Centennial Vision

So proud to be an Occupational Therapist in 2016.

As we enter a new year, it is thrilling to see how our profession and colleagues are all striving to achieve the CENTENNIAL VISION. Consider this:

We envision that OT is a powerful…

More and more, OT services are recognized for their early and continued emphasis on function and participation, and its holistic appreciation of the mind-body-environmental-cultural-societal interconnectedness

widely recognized…

(See below.)


Yes, we are informed by the neurosciences, our knowledge of development, physiology, physics, behavior and psychology,


We are increasingly deferring to research to guide our clinical decisions.

and diverse workforce…

Look around you. OTs and OTAs today, in your schools, your local OT organizations and AOTA. Our therapists come from the broadest of backgrounds and bring unique insightful perspectives.

meeting society’s occupational needs.

Occupational needs? How does that apply to us therapists working within the educational system?

First, recognize that our society is the school system and our population is the children within them.

As far as their occupational needs, they are threefold. We are charged with helping children:

  1. Reach their educational potential
  2. Access their grade level curriculum
  3. Fully participate in the school environment

But there is that one clause, “widely recognized” that still eludes us. While consumers are increasingly pursuing Occupational Therapy services as the holistic solution to their complex needs, other providers are closing in on our domain.

Please, my friends. Do not be complacent and think that our Centennial Vision will realize itself. It is important that we protect this marvelous profession before others claim ownership of Activities of Daily Living, Leisure and related functional activities.

It is already happening.

Learn more from your state organization. Join your state organization. Attend AOTA’s national convention. We are a marvelous supportive and generous group. Let’s not become an irrelevant profession simply because someone else seized an opportunity to write into their licensure bill practice domains that have historically, empirically and conceptually been ours.

And let’s have a happy, healthy, productive, and widely recognized New Year, everyone.


First things first… we had to establish a baseline. That involved administration of the 3 different outcome assessments to all the students, both those who were assigned to the control group and those receiving intervention via The Size Matters Handwriting Program.

Next, to insure that there were no significant or unexplained changes in the scores, re-administration of these same tests occurred two weeks later (i.e. Week 3). Less time and the child may have demonstrated learning of the test. More time and normal development may have kicked in.

This meant that the actual Treatment Phase began on Week 4.

Of course, prior to any testing or instruction, participating teachers were in-serviced on the Size Matters Handwriting Program and given Fidelity Manuals specific to their grade. The Manuals detailed the content to be covered and provided explicit day-to-day lesson plans. Tammy and Kelly, as site managers of Boston and Albany, were given full versions of each of the three grade level protocols.

In consideration of the added demands on the teachers, content was limited to letters considered do-able for each particular grade within the given time frame. The same finite ranges of the alphabet were also  used in the testing. This meant that Kindergarten would only be tested and taught the upper case alphabet. First grade would focus on the lower case alphabet and second grade would cover both upper and lower case letters.

No time for numbers. Remember, there were only 8 weeks (i.e. 40 days) to drill and master the details of printing so that significant change could be observed and measured.

In addition, the teachers were supplied with the following materials:

K 1 2
Fidelity Manual
Student Workbook
Adapted Writing Paper
Magnetic Rectasquare Board
The Dice Game

It’s important to note that Kindergartners alone were provided with consumable workbooks. Grades 1 and 2 wrote solely on sheets of Adapted Writing Paper with only class-wide references supporting the program.

In other words, while Kindergarten’s potential investment in materials would need to be renewed every year, we postulated that an effective, efficient, engaging and measurable handwriting instructional program could still be implemented with essentially a one-time minimal investment.

Gotta love those savings.

Let’s see how it turned out.

Research Publication and Presentation News

We have two manuscripts submitted.

The first is about the Efficacy of the Size Matters Handwriting Program. It underwent some minor editing revisions at the request of the Occupational Therapy Journal of Research (OTJR). We hope to learn soon of its publication date.

The second is about the use of the VMI—the Beery Buktenica Test of Visual-Motor Integration as an outcome measure for handwriting. It is under review by the American Journal of Occupational Therapy (AJOT).

As you may recall, the VMI was one of the three tests administered to the children participating in our study. The other two were the Test of Handwriting Skills, which is standardized, and the Minnesota Handwriting Assessment, which is norm-referenced. These latter two tests constitute the data analyzed in the first article as they specifically measure handwriting. The VMI has always contended that it is reliable and valid predictor of handwriting readiness. However, we are learning that it is not necessarily a meaningful correlate as an outcome measure, especially in older children.

The results of these findings will be presented at the AOTA national conference in Nashville on Friday, April 17 from 8:00 AM to 9:00 AM.

2015ImSpeaking, research

The full articles explain more. Hopefully, you’ll get to read them in their entirety soon.

Stay Tuned!

Coming Soon!

We’d hoped to debut at the 94th AOTA conference in Baltimore this past week. But an unfortunate fall by our mechanical engineer left our momentum minus two much-needed upper extremity limbs.

The good news is that Joe is on the mend… thanks to his Occupational Therapists! Imagine that. And he’s gaining strength, range of motion and mobility daily. The fractures of both his left humerus and his right radius are healing on schedule.

But despite his hospitalization, he’s been in steady contact with the manufacturers and other professionals poised to finalize this exciting new product.

Charged with bringing to market a product that is:

  1. Child-proof
  2. Low profile
  3. Installs quickly
  4. Quiet
  5. Affordable… and most importantly,
  6. Provides needed sensory relief for our impulsive, sensory seekers, anxious, hyperactive or struggling students

… Joe assures us that “He’s got that covered!”

Stay tuned for this game-changing accommodation poised to impact attention, focus and academic scores!

Updating Update

The good news is that the bad news could be worse. Our study was again rejected, but would be reconsidered if we made revisions.

The Journal of Reading and Writing gave us a lot of pointers on how we could strengthen the manuscript as per their specifications. They wanted more information on why handwriting is important in the 21st century. A comparison of the Size Matters Handwriting Program to other existing programs was also felt to be needed to further substantiate why ours is different.

It was also interesting to read how one man’s APA standards are different from another’s. All of us were baffled by those critiques, but since we aim to please (and to get published), we’ll make those changes, too.

Tables needed an accompanying narrative. More statistical calculations were requested. I can’t even tell you which ones they preferred, but out statistician is already hot on the trail. If there was ever a man who could argue his ANCOVA over his ANOVA, it’s Eugene.

So, we’re still at it. This doesn’t dilute the merit or validity of the study. It just delays the public from knowing how effective the Size Matters Handwriting Program is.

Guess you’ll have to tell them yourselves.

Research Manuscript Update

What an eye-opening experience this has been!

The time elapsing from the formulation of a research question to implementation of an actual study, analysis of the data, literature review, write-up and finally publication spans so many years that I’m in awe of anyone who makes it to the end.

At this point now, we’ve written and rewritten our manuscript multiple times to respond to the concerns of the initial reviewers.  All valid points, they felt as if we had not done a convincing job explaining the importance of handwriting in the 21st century as well as what the control groups were doing while the treatment group was learning about letter sizes.

Towards that end, we added statistics on the impact of the Common Core on handwriting instruction.  Its absence of any reference to handwriting beyond first grade compels school districts across the country to relegate instruction to an incidental approach.  And in fact, that’s how we described what the control group was doing.  It wasn’t ignored, but there was no formal lesson plan either.

We also added the MRI studies by Dr. Karin James.  In graphic detail, she acknowledged the significant difference in brain activity for children taught to print versus those simply taught to recognize letters or to keyboard.

And so the waiting begins again.  I’ll let you know further feedback as soon as I do.

SLIDES – Outcome Measures

Nine subtests from the THS were used. The Upper Case series were given to Kindergartners. Lower Case series were given to 1st graders. All of the subtests were given to 2nd graders. Note the progression from having no visual model, to dictation and copying of letters, words and sentences. This is a standardized test.
The MHA is a norm-referenced copying test appropriate for only the second half of 1st grade and all of 2nd grade.
From a statistical standpoint, results at a .001 level are the closest a statistician will come to saying that there is undoubtedly a causal effect of the intervention. Keep the color scheme in mind when viewing the Post Test scores.


SLIDES – Post tests

Impressive. The Kinder gardeners caught on quickly.
Both control groups and experimental groups had an equal improvement in spacing scores.
Interestingly, there was a significant decline in the speed with which the experimental group completed all the tests compared with the control groups. The teachers reported that the children in the experimental groups were especially careful to make their letters touching the lines in all the right places.
But for everything else… the results were huge, especially for Alignment and Size.
Note the difference in the change scores between the Experimental and Control groups.
Second grade experimental groups made amazing changes.


SLIDES – Looking backward and forward

0009sIThis study took place in the Spring of 2012.  As the children in the experimental group began learning and employing the concepts, the teachers in the control group couldn’t help but notice.  Both site managers reported that the control teachers were excited for the study to end so their students could use the same materials and reap the same benefits.

This year, both have done just that.  The program is in full swing in these two schools and many others across the country.

But one research study does not a body of evidence make.

If you are interested in exploring the various applications, validity, comparability or longitudinal strength of the Size Matters Handwriting Program, please let us know.

Be part of science.  Advance our profession.  Early adopters across 30 states are already enjoying the difference.

Because when it comes to neat printing… SIZE MATTERS!