Effectiveness of occupational therapy in remediating handwriting difficulties in primary students: cognitive versus multisensory interventions

Abstract

The purpose of this study was to compare the effect of cognitive versus multisensory interventions on handwriting legibility of primary students referred to occupational therapy for handwriting difficulties. Using a randomized three-group research design, 72 first and second-grade students were assigned to either a cognitive intervention, multisensory intervention, or no intervention (control) group. Letter legibility was measured before and after 10 weeks of intervention. Analysis of variance of difference scores showed no statistically significant difference between the intervention groups. Grade 1 students improved with or without intervention, but grade 2 students showed dramatic improvement with cognitive intervention compared to multisensory intervention (d = 1.09) or no intervention (d = .92). Several students in both grades showed declining performance in the multisensory and control groups, but no students had lower legibility after cognitive intervention. These results challenge current occupational therapy practice of using a multisensory approach for remediation of handwriting difficulties, especially for students in grade 2.