An Innovative method of yogic technique “Hand stretchbreathing” in correcting poor hand writing

Introduction

Proficient handwriting is an integral part of education system to meet the common demands of class room especially for school going children and to test the knowledge of a student in academic subjects. Studies says that 30% to 60% time of a child is spent in fine motor activity for writing as the most predominant task .The hand writing skill is an important prerequisite for successful academic accomplishment. Unfortunately difficulties in hand writing are the commonest problem seen in primary school children especially in boys.

Handwriting skill is emphasized in the elementary grades, and students with poor hand writing may have lowered self-esteem and frustration because of their inability to express their ideas fully in written form. There is an indisputable role of proximal and distal muscular activity of upper limbs in developing hand-writing task. It is also proved that there is a relation between the muscle activity with the speed and quality of writing. Another essential foundation of hand writing skill is fine motor control, which is a must to guide the pencil through required formation. Similarly motor planning is required to reproduce the required shape accurately. The grip and motor responses involved in hand writing become automatic in most children, where as many struggle to master hand writing skills .

“Samathwam yoga uchyathe ” Yoga is the way of living to attain stability in physical, mental and social realm .Stable and comfortable posture is called Asana. By stabilizing the body through such practice with alignment strength and grace, one can stabilize and quite the mind also. Pranayama is the act of controlling movement of inhalation and exhalation of breath with the result that the mind again quite but inwardly alert .which has profound influence on body and mind. In yogic breathing exercises, breathing is synchronized with physical movements to impart all the possible benefit in physical ,mental and emotional components.

Hand stretch breathing is one among yogic breathing exercise in which shoulders are in flexion ,Elbows in extension, wrist in extension and proximal and distal inter phallyngeal joints in hyper extension .Stretch and release of proximal and distal muscles of upper extremity occurs in these steps with stimulation of fine motor activity of hands . As the breathing regulation is done along with stretch and relaxation , it also influences the brain , calms the mind & improves attention ,concentration and memory along with strengthening the muscles of upper limb.

Materials and Method

A study in the children with poor hand writing was carried out in the department of clinical yoga at Ayushkameeyam Ayurvedic Child and Adolescent care center (ACACC), Purakkattiri, Kozhikode,Kerala .

Method: A Sample size of 50 was randomly selected from the patients with presenting complaint of poor hand writing from the department of special education.

Selection criteria: Criteria selected for poor hand writing are 1) Failure to start at or drift away from the margin 2) Letters of incorrect or uneven size , height or spacing within the word 3) Malformed letters 4) Substitution or omission of a letter or word 5) Improper pencil holding 6) Very slow in writing 7) Non legibility. Patients with 2 or more of above criteria noted from special education department are trained and advised to do Hand stretch breathing 20 times every day for two months continuously in the morning.

Assesment criteria: The characteristics of selection criteria are assessed on the day first before starting the therapy in an ordinal scale with 6 categories ranging from 0 to 5 . Then the hand writing are grouped in to 4 leves such as

a) Level 1:Very poor hand writing ( score 25 and above)

b) Level 2:Poor hand writing ( score 15 to 25 )

c) Level 3:Acceptable hand writing ( score 10 to 15)

d) Level 4:Good hand writing ( score 0 to 10)

The scores are counted and each child’s total score are used to determine the improvement in handwriting skill by comparing with the score obtained after therapy.

Hand stretch breathing: Here one has to stand in Thadasana by resting the palm in front of the chest with interlocked fingers. While inhaling, stretch the arms straight out at shoulder level in front of the body keeping fingers interlocked with a simultaneous twist of hand so that the palm faces forward. While exhaling, reverse the steps and bring back the palms to rest on the chest. The same steps may be repeated by stretching the arms above the forehead at an angle of 135 degree and vertically above the head at an angle of 180 degree.

Inclusion criteria

• Children between 5 to 15 years

• Subjects fulfilling 2 or more of the selection criteria

Exclusion criteria

• Physical disabilities with upper limb muscle power less than grade 4

• Severe mental retardation

Result: The result suggest that 92% of the children showed significant improvement in hand writing skill after 2 months of regular practice of Hand stretch breathing. Out of 50 participants 7 participants shown improvements in such a way that there is significant improvement in terms of progression in levels. An average of 4 scores have been improved in children when compared with previous scores done before therapy even though it does not make any up gradation in levels. 2 children progressed from very poor hand writing category to poor hand writing category and from poor hand writing to acceptable level. 3 children reached from acceptable level to good handwriting category. 4 participants did not show any change in scores. 50% of the children within good hand writing category shown an improvement of an average of 5 scores. It is found that there is maximum of improvements seen in ability to start on margin, speed of writing, letter size and formation, pencil holding, spacing, and legibility after two months of therapy. It is also found that there was no drop out cases because of the need and commitment of parents.

Even though improvements seen in 46 children out of 50 children, level wise up gradation seen in only 7 children

1. Out of 19 children of level 1, up gradation of 2 children to Level 2

2. Out of 22 children of Level 2, up gradation of 2 children to Level 3 and 2 children promoted from Level 1

3. Out of 6 children of Level 3, up gradation of 3 children to Level 4 and 2 children promoted from Level 2

4. 3 children of Level 3 continued with improvements and 3 got promoted from Level 3.

Discussion

The development of writing ability is not only significant in building Childs’s self esteem, but also considered as vital component for success in school. The development of handwriting begins at early childhood that becomes more intentional with time. The design pattern advances to more precise shapes and letters as child grows. By age 2 the child learns to draw letters by imitating geometric shapes, initially with vertical strokes followed by horizontal strokes and later circles by age 3. By age 4 child copies cross, square by age 5 and triangle by age 5years 6 months. The ability to copy geometric shapes indicates that the child is ready to study.

Hand writing can be graded 1 to 5 in developing age ie between age 6 to 11 years. Quality of hand writing develops ( 6 to 7 years of age) in Grade 1 ,reaches plateau ( 7 to 8 years of age) in Grade 2, hand writing becomes automatic, organized and use it as a way to express the ideas (8 to 9 years of age) in Grade 3, Speed develops though out in primary school in linear pattern in Grade 4 and overall development in middle school years to Grade 5 . If children at risk for poor hand writing are identified in their preschool level itself, it will definitely contribute the healthy development of the hand writing skill and will prevent worsening of the same .Similarly it is seen that the hand writing can be improved even at any age if the person really wish for it and follow the remedial measures if there is no irreversible pathology behind. So identifying the problem is very important and more over this specific yogic exercise “Hand stretch breathing” will not lead any complication.

Legibility and speed are the two important elements in hand writing. Legibility may be affected by formation, size, spacing, slant and or alignment. Speed is the another task of a child to meet the class room demand .The other extrinsic factors which influence hand writing are posture of the child, height of chair or desk, lighting ,noise, type of materials used such as pen ,paper etc. Writing also requires proper hand manipulation, that is accomplished with the help of intrinsic muscles and simultaneous proximal stability which may be motivated by systematic flexion and release of elbow and wrist. To have legible hand writing, there should be adequate finger thumb movements with accurate precision and speed .

Out of 50 children identified with poor hand writing, 46 were having varied degrees of improvements in scores when hand writing assessment is done before and after therapy. Children’s Improvements were noted with minimum score reduction of 1 to maximum score reduction of 6 after therapy. Only 4 children had no improvements in score after therapy but they were having improvements in their behavior, alertness and attention. Even though the table 1 showing number of children in each level before and after therapy do not show much difference, there was improvements individually which cannot be seen in the table because they were not upgraded to the higher Levels of Hand writing. One of the child have shown reduction of 6 scores , 5 of them with reduction of 5scores, 12 of them with reduction of 4 scores and so on.

Number of children in level 1 were 19 before therapy and 17 after therapy in which 3 children did not have any improvement on assessment after therapy. 2 children had good level of improvements and progressed to Level 2. All others were having improvements with an average of 3 scores. Number of children in Level 2 were 22 before and after therapy. 2 children got progressed from Level 2 to Level 3 and 2 children progressed from Level 1 and reached Level 2 after therapy which made equality in number before and after therapy in Level 2. Only 1 child from Level 2 did not show any improvement in hand writing after therapy. All the other 21 children had improvements with maximum of 5 scores and minimum of 2 scores. Total number of children in Level 3 were 6 before therapy and 5 after therapy. Out of 6 children, 3 children were progressed in to Level 4 and 2 children progressed from Level 2 and reached Level 3 and made the number 5 after therapy. There were improvement in score level from minimum score of 1 to maximum score of 4. There were only 3 children in Level 4 before therapy and that became 6 after therapy which means 50 % of increase in number .There were maximum of improvement in this Level with minimum score of 4 and maximum score of 6, which shows that there is a role of Hand stretch breathing even though the child is at the Level 4. Table 2 explains that 92 % of the children attained overall improvements .4% were improved from Level 1 to Level 2 and Level 2 to Level 3.There were 6% improvement from Level 3 to Level 4 where as 8% did not show any improvements. The present study Put light on the role of a yogic technique “Hand stretch breathing” in improving hand writing skill by altering some of the underlying mechanism responsible for poor performance of handwriting in a group of children with handwriting difficulties. Deficit in fine motor co ordination and visual motor integration have often been seen as explanation for poor quality of hand writing. Some studies prove that the speed of hand writing is slower and also cognitive (flexibility) planning is less proficient in children with hand writing difficulties .

Hand stretch breathing is one among yogic breathing exercise in which the initial step thadasana balances body and alert the mind .when fingers are interlocked and rested palm on chest the person becomes more alert and fine motor activity get stimulated. when the arms stretched out straight with inhalation at shoulder level in front of the body keeping fingers interlocked with a simultaneous twist of hand so that the palm faces forward and reverse back with exhalation – the shoulders goes in flexion ,Elbows in extension, wrist in extension and proximal and distal inter phallyngeal joints in hyper extension .Stretch and release of proximal and distal muscles of upper extremity occurs in these steps with stimulation of fine motor activity of hands . As the breathing regulation is done along with stretch and relaxation, it also influences the brain , calms the mind & improves attention, concentration and memory along with strengthening the muscles of upper limb.

Thus Hand stretch breathing physically strengthens hand muscle capacity ,neurologically co ordinates the signals from brain to musculoskeletal system, psychologically it provides calming and soothing effect , removes emotional liability and provides relaxation which is required while writing .

Conclusion

Hand stretch breathing is a yogic breathing exercise which can be adopted to improve hand writing. Now it is a clinically proven method in poor hand writing developed at ACACC, Purakkattiri, Kozhikode, Kerala. This method may be adopted to improve hand writing by developing fine motor activity, empowering proximal and distal muscles of upper limb, expansion of attention & by stimulating the brain and calming the mind. Further study is needed to evaluate the improvements in each component of hand writing with statistical analysis by yogic methods keeping this study as a preliminary step.