Handwriting: Anatomy of a Collaborative Assessment/Treatment Model

Erhardt RP, Meade V. Stillwater, MN 55082, PDP Press Inc, 2005, spiralbound, 150 pp, illus, ISBN: 0-9623703-7-1, $45.

The purpose of this book is to provide a well-documented case report that describes a team approach, current research, and family/client-based natural environment intervention for a client with handwriting difficulties. The authors are two highly respected clinicians, Rhoda Erhardt, an occupational therapist, and Vickie Meade, a physical therapist. The authors’ intended audience includes occupational therapists and physical therapists, health care professionals who are involved with multidisciplinary teams, and parents or other people interested in the proficiency of case management.

This book reflects the thought processes that went into examination, intervention, and follow-up re-evaluation (outcomes) of a 13-year-old boy with handwriting problems. One chapter reviews the literature regarding handwriting and visual-perceptual motor function. Looking at the literature review helped me understand the authors’ approach regarding their initial question: Is the child’s handwriting the problem or the symptom?

This book is written with verbatim examples of some of the discussions that took place during the year in which the authors treated this client. It was refreshing to see that these 2 therapists worked so well together and posed questions to each other to further their basis for intervention and changes to the treatment plan. Documentation of the various examination results and related literature concerning the testing tools are included in the book.

The story of this client and the team’s clinical reasoning and collaborative process is easy to follow and offers the additional value of inspiring others to work together and pool their resources. Using the “case story” format instead of the “case study” format allowed the authors to illustrate the trial-and-error process, clinical reasoning process, and spontaneous interactions distinctly. This richness of detail and multiple perspectives makes the case “real” and not just another report of facts. As described in the text, the case study format includes quantitative data; is evidence-based with specific data that support theoretical ideas; is written in the professional jargon; is presented by an expert; has a beginning, middle, end; and is written in third person. On the other hand, the case story includes qualitative, descriptive information presented in the first person. It uses “emotional writing,” includes examples that are experientially enriched, and is process-oriented. Because this format uses the oral tradition of reporting, it is relatively open ended and not necessarily in chronological order. Photos and other figures add to the clarity of the story.

The book contains a 10-page reference list that appears to be comprehensive for this study. Some of the references, however, were used in a retrospective manner as the authors compiled their data and wrote this book. According to the authors, it was “several years after the completion” of their study that they participated in a workshop for writing case stories in 2002. Several references in the story were cited from literature dating from 2002 through 2004. Chapter 16 is important in this respect, because the authors reflected back on this client and questioned their choices and compared these choices to what is current care in the literature.

The appendixes include an article reprinted from American Journal of Occupational Therapy, charts on various characteristics and possible teaching strategies for different learning styles (auditory learners, visual learners, tactile/kinesthetic learners), and activity charts that were related to their study.

For practicing physical therapists who have been treating children for a while, this text would serve only as a reminder of the importance of collaboration and evidence-based practice. For those who have not been treating children and are thinking about working with school-aged children, this text would be helpful when organizing and assisting a team in the examination and in the creation of an effective plan of care for a client with handwriting problems or similar problems.

Overall, the text is well organized and meets its objective of providing an in-depth look at teamwork for examination and intervention for a school-aged child with handwriting difficulties. Handwriting: Anatomy of a Collaborative Assessment/Treatment Model is easy to read. Each chapter can stand alone; however, the sequence of the report flows easily, so that skipping to a chapter out of sequence disrupts the fluidity of thought. This is not a text that should be required in physical therapist education programs, but is a good addition to a beginning pediatric physical therapist’s professional resource library. The philosophy of collaborative, family-oriented, evidence-based examination and intervention is the most significant “take-home” aspect of this book.

• Physical Therapy