Sensory Motor Lateralization as Handwriting Intervention in School-Based OT

Developmental Dysgraphia Clinical Trial

— SML  

Official title:

Handwriting Intervention, With vs. Without a Rightward Bias, in a Junior High School-A Randomized Controlled Study

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03903614
• Other study ID #: TengM
• Secondary ID: Conventional Sch
• Status: Completed
• Phase: N/A
• Start date: September 12, 2012
• Est. completion date: June 12, 2013

Study information

• Verified date: April 2019
• Source: Teng, Mary H.
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Children who attend School-Based Occupational Therapy (SBOT) show mixed dominance and a liable decreased in the structural and functional differentiation between the two hemispheres. The lack of right-left disparity has been found to link to mirror invariance, poor spatial organization, fragmentary reversals, and handwriting difficulty. This study intends to find out, whether, Sensory Motor Lateralization (SML), "With" a rightward bias, profits handwriting more than the conventional (CON) "Without".

Description:

10 to 30% of school children suffer handwriting difficulty. Many of them are eventually referred to SBOT for remedial intervention. Among these children, 70% show mixed dominance in their hand and/or leg use, and a likely functional and structural interhemispherical asymmetry reduction. This would make them right-left symmetrical. Learning, thus, may be challenged, because people who are right-left balanced would not have a consistent reference point to process the learning materials regularly in any pre-determined directions. They are, thus, prone to suffer mirror invariance, fragmentary reversal errors, and handwriting difficulty, especially with the fast and accurate construction of asymmetrical letters from memory.

To enhance right-left disparity, dispel mirror invariance, and facilitate the automatized handwriting, SML preferentially belabors one's right eye, ear, hand and leg in therapy, that would greater engage the left hemisphere for its acclaimed vantages over learning. This study investigates, whether SML, wielding such a rightward bias, profits handwriting greater than CON.

Other known NCT identifiers

• NCT03514992

Recruitment information / eligibility

• Status: Completed
• Enrollment: 16
• Est. completion date: June 12, 2013
• Est. primary completion date: January 4, 2013
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• Any Special or Regular Education students with Individualized Education Plans (IEPs), OT mandates, and handwriting goals.

• Has Intelligence Quotient (IQ) equal to or above 60.

• Ambulatory.

• Proficient in English, and fluent in naming, identifying, and accessing the sequence of letters in the alphabet.

• The students who attend Physical Therapy (PT), Adaptive Physical Education (PE), and any other programs are included, if the programs being provided are skill-, theme-, or task-oriented, not involving any muscle strengthening activities.

Exclusion Criteria:

• All are excluded, if the study candidates have any medical condition(s) that would prohibit them from the full physical participation in school.

Related Conditions & MeSH terms

• Agraphia
• Developmental Dysgraphia

Intervention

Behavioral:
• SML
SML consists of supervised handwriting practice, fitness exercises, and fine motor speed drills that preferentially belabor a participant's right eye, ear, hand and leg during therapy.
• CON
CON consists of supervised handwriting practice, fitness exercises, and fine motor speed drills on the participant's dominant hand.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Mary H. Teng

References & Publications (23)

Adi-Japha E, Landau YE, Frenkel L, Teicher M, Gross-Tsur V, Shalev RS. ADHD and dysgraphia: underlying mechanisms. Cortex. 2007 Aug;43(6):700-9. — View Citation

Anguera JA, Russell CA, Noll DC, Seidler RD. Neural correlates associated with intermanual transfer of sensorimotor adaptation. Brain Res. 2007 Dec 14;1185:136-51. Epub 2007 Oct 11. — View Citation

Assmus A, Marshall JC, Noth J, Zilles K, Fink GR. Difficulty of perceptual spatiotemporal integration modulates the neural activity of left inferior parietal cortex. Neuroscience. 2005;132(4):923-7. — View Citation

Bryden PJ, Bruyn J, Fletcher P. Handedness and health: an examination of the association between different handedness classifications and health disorders. Laterality. 2005 Sep;10(5):429-40. — View Citation

Coghill RC, Gilron I, Iadarola MJ. Hemispheric lateralization of somatosensory processing. J Neurophysiol. 2001 Jun;85(6):2602-12. — View Citation

Corbetta M, Shulman GL. Control of goal-directed and stimulus-driven attention in the brain. Nat Rev Neurosci. 2002 Mar;3(3):201-15. Review. — View Citation

Davidson RJ, Jackson DC, Kalin NH. Emotion, plasticity, context, and regulation: perspectives from affective neuroscience. Psychol Bull. 2000 Nov;126(6):890-909. doi: 10.1037/0033-2909.126.6.890. Review. — View Citation

Dundas EM, Plaut DC, Behrmann M. The joint development of hemispheric lateralization for words and faces. J Exp Psychol Gen. 2013 May;142(2):348-58. doi: 10.1037/a0029503. Epub 2012 Aug 6. — View Citation

Granert O, Peller M, Gaser C, Groppa S, Hallett M, Knutzen A, Deuschl G, Zeuner KE, Siebner HR. Manual activity shapes structure and function in contralateral human motor hand area. Neuroimage. 2011 Jan 1;54(1):32-41. doi: 10.1016/j.neuroimage.2010.08.013. Epub 2010 Aug 12. — View Citation

Hirnstein M, Bayer U, Ellison A, Hausmann M. TMS over the left angular gyrus impairs the ability to discriminate left from right. Neuropsychologia. 2011 Jan;49(1):29-33. doi: 10.1016/j.neuropsychologia.2010.10.028. Epub 2010 Oct 28. — View Citation

Hirnstein M, Hugdahl K, Hausmann M. How brain asymmetry relates to performance - a large-scale dichotic listening study. Front Psychol. 2014 Jan 2;4:997. doi: 10.3389/fpsyg.2013.00997. eCollection 2014. Erratum in: Front Psychol. 2014;5:58. — View Citation

Hlustík P, Solodkin A, Gullapalli RP, Noll DC, Small SL. Functional lateralization of the human premotor cortex during sequential movements. Brain Cogn. 2002 Jun;49(1):54-62. — View Citation

Hoy MM, Egan MY, Feder KP. A systematic review of interventions to improve handwriting. Can J Occup Ther. 2011 Feb;78(1):13-25. Review. — View Citation

Hughes CM, Reissig P, Seegelke C. Motor planning and execution in left- and right-handed individuals during a bimanual grasping and placing task. Acta Psychol (Amst). 2011 Sep;138(1):111-8. doi: 10.1016/j.actpsy.2011.05.013. Epub 2011 Jun 12. — View Citation

Jäncke L. A differential effect of concurrent verbal activity on right arm movements rightwards and leftwards. Cortex. 1993 Mar;29(1):161-6. Erratum in: Cortex 1993 Jun;29(2):366. — View Citation

Lee DR, Kim YH, Kim DA, Lee JA, Hwang PW, Lee MJ, You SH. Innovative strength training-induced neuroplasticity and increased muscle size and strength in children with spastic cerebral palsy: an experimenter-blind case study--three-month follow-up. NeuroRehabilitation. 2014;35(1):131-6. doi: 10.3233/NRE-131036. — View Citation

Mazziotta JC, Phelps ME. Human sensory stimulation and deprivation: positron emission tomographic results and strategies. Ann Neurol. 1984;15 Suppl:S50-60. — View Citation

Peters M, Reimers S, Manning JT. Hand preference for writing and associations with selected demographic and behavioral variables in 255,100 subjects: the BBC internet study. Brain Cogn. 2006 Nov;62(2):177-89. Epub 2006 Jun 23. — View Citation

Sabaté M, González B, Rodríguez M. Brain lateralization of motor imagery: motor planning asymmetry as a cause of movement lateralization. Neuropsychologia. 2004;42(8):1041-9. — View Citation

Saugstad LF. Cerebral lateralisation and rate of maturation. Int J Psychophysiol. 1998 Jan;28(1):37-62. Review. — View Citation

Schott GD. Mirror writing: neurological reflections on an unusual phenomenon. J Neurol Neurosurg Psychiatry. 2007 Jan;78(1):5-13. Epub 2006 Sep 8. Review. — View Citation

Vingerhoets G, Acke F, Alderweireldt AS, Nys J, Vandemaele P, Achten E. Cerebral lateralization of praxis in right- and left-handedness: same pattern, different strength. Hum Brain Mapp. 2012 Apr;33(4):763-77. doi: 10.1002/hbm.21247. Epub 2011 Apr 15. — View Citation

Vingerhoets G, Sarrechia I. Individual differences in degree of handedness and somesthetic asymmetry predict individual differences in left-right confusion. Behav Brain Res. 2009 Dec 1;204(1):212-6. doi: 10.1016/j.bbr.2009.06.004. Epub 2009 Jun 10. — View Citation

* Note: There are 23 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	SML excels CON in Visual Motor Integration	Assess by the Developmental Test of Visual Motor Integration (DTVMI). The minimum is 0, and the highest is 30. The higher scores represent better treatment outcome	Change from Baseline raw score at 3 months
Other	SML excels CON in Visual Perception	Assess by the Developmental Test of Visual Motor Integration (DTVMI). The minimum is 0, and the highest is 30. The higher scores represent better treatment outcome.	Change from Baseline raw score at 3 months
Other	SML excels CON in Motor Coordination	Assess by the Developmental Test of Visual Motor Integration (DTVMI). The minimum is 0, and the highest is 30. The higher scores represent better treatment outcome	Change from Baseline raw score at 3 months
Primary	SML excels CON in manuscript letter legibility	Assess by the percent accuracy score of manuscript letter legibility derived from the Wold Sentence Copying Test (WSCT). TThe letter legibility score was calculated by counting the total number of letters the participant wrote minus the writing errors per THS-R criteria, divided by the total number of characters written, and multiplied by 100. The minimum is 0, and the maximum is 100. The higher values represent better treatment outcome.	Change from Baseline percent accuracy score at 3 months
Primary	SML excels CON in script letter legibility	Assess by the percent accuracy score of script letter legibility derived from the Wold Sentence Copying Test (WSCT). The letter legibility score was calculated by counting the total number of letters the participant wrote minus the writing errors per THS-R criteria, divided by the total number of characters written, and multiplied by 100. The minimum is 0, and the maximum is 100. The higher values represent better treatment outcome.	Change from Baseline percent accuracy score at 3 months
Primary	SML excels CON in manuscript transcription speed	Assess by WSCT.Speed was derived from the total number of letters written timed 60, divided by the total number of seconds used, and recorded as number of letters per minute. The minimum is 0, and there is no maximum. The higher values represent better treatment outcome.	Change from Baseline letters per minute at 3 months
Primary	SML excels CON in script transcription speed	Assess by WSCT. Speed was derived from the total number of letters written timed 60, divided by the total number of seconds used, and recorded as number of letters per minute. The minimum is 0, and there is no maximum. The higher values represent better treatment outcome.	Change from Baseline letters per minute at 3 months

External Links

•   Bédard, P., Wu, M., & Sanes, J. N. (2011). Brain Activation Related to Combinations of Gaze Position, Visual Input, and Goal-Directed Hand Movements. Cerebral Cortex, 21(6), 1273-1282.
•   Beeson, P. M., Rapcsak, S. Z., Plante, E., Chargualaf, J., Chung, A....Trouard, T. P. (2003). The neural substrates of writing: A functional magnetic resonance imaging study. Aphasiology, 17(6/7), 647-665.
•   Corballis, M. C. (2014). Left brain, right brain: facts and fantasies. PLoS Biology, 12(1), e1001767.
•   Feder, K. P., & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine and Child Neurology, 49(4), 312-7
•   Frey, S. H. (2008). Tool use, communicative gesture and cerebral asymmetries in the modern human brain. Archives of Philosophical Transactions of the Royal Society of London Biological Sciences, 363, 1951-7.
•   Gonzalez, C. L. R., Ganel, T., & Goodale, M. A. (2006). Hemispheric specialization for the visual control of action is independent of handedness. Journal of Neurophysiology, 95, 3496-3501.
•   Gotts, S. J., Jo, H. J., Wallace, G. L., Saad, Z. S., Cox, R. W., & Martin A. (2013). Two distinct forms of functional lateralization in the human brain. Proceedings of the National Academies of Sciences of USA, 110(36), E3435-344
•   Guerraz, M., Blouin, J., & Vercher, J. L. (2003). From head orientation to head control: evidence of both neck and vestibular involvement in hand drawing. Experimental Brain research, 150, 40-9.
•   Heilman, K. M., Howell, G., Valenstein, E., & Rothi, L. (1980). Mirror-reading and writing in association with right-left spatial disorientation. Journal of Neurology, Neurosurgery, and Psychiatry, 43(9), 774-80.
•   Sibley, B. A. and Jennifer L. Etnier, J. L. (2003). The relationship between physical activity and cognition in children: A meta-analysis. Review Article. Pediatric Exercise Science, 15, 243-256.
•   Weintraub, N., & Graham, S. (2000). The contribution of gender, orthographic, finger function, and visual-motor processes to the prediction of handwriting status. The Occupational Therapy Journal of Research, 20(2), 121-140