by Shoshanah Shear
Handwriting and writing position are often discussed in a school setting but what about our other clients. Let us consider a patient who is in hospital. Enabling a patient to engage in drawing, art, a pre-writing task, or writing itself following an illness or injury is invaluable. However, it can be a challenge to provide the necessary angle for a writing surface when working at the bedside. Some hospital-based OT departments have a table surface that adjusts in height as well as the angle of the writing surface. But such equipment is not always available or, if it is, there are times that a portable version is preferable.
The various slanted writing surfaces available through Therapro offer the solution. I particularly love the Collapsible Writing Surface. It opens the door to varying both the activity used in treatment as well as the location for the session.
Imagine for a moment a patient in an orthopedic ward following an MVA. The patient has multiple fractures with exoskeleton / P.O.P. and is depressed and uncooperative with all staff members. After persuading the doctor to refer to OT, a brief history reveals that the patient is an artist and the thought of not being able to draw is what depresses them enough to interfere with function on all levels.
As an OT, we can build up the grips of a pencil or paint brush. Another option to easing use of writing implement is through Triangular Crayons and Pencil Crayons. Triangular writing implements can also enable a patient of this nature to return to drawing by easing the demands of the small muscles in the hand. Although strengthening these muscles will be important, the first step might be to encourage return to meaningful activity, hence the need for an easier means of holding the writing or drawing implement.
Using the portable, collapsible slanted writing surface or easel, one can now take the patient out of the ward (whether on a trolley or in a wheelchair) and into either the OT department or, better still, the garden. A change of environment does wonders for the patient psychologically, not to mention the hope offered by enabling an artist to return to what they love best – drawing, painting or creating. Many artists gain inspiration from nature, hence being able to get into the garden can literally be a breath of fresh air that instills a desire to regain function.
Through this brief example, we can see that writing and being involved in creative pursuits is a necessary skill and activity for various age groups and types of clients, not only for children at school. The tools and equipment that are beneficial in the classroom can be equally important in a hospital or other setting.
The write slant boards or Better Board Slant Boards are also of benefit to:
- a woman who is expecting and is placed on bedrest.
- the elderly who has limited space due to downsizing and increasing need to take care of their backs. The fact that the slant boards are light and collapsable makes handling and storage easy for an older person.
Still related to positioning, two cushions that I have used quite often in my practice are the Disc‘O’Sit and the Movin’ Sit Air Cushion. I love the fact that they are portable and adjustable in terms of air pressure. This makes it possible to take these cushions to a treatment or evaluation in a home or workplace.
One group of clients I have found to benefit from these cushions is a pregnant woman who is experiencing lower back pain. Pregnancy related lower back pain is a common complaint which can be alleviated with appropriate exercise and positioning.
Occupational Therapist, healing facilitator, certified infant massage instructor, freelance writer, author of “Healing Your Life Through Activity – An Occupational Therapist’s Story” and co-author of “Tuvia Finds His Freedom”.
Using Sensory-Based Materials
The little girl in the photo is facing backwards while her hands bear weight on top of a vibrating cushion like a 
This vibrating ring stack is made by inserting a motorized pen, like a 
The girl in the photo reaches for rings positioned in front of her before rotating her body to place them over a ring stack. This “ring stack” is actually a cat toy and the mouse on top of a spring squeaks when moved. The sensory aspects of this activity help her to visually attend while developing postural control.
During a typical Hippotherapy session, I spend time walking and trotting, followed by stopping to complete a simple hand activity such as this lacing board. When finished I encourage the child to say or sign “go” to continue movement. Most children are eager to resume movement.
A horse’s rear end is wide and functions as a convenient work surface. I adapted this puzzle by attaching the pieces with Velcro to the box cover. I encourage the child to use one hand to stabilize the box lid while pulling them off. Of course, this activity also teaches children to identify animals and imitate sounds. The 
It’s a good idea to create OT objectives to improve functional skills such as opening and closing buttons because:
This toy is made out of detergent bottles and a strip of fabric. It’s simple to use – the child pulls the handle while in various positions. It can also be used during non horse activities to work on many skills. Please check out my book 
Barbara A. Smith has worked with children and adults with developmental disabilities for over 40 years! She is the author of the Recycling Occupational Therapist, From Rattles to Writing: A Parent’s Guide to Hand Skills and From Flapping to Function: A Parent’s Guide to Autism and Hand Skills. Learn more about her work at