Enhancing Handwriting Performance of Children with Developmental Coordination Disorder (DCD) Using Computerized Visual Feedback

Abstract

Recent studies have analyzed the writing metrics of children with developmental coordination disorder (DCD) using computerized systems. To date, the use of computerized visual feedback to improve handwriting has not been investigated. This study aimed to examine the effects of computerized visual feedback on handwriting performance in time, spatial orientation, and pressure indices for children with DCD. Twenty-seven children aged 7 to 12 years with DCD assessed by the Movement Assessment Battery for Children and the Developmental Coordination Disorder Questionnaire received one weekly intervention session for 8 weeks, during which they twice copied an excerpt onto a tablet. Once, they received visual feedback where the writing color corresponded to the degree of pressure on the writing surface, and once they received no visual feedback. The two conditions were counterbalanced throughout the sessions. Pre-intervention sessions were compared with post-intervention sessions and with new texts for time, spatial orientation, and pressure measures. The findings revealed significantly decreased total and mean letter writing, in-air, and writing time and increased capacity in the visual feedback condition. In the spatial variables, a significant decrease in letter height variance was found. Pressure increased significantly throughout the intervention with visual feedback, whereas it decreased post-test in the writing task in both conditions and was maintained in the new text. Visual feedback intervention can increase the kinesthetic-haptic feedback required to regulate pressure during writing, promoting more efficient feedforward processes and improving output quality and capacity. The training effectiveness was transferable, and the intervention accessibility could increase student autonomy.

Keywords: handwriting; intervention; pressure; regulation; spatial; temporal; visual feedback.

Figure 1

Example of the writing color change according to the degree of pressure on the tablet in an intervention session. Note: Red indicates high pressure on the tablet surface, whereas black indicates appropriate pressure.

Figure 2

Study design demonstrating the flow of randomly counterbalanced feedback conditions throughout the sessions.

Figure 3

Pre- and post-intervention temporal measures of writing with visual feedback. * p < 0.05; ** p < 0.01; *** p < 0.001.

Figure 4

Interaction effect between the total writing time (pre- and post-intervention) X group (with and without visual feedback). * p < 0.05; *** p < 0.001.

Figure 5

Pre- and post-intervention spatial measures of writing with visual feedback. * p < 0.05.

Figure 6

Differences in the number of (non-omitted) letters written. * p < 0.05; *** p < 0.001.

Figure 7

Writing pressure pre-intervention (first session) and post-intervention (eight session) with and without visual feedback.

Figure 8

Writing pressure pre-intervention (first session) and post-intervention (eighth session), with and without visual feedback.