title: Handwriting, visuomotor integration, and neurological condition at school age.
abstract: OBJECTIVE
  the study investigated the relationships between handwriting, visuomotor integration, and neurological condition. We paid particular attention to the presence of minor neurological dysfunction (MND).
  
  
  METHODS
  participants were 200 children (131 males, 69 females; age range 8-13y) of whom 118 received mainstream education (mean age 10y 5mo, SD 1y 4mo) and 82 special education (mean age 10y 8mo, SD 1y 2mo). Each child had four assessments: a neurological examination, which paid attention to the type and severity of MND, a test to measure motor performance, a handwriting test, and the Developmental Test of Visual Motor Integration.
  
  
  RESULTS
  dysgraphic handwriting and slow writing speed were closely related to the severity of neurological dysfunction (both p<0.001); impaired visuomotor integration was related to the presence of MND (p<0.001) but somewhat less to its severity. Impaired handwriting and visuomotor integration were strongly related to two specific dysfunctions: fine manipulative disability and coordination problems (both p<0.001). Impaired visuomotor integration was weakly related to dysfunctional muscle tone regulation (p=0.009) and sensory dysfunction (p=0.042).
  
  
  CONCLUSIONS
  poor handwriting and impaired visuomotor integration are related to MND, but in a differential way. Poor handwriting is related to the severity of neurological dysfunction and to dysfunctions of complex supraspinal circuitries. Impaired visuomotor integration is associated with the presence of any of the most common types of MND.
authors.affiliation: Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Netherlands.
authors.forename: Jessika F
authors.initials: JF
authors.lastname: van Hoorn
authors.forename: Carel G B
authors.initials: CG
authors.lastname: Maathuis
authors.forename: Lieke H J
authors.initials: LH
authors.lastname: Peters
authors.forename: Mijna
authors.initials: M
authors.lastname: Hadders-Algra
mesh_terms: D000293:Adolescent; D002648:Child; D015986:Confounding Factors, Epidemiologic; D004519:Education, Special; D005260:Female; D006236:Handwriting; D006801:Humans; D016015:Logistic Models; D008297:Male; D009048:Motor Skills; D009422:Nervous System Diseases / Q000175:diagnosis / Q000503:physiopathology*; D009426:Netherlands; D009460:Neurologic Examination; D011597:Psychomotor Performance; D012574:Schools; D012720:Severity of Illness Index