1: Teaching Handwriting to Young Children with Visual Impairment: Multi-Sensory Strategies & Intervention
Joan Henriksen, MOTz
Kitty Edstrand, Ph.D. TSVI/COMS
NMSBVI-Early Childhood Program
2: Background/Introduction
•	NMSBVI Early Childhood Program OT and former classroom teacher
•	Study was collaboration with Dr. Savaiano at University of Nebraska
•	This presentation is a result of that collaboration and what we truly learned in our study!
3: NMSBVI Early Childhood Program
•	Setting: center-based preschool program for children with visual impairments
•	Participants
o	All in same classroom, most were at age/grade level in instruction. 
o	Receive instruction in academic subjects, ECC, and therapy support as appropriate
o	Joan was OT assigned to this classroom
o	Attend all day 4 days a week
o	5 students
4: What questions prompted this study?
•	The instruction of a visual learning (print) media to a child with a visual impairment is a unique challenge.
•	Direct and thoughtful instruction is needed to bridge the gap that is created by a lack of incidental learning.
•	Literacy statistics demonstrate the need for evidence-based instruction in print literacy for students who are blind or visually impaired.
•	Literacy is not only reading but writing. There are strategies for low vision students to access reading print but what about writing print?
5: What question prompted this study?
Do we have handwriting programming on the market that can meet this need for preschool and kindergarten students with visual impairments who are print learners?
6: Learning Without Tears
Why did we choose Learning Without Tears?
•	Nationally recognized and implemented program that is already often used with students with visual impairments
•	Ease of modifying up or down for students as needed
•	Emphasis on multi-sensory learning including:
o	Manipulatives
o	Writing boards with tactile components
o	Music and movement-based learning
7: Learning Without Tears Materials
•	Mat Man
•	Wooden Pieces
•	Chalkboard
•	My First School Book
(picture of students and teacher sitting on floor in a preschool classroom with LWT matman (wooden pieces for head and limbs, blue mat for body) laid out on floor in middle of circle)
8:HWT “Kit”
picture of HWT kit: wooden pieces, workbook, chalkboard, blue mat
9: Preschool Workbook
picture of green “My First School Book” preschool workbook part of the curriculum
10: picture of page L from Prek workbook
Each workbook letter page shows how to build the letter with the pieces, draw it on the chalkboard along the top. The middle as a picture of something that starts with the letter for kids to color in (lizard for L), and 4 tiny smiley faces and light gray letter along the bottom for child to trace.
11: Research Questions
1.	Is the LWT preschool curriculum appropriate and feasible “as-is” for students with visual impairments/low vision?   Can students who are visually impaired learn letter formation using the LWT curriculum as it is written?
2.	Does the LWT preschool curriculum teach the skills it claims to teach to students with visual impairments?
12: Method
•	Learning Without Tears curriculum
•	Single-case design across letters
o	Tier 1: L
o	Tier 2: E, F
o	Tier 3: H, T
13: Data Collection
•	Video performance, final writing samples
•	Participants were not given instruction during the probe and were simply instructed "Make your worksheet look like mine. Trace here and write here" 
•	Probes were collected to gather baseline, post-intervention. maintenance
14: Scoring
1.	Mechanics: tracing, horizontal and vertical lines, starting at the top, sequence of strokes
2.	Accuracy: how well they traced the model or stayed within writing space on the probe
•	Could only score for accuracy if mechanics was 100%
•	Each letter (L, E, F, H, T) had unique point value.
•	Probes had 4 opportunities
•	Dependent variable was number of total points per probe
15: Scoring 2
Walk through example with L
16: Procedure
1.	Probe(s) before group lesson
2.	Group lessons: 
o	Full Instruction (Day 1)
o	Warm-up (song/motor activity)
o	Sight read letter
o	Model writing letter
o	Wooden pieces (each student)
o	Letter worksheet (from book)
•	Identify Letter
•	“Look and Learn”
•	“Color and Draw”
•	“Trace and write”
3.	Reinforcement lessons were based off LWT curriculum “practice activities”
o	Warm-up
o	Sight read letter
o	Model writing letter
o	Students write letter 3-4 times with feedback from adult

4.	Reinforcement 1: White board
5.	Reinforcement 2: Chalkboards
6.	Reinforcement 3: Wooden piece
 	Thursday	Friday	Monday	Tuesday	
Week 1	Full Instruction	Reinforcement 1	Reinforcement 2	Reinforcement 3	
Week 2	Reinforcement 1	Reinforcement2	Reinforcement 3	Reinforcement 1	
17: Participants
Name 	Age 	Diagnoses	Related Services 	Vision 	Learning Media 	
Student A: Andrew	4 yr 1 mo 	Ocular Albinism 
Nystagmus 
Amblyopia 	O&M 	CNSM 	Dual 	
Student B: Allison	3 yr, 11 mo 	Cerebral Visual Impairment, Esophoria  	OT, PT, O&M 	20/30 	print 	
Student C: Claire	3 yr 7 mo 	Retinal Dystrophy (Leber’s Congenital Amaurosis)  
Strabismus 
Exophoria nystagmus (strab surgery 11/2021) 	O&M 	F&F 	Dual 	
Student D: Brian	3 yr, 11 mo 	Optic Nerve Hypoplasia 	OT, PT, O&M 	Brief F&F 	braille 	
Student E: John	3 yr, 7 mo 	Hyperopia and CVI 	OT, PT, SLP, O&M 	CSM 	print 	
18: Student A: Andrew
•	single case graph of Andrew’s performance
19: Student A: Andrew Summary
Andrew began the study with the highest level of skill. He was able to easily trace the letters accurately but sometimes struggled with the proper mechanics. At the end of the school year, he was able to write all letters from a model and write some from memory. He was also able to write his full name from memory.
20: Andrew Examples
Pictures of Andrew’s writing probes baseline and Intervention letter F
Pictures of Andrew’s writing samples baseline and intervention letter F
21: Student B: Allison
•	single case graph of Allison’s performance
22: Student B: Allison Summary
Allison liked to do things her own way. She got bored of tracing the letters and initiated writing them from memory on her own.
23: Allison Examples
Pictures of Allison’s writing probes baseline and Intervention letter E
Pictures of Allison’s writing samples baseline and intervention letter H
24: Student C: Claire
•	single case graph of Claire’s performance
25: Student C: Claire Summary
When Claire was working on tracing her letters, she had difficulty with tracing in the proper mechanics and preferred to keep her crayon on the paper. She produced a loopy tracing that was accurate but did not follow proper mechanics. When she was copying from memory or from a model, she was able to use proper mechanics to complete the activity.
26: Claire Examples
Pictures of Claire’s writing probes baseline and Intervention letters E and F
Pictures of Claire’s writing samples baseline and intervention letter H and T
27: Students D and E –Brian & John
•	single case graphs of Brian and John’s performance
28: Students D and E –Brian & John
Brian started out with the least amount of pre-writing skills, his IEP goal for OT focused on being able to make dark marks on paper and sustain a writing stroke. While his progress was not measured by the study, he did sustain his ability to color and write. At the end of the school year, he was working on is signature of his first and last initial.

John began the study having difficulty focusing and combining his motor skills with vision for tracing. While his progress was also not measured by the study, he began to trace lines and attempt to write.
29: Brian Examples
•	picture of Brian’s L workbook page with physical guidance and independent practice
•	picture of Brian’s T workbook page with no physical guidance and independent practice
30: John Examples
•	picture of John’s writing probes baseline and intervention L and H 
31: The next year
•	Follow-up on participants the next school year
32-33: Discussion/Limitations
Were the study parameters appropriate?
•	Our scoring was very strict
•	Focus on tracing vs. writing (developmental appropriateness)
•	Students were engaged in the curriculum lessons and activities; the probes were the hard part
Probe Fatigue
•	-rubbing eyes or removing glasses
•	-laying head down 
•	-rocking the desk or chair
•	-leaving the activity
We wanted this to be a fun activity for the students, so any signs of stress were honored, and they were allowed to “quit” at any time.
34: Future Directions/Questions
•	More holistic approach to scoring: “Does it look like the letter?”
•	Sequence of strokes is important for developing motor memory of the letter
•	If tracing is not an effective print learning strategy for students with visual impairments? What would be a better one?   Will these students be best served by keyboarding?
35: Activity Ideas
36: Resource:
Learning Without Tears https://www.lwtears.com/
37: Contact
Kitty Edstrand- KittyEdstrand@nmsbvi.k12.nm.us
Joan Henriksen- JoanHenriksen@nmsbvi.k12.nm.us