Geometric-Based Handwriting Intervention: Development, Feasibility and Randomized Clinical Trial

Chinese Legibility Scale is the self-develop assessment tool to investigate a child's handwriting legibility objectively. Children will be asked to copied 10 Chinese characters on paper within 2*2cm squares to complete the copying paper. Meanwhile, the performance time will be recorded when the child start writing the firs stoke until finish the last stroke of the last character. These Chinese characters are selected from three versions of current mandarin textbooks according to each grade and those with high-frequency and around the average stroke counts will be chosen. Then, characters can be classified into five types of structures based on the visual similarity of character, including top-down (vertical), left-right (horizontal), P-shaped, L-shaped and enclosed. Ultimately, there are 20 characters in total for each grade with five types evenly. The scale will be scored by a therapist blind to the experiment to decide children's writing legibility.

The CHEF is an observational assessment designed to objectively measure the handwriting performance of school-aged children. It is composed of 25 items and divided into five main dimensions, including construction, accuracy, direction of the characters, writing speed and pencil grip. Items are descriptions of common writing problems by scored on 5-point Likert scale according to the frequency of the problem.

The DTVP-3 is commonly used as a standardized and norm-referenced test to assess visual perception skills for children aged 4 through 12 . The testing time will range from approximately 20 to 40 minutes depending on the child's ability. It is composed of 5 subscales: eye-hand coordination (EH), copying (CO), figure-ground (FG), visual closure (VC) and form constancy (FC). The result of the five subtests can be combined to form three composites: motor-enhanced visual perception, motor-reduced visual perception, and general visual perception. The first two subtests involve motor-enhanced visual perception skills and are summed together to represent visual-motor integration abilities. The latter three subtests (FG, VC and FC) are non-motor involved and are summed together to represent motor-reduced visual perception. The combination of motor-enhanced and motor-reduced visual perception could be the general visual perception skills.

The Beery-Buktenica Developmental Test of Visual-Motor Integration is a standardized, norm-referenced test to assess visual-motor integration. During the test, the child is required to copy a series of geometric designs, and his/her performance is compared with standard criteria and reference designs.

The PMQ is an activity-based measurement of motivation and is designed to measure motivation and the experience of receiving specific therapeutic activities . The items of PMQ are modified from existing questionnaires Pediatric Motivation Scale and based on tenets of self-determination theory. The PMQ consists 12 items containing three motivation domain: (1) extrinsic motivation, (2) basic psychological needs, and (3) intrinsic motivation by 5-point Likert scale. The PMQ represents the motivation condition through the intervention from children their own view. In addition, several open-ended questions are added in children's version to reflect perspective of children while receiving the VPMCI program to obtain qualitative information.