Write, Write, Shake, Shake…Why Some Children Shake Their Hands When They Write and What To Do About It.

Many children hate handwriting, but for some, it can be a labour of pure agony. Have you ever noticed your child shake or rub his hand or elbow while doing homework or writing? If so, this can be a sign of poor handwriting endurance.

Write Write Shake Shake

I don’t know about you, but I remember the ache of writing final exams, those 3 hours of agony, trying to block out the pain of throbbing elbows, pulled up shoulders and aching fingers. It was only later when I realised that this wasn’t normal. While everyone got sore and tired hands, they didn’t feel the extent of pain I felt in exams. Now, as an OT, I am particularly conscious of how children experience the act of handwriting. Typically, handwriting instruction focuses on teaching children the mechanics of forming letters, spacing them correctly, resting them on the line, etc. But little focus is given to handwriting endurance because so little is known about it and awareness is lacking, particularly in those who have never really experienced these challenges.

Handwriting endurance is the ability to maintain handwriting over long periods of time. This time will depend on the age/grade of the child, but young children would only be able to write for 5-10 minutes, while secondary school pupils are expected to write exams of 2-3 hours (and sometimes more). In order to maintain handwriting for this period of time, we need a lot more than just strong fingers. Here’s what goes into the seemingly simple task of handwriting:

Postural Control: We need to be able to hold a stable position in your chair and hold your weight up through your spine (not slumped over leaning your head on your arm/hand.

Muscle Tone: The tension in our muscles not under conscious control is called muscle tone. This prepares us for functioning. If this tone is lower, a child can appear “floppy” and may have poor joint stability (see below). A number of children are born with lower muscle tone and some children don’t get the opportunity to develop their muscle tone in the early years. Muscle tone is probably one of the biggest factors in handwriting endurance. If our tone is low, we need more strength in the muscles to achieve the same thing as another child/adult would. Although there are strategies that can improve muscle tone (see below), these are short-lived and need to be repeated before every handwriting exercise if a child’s tone is lower.

Joint Stability: Stable joints are necessary for effective function. Joints are held in place by ligaments and muscles (via the tendons). Where a child has looser ligaments or lower muscle tone, the child may seem hypermobile, have joints that bend back further than expected and/or complain of pain when writing. These children can sometimes also develop a very tight pencil grasp to compensate for this instability.

Muscle strength: The strength that are in the individual muscles used for handwriting, from the shoulder muscles down to the smaller finger muscles, these are all important. Muscle strength, as in the case with most muscles, can be improved with exercise (see below).

What to do about it?

The old adage “They will get used to it” only applies to typically developing children with no difficulties in joint stability or muscle tone. If your child complains of sore hands, or shows other signs of poor handwriting endurance (e.g. rubbing their hands, elbows or shoulders or shaking the hand or arm out), it is suggested that you follow up with an occupational therapist. In some cases, your child may need some simple remediation, or it is possible that your child needs to use a computer instead of handwriting. But here are some useful strategies you can use in the meantime:

Work on a vertical surface: Working on blackboards or white boards or taping work to windows or walls helps build on shoulder strength and postural control.

Do active games with the shoulders and arms: Play wheelbarrow races, swing a bat or carry in the shopping bags. These activities will also strengthen the shoulders and improve postural control. However, an important word of caution: If your child bends their elbows back (further than a straight line), don’t let your child do any weight-bearing activities on their arms such as wheelbarrows or handstands. These could further stretch and weaken the joints. If your child has noticeable joint hyper-extension in their elbows, you may want to check with your GP, physiotherapist or occupational therapist if this needs further examination.

Do resistive activities with the hands: Finger strength can be built up through art-and-craft type activities that have resistance. For younger children this would include play dough, buttons, baking (especially kneading dough), etc., while older children/teens could use clay, elastics (e.g. loom bands) and baking.

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