**3.4 Rehab Clinic, The Hong Kong Polytechnic University**

In view of the pressing needs to fulfill the demands of the services on dyslexia, the Clinic has launched the occupational therapy interventions for school-age children with dyslexia.

In Hong Kong, children start their Chinese and English handwriting training in the preschool age. Writing Chinese characters is different from other written language. Chinese handwriting appears to be more critical since Chinese characters are as logographic nature. It is more complex as the skills involve multiple stroke sequence and direction (Lam, Au, Leung, & Li-Tsang, 2011). Chinese characters are composed of many sharp turns of stroke and demand frequent pen lifts (Tseng, 1998). It also involves advanced visual motor and visual sensory processing skills. Hence, children are frequently referred to occupational therapists for handwriting difficulties. The interventions with a combination of approaches based on children individual problems include:


#### **3.4.1 Visual perceptual training**

Visual perception is an important ability that enables one to make sense out of what is seen (in contrast to visual acuity tests that merely determine something seen by the individual). It is one of the essential components for learning Chinese handwriting, especially for Hong Kong children who are required to have a good legibility on the handwriting in their learning culture. Besides, Chinese characters are logographic nature. Its stroke pattern sequence and direction are more complex. Children should have good visual spatial skills in order to write the characters with good positioning of strokes and proportioning of radicals in a squared-area. The following areas are the main components on our visual perceptual training:

#### **Training on visual memory**

Some children have difficulties in memory which preserves some characteristics of senses pertaining to visual experience. They need longer time to capture and memorize new characters and symbols.

## **Training on visual form-constancy**

38 Learning Disabilities

The HKEAA Task Group on Special Examination Arrangements is responsible for deciding to approve or reject the application. Candidates dissatisfied with the decision can appeal by giving reasons and supporting documents to The Appeal Panel for Special Needs. They

In view of the pressing needs to fulfill the demands of the services on dyslexia, the Clinic has launched the occupational therapy interventions for school-age children with dyslexia. In Hong Kong, children start their Chinese and English handwriting training in the preschool age. Writing Chinese characters is different from other written language. Chinese handwriting appears to be more critical since Chinese characters are as logographic nature. It is more complex as the skills involve multiple stroke sequence and direction (Lam, Au, Leung, & Li-Tsang, 2011). Chinese characters are composed of many sharp turns of stroke and demand frequent pen lifts (Tseng, 1998). It also involves advanced visual motor and visual sensory processing skills. Hence, children are frequently referred to occupational therapists for handwriting difficulties. The interventions with a combination of approaches

• visual perceptual and visual motor training to improve children abilities to discriminate the fine differences in the form and position of strokes in the Chinese characters • sensory integration therapy emphasizing tactile and vestibular input to attend and

• training on fine motor accuracy to assist children with low muscle tone, postural

• learning keyboard typing as an alternated way to assist children in managing the

Visual perception is an important ability that enables one to make sense out of what is seen (in contrast to visual acuity tests that merely determine something seen by the individual). It is one of the essential components for learning Chinese handwriting, especially for Hong Kong children who are required to have a good legibility on the handwriting in their learning culture. Besides, Chinese characters are logographic nature. Its stroke pattern sequence and direction are more complex. Children should have good visual spatial skills in order to write the characters with good positioning of strokes and proportioning of radicals in a squared-area. The following areas are the main components on our visual perceptual

Some children have difficulties in memory which preserves some characteristics of senses pertaining to visual experience. They need longer time to capture and memorize new

instabilities, weakness on hand grip strength and hand coordination.

• supervised breaks in examinations lasting 90 minutes or more; and

would be notified of the appeal result prior to the examination.

**3.4 Rehab Clinic, The Hong Kong Polytechnic University** 

based on children individual problems include:

focus

training:

written works

**3.4.1 Visual perceptual training** 

**Training on visual memory** 

characters and symbols.

• other special arrangements such as use of computer in answering questions

Some school-age children have weakness to mentally turn and rotate objects or picture. This skill is essential to distinguish differences in size, shape, and orientation of Chinese characters, especially those not printed in a normal horizontal alignment or in different font sizes. Training on visual form- constancy can improve their reading speed and accuracy.

#### **Training on visual sequential-memory**

This helps to improve children abilities to conduct visual decoding and encoding. This is an essential component for English spelling.

#### **Training on visual spatial relationship**

Some children have difficulties in perceiving the positions of objects in relation to oneself and other objects. Children with visual spatial problems will have poor alignment and spacing in the written outputs.

#### **Training on visual closure**

Children with problems in visual closure have weaknesses to identify a whole figure when only fragments are presented.

#### **Training on visual discrimination**

Visual discrimination skills involve the ability to perceive words accurately by noting similarities and differences in words. This is an essential ability for the children to differentiate complex figures among different Chinese characters.

#### **Training on figure ground perception**

Figure ground perception is the tendency to discriminate between target and background stimuli. The stimulus perceived as the target is regarded as the figure. The other stimuli not perceived as the target make up the background, or ground. It is important for children to capture important content in a reading paragraph.

#### **Training on visual motor skill**

Visual motor skills have been defined as "the ability to integrate the visual image of letters or shapes with the appropriate motor response" (Schneck, 1996). These skills have been shown to be highly associated with other functional activities like handwriting. Besides, visual-motor skills can be multifaceted and influenced by number of factors, including pencil grip, fine motor skills, eye-hand coordination, kinesthesia, motor planning, and visual perceptual skills. Activities involving visual scanning and visual tracking like mazes, driving game, throwing, and cycling can improve visual motor skills.

#### **3.4.2 Sensory integration**

While traditional handwriting tasks involve paper work and require children to be seated, sensory integration and multisensory modalities become one of the core treatment programs for the school-based occupational therapy. Although the research on the effectiveness of a multisensory approach has been sparse and the results of finding are inconsistent (Harris & Livesey, 1992; Lockhart & Law, 1994; Oliver, 1990), a study in United States found that

Dyslexia in Hong Kong: Challenges and Opportunities 41

option for students who struggle with handwriting problems. Although there is no study proving that children with dyslexia have better performance on keyboard writing, students are able to keyboard faster than handwriting. Among the slowest writers, 75% achieved more text production with keyboard than with handwriting (Rogers, Case-Smith, 2002). These results indicated that keyboarding performance requires distinctly different skills from handwriting. Keyboarding can increase and improve a student's written output in their academic study. Hence, students with learning difficulties are suggested to learn both handwriting and keyboard writing skills. The mastery of handwriting as well as

The following parts summarize the critique made by Ngan-Keung (2008) on the adequacy

• publication of Hong Kong Test of Specific Learning Difficulties in Reading and Writing for Primary School Students and The Hong Kong Specific Learning Difficulties

• development of support guidelines and teacher training workshops at foundation level

These actions were somehow successful which could be reflected by the increase in the awareness among primary school teachers and social workers and hence better acceptance of towards the dyslexia students and provision of some simple accommodations in classes

However, most if not all efforts were put on primary education only. This might be due to the misconception that dyslexia is merely a short-term learning difficulty. There is nothing

In view of this, parents started advocating for tailor-made policies from government and more collaboration among various government departments and concern groups. With many struggles, there have been a number of achievements. SLD has finally been included in the Hong Kong Rehabilitation Programme Plan. The Hong Kong Test of Specific Learning Difficulties in Reading and Writing for Junior Secondary School Students was published in 2007. More awareness has also been attained among secondary schools, Labor and Welfare Department, and community rehabilitation centers on the importance of lifelong support to

The school support to students with dyslexia remains very insufficient and ineffective. It could be attributed to the lack of knowledge and teaching methods in teachers and lack of resources and guidance in schools from the government. Both students and parents thus suffer a lot. Students have poor confidence and self-esteem. Some of them had emotional and psychological problems and even committed suicide. Parents' burdens (both psychological and financial) had never been small. A study revealed that about 55% of

The actions aiming to satisfy the ever rising parental and professional needs include:

• launch of new funding system for primary schools to support dyslexic students

Behaviour Checklist (for Primary One to Primary Four Students)

keyboarding is critical for success in school and work.

**4. Appraisal of the work done in Hong Kong** 

to concern about further education or employment.

Nevertheless, there is still much room for improvement.

by EDB

and examinations.

the individuals with dyslexia.

and effectiveness of the efforts paid to the dyslexic services.

approximately 90% of school-based occupational therapists responded used multi-sensory approach when treating students with handwriting problems (Woodward & Swinth, 2002).

In school, occupational therapists design activities which are rich in tactile, vestibular and proprioceptive stimulation can increase body awareness, motor planning and attention. Besides, activities with proprioceptive stimulation can assist children in improving their muscle control which is essential for a good pencil grip and a good posture for handwriting tasks. Here are some activities with multisensory modalities aiming to improve children handwriting abilities:


#### **3.4.3 Training on fine motor accuracy**

In addition to visual-perceptual problems, fine motor development problems also affect children handwriting. Motor skills are remediable through practice in many cases. If children have weak hand muscles, poor wrist control or in-hand manipulation skills, the skills can be strengthened through various fine motor activities designed by occupational therapists such as playing guitar or threading.

Empirical evidence also shows that pencil grips would affect children's handwriting legibility and speed (Schneck, 1988). The lateral quadrupod and four-finger pencil grips are found to be as functional as the dynamic tripod, lateral tripod, and dynamic quadrupod pencil grips (Koziatek & Powell, 2003). Besides, occupational therapists have to prescribe a pencil grippers or adaptive pencils to those with immature pencil grip. This can faciltiate and improve their hand wirting legibilty as well as their wirting speed.

#### **3.4.4 Mastery of keyboard typing**

Children with poor handwriting often score a lower grade on the content of their written work. Relationship between poor handwriting and difficulties has also been shown in many other areas of academic learning (e.g. spelling, writing composition and grammar) (Berninger, Mizokawa & Bragg, 1991; Campbell, 1973). Students with learning disabilities have difficulties in writing which needs to be adequately configured, aligned and spaced in a timely manner. As computers are more available nowadays, word processing is another

approximately 90% of school-based occupational therapists responded used multi-sensory approach when treating students with handwriting problems (Woodward & Swinth, 2002). In school, occupational therapists design activities which are rich in tactile, vestibular and proprioceptive stimulation can increase body awareness, motor planning and attention. Besides, activities with proprioceptive stimulation can assist children in improving their muscle control which is essential for a good pencil grip and a good posture for handwriting tasks. Here are some activities with multisensory modalities aiming to improve children

In addition to visual-perceptual problems, fine motor development problems also affect children handwriting. Motor skills are remediable through practice in many cases. If children have weak hand muscles, poor wrist control or in-hand manipulation skills, the skills can be strengthened through various fine motor activities designed by occupational

Empirical evidence also shows that pencil grips would affect children's handwriting legibility and speed (Schneck, 1988). The lateral quadrupod and four-finger pencil grips are found to be as functional as the dynamic tripod, lateral tripod, and dynamic quadrupod pencil grips (Koziatek & Powell, 2003). Besides, occupational therapists have to prescribe a pencil grippers or adaptive pencils to those with immature pencil grip. This can faciltiate

Children with poor handwriting often score a lower grade on the content of their written work. Relationship between poor handwriting and difficulties has also been shown in many other areas of academic learning (e.g. spelling, writing composition and grammar) (Berninger, Mizokawa & Bragg, 1991; Campbell, 1973). Students with learning disabilities have difficulties in writing which needs to be adequately configured, aligned and spaced in a timely manner. As computers are more available nowadays, word processing is another

and improve their hand wirting legibilty as well as their wirting speed.

handwriting abilities:

• block design

• parquetry

• wrist weights

• "Sky writing" –writing letter in the air • finger tracing in a bag of hair gel

• writing with chalk and chalkboard

• shape tracing with vision occluded • tracing letter over transparency • verbal cues while writing

• finger writing with shaving cream

**3.4.3 Training on fine motor accuracy** 

therapists such as playing guitar or threading.

**3.4.4 Mastery of keyboard typing** 

• black construction paper covered with salt

• writing on a tray of rice or sand with a finger

• colored writing lines representing the sky, grass and dirt • design copying on paper strips and masking tape on the floor option for students who struggle with handwriting problems. Although there is no study proving that children with dyslexia have better performance on keyboard writing, students are able to keyboard faster than handwriting. Among the slowest writers, 75% achieved more text production with keyboard than with handwriting (Rogers, Case-Smith, 2002). These results indicated that keyboarding performance requires distinctly different skills from handwriting. Keyboarding can increase and improve a student's written output in their academic study. Hence, students with learning difficulties are suggested to learn both handwriting and keyboard writing skills. The mastery of handwriting as well as keyboarding is critical for success in school and work.
