

Saccadic eye movements are needed for reading and keyboarding. Two tests are available that test saccadic movements in school-age children:

Developmental Eye Movement Test (DEM), and King-Devick Saccade Test (K-D).

According to the AOA’s Clinical Practice Guideline on Learning Related Vision Problems, these tests "simulate reading, using a rapid number-naming strategy in which numbers are placed in horizontal spatial arrays to be read in the left-to-right and top-down fashion of normal reading. The time to complete the task and the number of errors are the clinical outcomes. Presumably, slower and/or error prone performance would indicate poor saccadic eye movement control."
Visual Scanning

Visual scanning observations may include how the student chunks information as he copies; how long it takes the student to find keys; how long it takes the student to find pertinent information on the screen; and how long it takes the student to find his place on his work once he looks away from the material he is copying.

Formal tests are available, but it can be important to observe what the student is actually doing on the keyboard to determine a timed baseline of performance. This is done to document progress and to create activities that address the student’s delay or deficit areas.
Eye-Hand Coordination



Coordination of eyes and hands together is imperative to skilled hand use. A gross observation of eye-hand coordination skills may be made using simple tools. Eye tracking, hand dominance, visual attention, crossing midline, timing, coordination, and possible neglect of one side of the body can be observed while doing this task.

Use a scarf, balloon, ball, bubbles, or tissue to make observations. These each have different properties and elicit different responses. If building rapport is a struggle, this one will break the ice. Kids love it! Just toss the scarf in the air and ask the child to catch it. Watch to see if the child turns his face away from the object as it gets close to him. Can he track the object through its entire course, or do his eyes dart off the object? Does the child ready his hands in anticipation of catching the scarf? How is his timing? Can the child catch the object with either side of the body, or does he fail to catch it if it is thrown to one side? Difficulty with this activity suggests target areas for intervention.
Knowledge of Right vs. Left
Right vs. left orientation skills contribute to a child's sense of visual spatial orientation. Right vs. left skills are very important as they relate to school tasks. Right vs. left skills are very important as they relate to school tasks, especially keyboarding, as both hands are used, and right vs. left often is referenced in typing programs. When writing, right vs. left skills affect a student’s ability to determine where to begin, how to form letters, and where to place information on worksheets. Children should be able to identify right and left on their own bodies first, then on another person’s body, and finally in relation between objects. This is a tiered skill. If the child cannot do the first task, stop. He most likely will not be able to do the subsequent skills.

Five-year-olds may have been taught to identify a side based on a motor function; for example, “I use my right hand for writing.” Identifying right/left on oneself is a skill that should be well developed for a child between the ages of seven and eight. By age eight, children are developing directionality (an awareness of spatial positions of objects outside their bodies). Check this skill by placing three similar objects on the table. Use the phrases, “Pick up the object that is on the left,” or “the object to the right of the blue cube,” etc. Because of this developmental progression, letter reversals are common through first grade and into second grade. (46)

Hand and Arm Strength, Endurance, Coordination, and Tone

Hand and Arm Strength, Endurance, Coordination, and Tone

Underlying tone and strength significantly contribute to a child’s skill and success with keyboarding. A child who fatigues quickly will lose interest, and may do better with accommodations for academic work.
Muscle Testing

Having one’s hands on a moving child provides a dimension of understanding not gained by observation alone. This test is standardized for adults. Although it is not for children, a quick test of muscle strength of a child’s fingers, thumbs, wrists, elbows, and shoulders often reveals valuable information about proximal and distal strength needed to complete fine motor work. A few muscle groups are included in this set of tasks to get a general idea about strength while not overtaxing the child. Wrist extension strength is particularly important for sustained keyboard work.

Following directions is a component of this task, and may reveal information about body awareness, motor planning, and processing, along with strength. A child as young as age four often can follow directions to complete each movement. Prior to that age,observations of the child participating in a variety of functional activities may provide information about strength. For example, connecting pop beads, pulling pop tubes, opening containers, or removing marker caps, and the ability to move across the floor and over obstacles suggests a child has sufficient strength to perform other fine motor tasks.

Children often need more than verbal directions; they need the therapist to demonstrate the positions (visual cuing). At times, therapists need to place the child’s arms and hands in the correct positions, or they may use imagery to help the child understand; for instance, "Put your arms out as if you were going to fly." It is important to note how easily the child follows directions and can assume positions, as it provides information about coordination, motor planning, and body awareness.

Stabilize above the joint being tested, and apply pressure below the joint (see photos). Pressure should be applied and released gradually. The amount of resistance given should match the child’s size and weight. Experience with this type of testing increases confidence regarding the amount of pressure, and muscle grading.

Use of muscle grades are not necessary, as they most likely will be meaningless to most who read the report. However, noting whether the child "demonstrated adequate strength to support fine motor work," or "appears to have decreased muscle strength, which may interfere with the child’s ability to support skilled fine motor work" would be useful to others, and help guide intervention.

Visual examination of the hands may reveal past injuries or structural differences not previously shared or known by parents or teachers. An observation of active range of motion may reveal asymmetry, and trigger an inquiry about previous injuries or musculoskeletal differences. A quick phone call to parents to review the child's medical history if it is not recorded in the child’s file may be helpful.

When performing manual muscle testing, first ask for permission to touch the child, and use simple directions such as those listed below. Muscle testing can be done standing or seated.

Children who are less stable, who need "grounding" because of behaviors, or who are low tone may benefit from being seated when muscle testing is done.



Shoulder Abduction: (Pictured above) “Put your arms out as if you are going to fly, and don’t let me push them down."

Shoulder Flexion: (Pictured above) “Put your arms out as if you are Frankenstein, and don’t let me push them down.”



Elbow Flexion: (Pictured above) “Show me how strong you are, and don’t let me pull your arms away from your body.”
Forearm Supination/Pronation: (No photo shown) Arms hang down next to the body, elbows bent to 90 degrees. Stabilize above the elbows, "test" just above the wrists, gently rotating the arms up or down. Say, “Turn your hands up to the sky, and don’t let me turn them over.” Then instruct, “Flip them over like pancakes, and don’t let me turn them back up to the sky.”



Wrist Extension/Flexion: (Pictured above) “Make your wrist look like this, and don’t let me push it down.”



Finger Flexion: (Pictured above) Make sure your fingernails are short. Say, “Wrap your fingers around mine, and don’t let me open them,” or “Squeeze tight! Don’t let me open your fingers!”
Finger Extension: (No photo shown) Support at the wrist, have the child extend his fingers, and very gently press down. “Straighten your fingers, and don’t let me push them down."



Thumb Flexion: (Pictured above) “Put your thumb in your palm, and don’t let me pull it away.”
Thumb Extension: (No photo shown) Support the hand, demonstrate a "thumbs up" and say, “Put your thumb up, and don’t let me push it down.”




Finger opposition or pinch: (Pictured above) “Make your fingers look like mine, and don’t let me open them.”

More extensive hand- and arm-strength testing may be needed if significant weakness is observed in these brief evaluations. (7)

Make sure to note a child’s general muscle tone. Low-tone muscles are easy to passively manipulate because they are not contracting to resist the movement. Hyper-mobility in joints may be noted. When muscles possess ideal tone, they are contracted to a level that provides stability to the joints, even at rest. When slight force is applied, the muscles can resist immediately. If tone is high, active and passive range might be limited, as muscles constantly contract. (32)
Finger Coordination

Control of the intrinsic muscles of the hand is needed to produce quality fine motor work. Observing tasks outlined here provide additional information about a child’s hand strength and coordination. Completion of the standard finger-touching task is an easy way to assess finger coordination. Have the student touch each finger to his thumb (both hands).







Check for coordination, speed, use of vision for guidance, and motor planning. Often, this is a task children have not done before. Novel motor tasks are useful when observing motor planning skills. Have the child repeat the finger touching on all fingers at least three times. Motor planning can break down with consecutive trials of unfamiliar tasks. Typical children easily complete this task by age four-and-a-half. (17)

If the child is unable to perform this task, downgrade by asking the child to make glasses (pictured above) and put hem on. Demonstrate making circles with the index finger and thumb. If the web space is collapsed, and the child is unable to see you through his "glasses," you might infer low tone or poor coordination.

Poor performance on this task might suggest potential difficulty with keyboarding.



Separation of the sides of the hand is needed to efficiently grasp a writing tool and use it with skill, and individuate fingers for keyboarding. Thumb, index and middle fingers are used for mobility (tripod grasp), and the ring finger and pinkie are tucked and used for stability. Asking students to make chickens (pictured to the right) with their fingers is a fun way to observe separation of the sides of the hand. Just show the child how to tuck in his ring finger and pinkie, and make beaks with the thumb, and pointer and middle fingers.



Making "butterflies" (pictured to the left) is another way to examine finger coordination and separation of the sides of the hand. Connect the index finger and thumb to make the body, and ask the child to "flap the butterfly’s wings." Watch for imitation and motor planning of this task.
Finger Individuation

Observe the child’s ability to depress a single key without moving the other fingers on the same hand while keyboarding, as well as the ability to depress a single key without moving the same finger on the other hand. For example, when one index finger is used, the other remains still. If it occurs, the child might have delays in development of laterality, sidedness, or bilateral coordination.
Gross Motor Skills

It may be very helpful to do a quick check of a child’s large motor skills. Muscle strength, tone, reflex development, motor planning proficiency, and vestibular function all contribute to performance in the classroom. These quick observations can informally assess a child’s quality of movement, and provide clues to address weaknesses in fine motor skill development. If difficulties with large motor skills are apparent, it may be helpful to include a physical therapist or DAPE teacher on the child’s team.

Observe the child’s general muscle tone and fluidity of movement. These observations may be made by completing the following activities:

  • hopping (two- to three-year-old)
  • galloping (three- to four-year-old)
  • skipping (five- to six-year-old)
  • jumping jacks (seven-year-old)


Look for quality of each movement, speed of the child’s body responses, and motor planning proficiency. (40) These skills follow a developmental progression. If the child cannot perform the lower-level skills, stop. Most likely, he will not be able to perform the next skill. It might be best not to continue, to reduce the possibility of feelings of failure. Observe direction following, coordination, and overall quality of movement.
Core Strength/Postural Control

Core strength is the basis for all refined movement. Children need proximal stability before they obtain distal mobility. Postural control impacts vision, oral motor skills, fine motor skills, and gross motor skills.

Postural control starts developing in the womb, as babies are folded into flexed positions. The balance between flexion and extension continues to develop after birth as babies work in and out of different positions. Think of young babies needing to be swaddled to feel calm. This keeps them in a flexed position as they sleep, but as they wake, they move into more extended positions. If they are startled, they extend into the Moro reflex.Either through reflex maturation, natural movements against gravity, or caregiver positioning, they constantly work through flexion and extension.

Watching a baby develop sitting balance is the perfect way to begin to understand where skilled movement originates. At first, a baby can use extension to pick his head up off a caregiver's shoulder, barely working against gravity. Then he is able to lift his head off the floor in prone position, using capital extensors. This is quite a feat, as head size is large relative to body size in infants.

The unrefined movements of babies as they grade and practice sitting, reaching, and standing demonstrates just how much work it is to balance muscle strength and coordination. All this work leads to refined movement of the entire body. The ballistic or jerky movements one observes as babies move eventually refine and smooth out over time. Nerve fibers are myelinated, muscle strength increases, and sensory/motor feedback loops are generated. A motor plan develops for each new skill.

At about four months of age, capital flexors are fully engaging, and we see a chin tuck when babies are moved from supine to a sitting position. Once babies have head control, postural control starts to develop from the shoulder girdle, moving down to the hips. At first, babies need full support at the head, then at the upper trunk, then at the hips. Babies cannot use vision skills or hands efficiently as trunk control develops if they are not provided external stability.

Some children who were prematurely born develop strong extension patterns, as they missed the intense folding in the womb. These children sometimes have weak flexion patterns in the neck and trunk. Avoiding placing these babies in prone, and not using walkers and jumpers sometimes is recommended to avoid promoting those patterns.

Weak chin tucks, poor head control, and unbalanced flexion/extension strength in the head and trunk may lead to poor vision skills, poor eye-hand control, poor oral motor skills, and poor endurance in seated positions.

Checking on this basic skill, and remediating weaknesses through intervention or adaptations might lead to improved outcomes in the classroom. It is critical to use prone extension, supine flexion, and plank positions in your assessments to examine postural control and strength.

Other researchers have quantified supine flexion and prone extension, and we offer those numbers here as a gross guide:

  • Three- to four-year-olds should be able to hold for ten to fifteen seconds.
  • Five- to six-year-olds should be able to hold for fifteen to twenty seconds.
  • Older than six years old should be able to hold for fifteen to thirty seconds.
  • jumping jacks (seven-year-old)


More important than the time it takes in each position is the observation of the child moving into, holding, and moving out of these positions. Watch for chin tuck, breath holding (a search for stability), scapula winging, shoulder girdle instability, head extension, and ease of maintaining each position. The level of effort is important to determine whether a child has proper postural stability and strength to support fine motor, oral motor, and visual work.



Check prone extension (airplane position, pictured above) and supine flexion (egg, pictured right) strength. Do the airplane position for children under six years old with arms at the sides of the body. Children age seven and older should hold their arms out in front of them.





The plank position (pictured above) uses flexion and extension simultaneously. Ask the child to assume the plank position on the elbows. The child should be able to hold the position for approximately ten seconds.

Watch to see if the child is having trouble getting into each position (motor planning/proprioception), or if he is too weak to maintain the position. Watch for segmentation of the body (only able to lift arms or legs, not both). (31)

Trunk instability and/or poor posture affect the quality (smooth vs. choppy) and accuracy of hand and arm movements. (40)

Weakness and instability in the trunk may decrease a child’s ability to remain comfortably seated on the floor or in a chair. If a child is moving a lot in seated positions, this may be a result of low tone or decreased strength. The child is continuously trying to "turn on" his muscles, which can be tiring and distracting. It also may cause a child to stabilize at the shoulder when writing, decreasing fluidity of movement and speed, and increasing the possibility of fatigue. (26) Doing "set-ups," either individually or as an entire class, to activate muscles may help reduce this problem as we work to improve strength. A quick yoga or Pilates break before seated work may improve fine motor outcomes.

This is a good time to check a child’s trunk rotation skills. To check trunk rotation, ask your student to swing a bat, or have him bring both hands together at midline and pretend he is an elephant swinging a trunk.

You also may test trunk rotation by standing behind the child, then asking him to take a ball from one side, and turn to pass the ball to you from the other side. Watch head, eye, and foot movements. Eyes and head should follow the ball as it moves from one side to the other, then move to search for the ball coming from behind on the other side. Watch for loss of balance as the child readjusts to take the ball from the other side. Watch for feet repositioning rather than movement of the trunk. Watch for lack of movement in the trunk, and smooth movement around the core of the body. Try this with someone with no apparent difficulties to get a feel for intact rotation skills. In this task, we are looking at the interplay between the vestibular, visual, and proprioceptive systems. Decreased strength, poor ocular motor skills, or decreased CNS function may cause poor trunk rotation.

Other Skills

Graphesthesia/Tactile Processing

It may be helpful to assess a child’s ability to process tactile information. Poor tactile awareness may interfere with a child’s ability to obtain adequate information from the hands to produce quality fine motor work and interfere with the acquisition of skills needed for keyboarding.

Ask the child to close his eyes, and with a pencil eraser, draw lines and basic shapes on the child’s palm. Use easily recognizable shapes such as a circle, square, or triangle, or easily recognizable letters such as “E,” “L,” or “A.” Use the same letters or shapes on each hand to get a fair read of any difference in dominant vs. non-dominant hands. Move slowly so the child has time to process each shape. Use enough pressure so the child can process the input. Make sure the child knows what these shapes or letters are before you start, by pointing to them on paper and asking what they are. After drawing each shape, have him trace what he felt on the palm with the other hand.




Draw the letters and numbers so they are right-side up for the child. If a child wants the shape repeated, erase his palm by rubbing your fingers across the palm a few times, then repeat. If a child cannot identify what you are drawing, let him watch you draw on the palm. If he then can identify the item, note that he can visually recognize the shape, but can’t process the tactile information. (7) Always show the child which shapes you have drawn to reduce feelings of failure if he can’t do it.
Proprioception/Kinesthetic Awareness

Proficiency in keyboarding requires a student to sense where to position his hands over the keys. While this is the ideal, some students will keyboard by sight, and be functional typists.

Proprioception and kinesthetic awareness relate to feedback and feed forward of information from and to our bodies through our sensory motor systems. Proprioception has been regarded as an unconscious sense. It provides information about the stationary position of body parts and movements. Kinesthesia is a conscious sense, and sometimes is considered a form of proprioception. It provides information about direction of joint movement, and the weight and resistance of objects. These two senses allow for imitation of motor action. If a student has poor proprioception and kinesthetic sense, he may have poor ability to plan and imitate or execute movements; may crash into other children or objects; and may not "sense" a writing tool appropriately in his hand, and apply too much or too little pressure.

Proprioception and kinesthetic senses allow us to initiate a movement, and move with quality. They provide us with an awareness of our body in space. Poorly graded movements, ballistic movements, and delayed movement (either processed slowly or executed slowly) may result from a deficit or delay in these two senses. Some children are unaware of where their body parts are in space. They primarily rely on visual information to tell them how and where to move. (44) Proprioception affects the timing of movements, and the amount of force used; thus it affects the ability to plan motor movements, move smoothly, position the body in relation to objects, and stabilize joints.

Observations of these skills may be done within the context of other tasks (use of vision to guide movements indicates reduced proprioceptive/kinesthetic sense) or directly, with some imitation exercises. Testing a child’s proprioception is a fairly straightforward task; however, the child should have good verbal-direction-following abilities to do this activity. Seat the child facing you. Ask him to close his eyes, and tell the child you are going to move one of his arms, and you want him to move the other arm to the same place/position. Do a demonstration on yourself and let the child move one of your arms, if needed, to clarify the direction. Then move one arm to 90 degrees. Check to see if the child can imitate the posture with his other arm. Try several positions (elbow bent, arm above head, arm straight out with palm up, etc.) The child should be able to approximate each movement with the other side of his body while vision is occluded. (54)

It also may be helpful to perform the Romberg Test. Ask the child to stand with both feet together, with his eyes open. Have him do the same thing with his eyes closed. If a child has difficulty balancing, or demonstrates significant swaying while standing with eyes closed, it indicates poor proprioception. This means he is using visual information to "know" where his body is in space. It is not uncommon for a child to fall over when he closes his eyes. Be prepared to catch or assist a child who cannot maintain an upright position without his vision. Similar information may be gained from watching a child stand on one foot with eyes open, then eyes closed. Another way to test this sense is to ask the child to walk on a line on the floor, eyes open, heel to toe, then eyes closed, heel to toe, making sure to stand near him as he moves.

Practical observations of body sense skills can be made, such as noting grading of pencil pressure, flexion and extension tasks, galloping, and skipping. Poor proprioception (body awareness) indicates the internal sensory feedback needed for accurate motor output is limited or delayed in its development.
Bilateral Coordination

Unlike handwriting, keyboarding requires the use of two hands in a coordinated manner. This is similar to playing a piano. Each hand has a specific job. A review of BOT-2 subtests, and observation of a student doing a typing activity will reveal areas of challenge and skill. Timing, coordinating both hands equally well, and sequencing are important skills. Observing activities such as tying shoes, stringing beads, cutting with scissors, etc., may reveal challenges. Use observations of several skills to strengthen statements about whether supporting skills are lacking or within normal ranges. A student with poor bilateral coordination may concentrate on one hand while being unaware of the other hand, or be unable to easily bring the other hand into the activity.
Motor planning

Motor planning is the ideation, planning, and execution of a motor task. Poor motor planning sometimes is called “dyspraxia.” Automation of motor tasks such as forming letters, or locating keys and striking them in the appropriate sequence can be delayed if a child has challenges with motor planning.

Using a mouse, track pad, and keyboard requires complex motor planning skills. For instance, to use a mouse, a student moves and holds the pointer while depressing or clicking the button, without extra movements. We can observe motor planning during gross motor testing, finger coordination tests, muscle testing, and during keyboarding trials. Observe this skill when a student skips, gallops or performs jumping jacks, or on the playground as the child approaches equipment.
A child who has average motor planning abilities should be able to watch another person perform an age-level task such as one listed above, and imitate it.
General Observations

Taking note of direction following, engagement, interests, and overall impression of the student’s potential following time together, may predict success with intervention, or provide discussion points with parents and staff.

Resources

Bibliography

Bibliography








Instructional Videos

IMG_1848

Related Research Articles