Haptic Guidance to Support Handwriting for Children With Cognitive and Fine Motor Delays.

Handwriting is an essential skill for developing sensorimotor and intellectual skills in children. Handwriting constitutes a complex activity relying on cognitive, visual-motor, memory and linguistic abilities, and is therefore challenging to master, especially for children with learning difficulties such as those with cognitive, sensorimotor or memory deficits. Recently-emerged haptic guidance systems have a potential to facilitate the acquisition of handwriting skills in both adults and children. In this paper we present a longitudinal experimental study that examined the effects of haptic guidance to improve handwriting skills in children with cognitive and fine motor delays as a function of the handwriting complexity in terms of visual familiarity and haptic difficulty. A haptic-based handwriting training platform that provides haptic guidance along the trajectory of a handwriting task was utilized. 12 children with cognitive and fine motor delays defined in terms of intellectual difficulty (IQ score) and mild motor difficulty in pincer grasp control, participated in the study. Children were divided into two groups, a target group and a control group. The target group completed haptic-guided training and pencil-and-paper test whereas the control group took only the pencil-and-paper test without any training. A total of 32 handwriting tasks was used in the study where 16 tasks were used for training while the entire 32 tasks were completed for evaluation. Results demonstrated that the target group performed significantly better than the control group for handwriting tasks that are visually familiar but haptically difficult (Wilcoxon signed-rank test, p 0.01). An improvement was also seen in the performance of untrained tasks as well as trained tasks (Spearman's linear correlation coefficient, 0.667; p = 0.05). In addition to confirming that haptic guidance can significantly improve motor functions, this study revealed a significant effect of task difficulty (visual familiarity and haptic complexity) on the effectiveness of haptic guidance for handwriting skill acquisition for children with cognitive and fine motor delays.