Motor Assessment With the STEGA iPad App to Measure Handwriting in Children

Abstract

Abstract Importance: Handwriting and the fine motor control (hand and fingers) underlying it are key indicators of numerous motor disorders, especially among children. However, current assessment methods are expensive, slow, and subjective, leading to a lack of knowledge about the relationship between handwriting and motor control. Objective: To develop and validate the iPad precision drawing app Standardized Tracing Evaluation and Grapheme Assessment (STEGA) to enable rapid quantitative assessment of fine motor control and handwriting. Design: Cross-sectional, single-arm observational study. Setting: Academic research institution. Participants: Fifty-seven typically developing right-handed children ages 9 to 12 yr with knowledge of cursive. Outcomes and Measures: Predicted quality, measured as the correlation between handwriting letter legibility (Evaluation Tool of Children’s Handwriting–Cursive [ETCH–C]) and predicted legibility (calculated from STEGA’s 120 Hz, nine-variable data). Results: STEGA successfully predicted handwriting (r2 = .437, p < .001) using a support vector regression method. Angular error was the most important aspect of STEGA performance. STEGA was much faster to administer than the ETCH–C (M = 6.7 min, SD = 1.3, versus M = 19.7 min, SD = 5.2). Conclusions and Relevance: Assessment of motor control (and especially pen direction control) may provide a meaningful, objective way to assess handwriting. Future studies are needed to validate STEGA with a wider age range, but the initial results indicate that STEGA can provide the first rapid, quantitative, high-resolution, telehealth-capable assessment of the motor control that underpins handwriting. What This Article Adds: The ability to control pen direction may be the most important motor skill for successful handwriting. STEGA may provide the first criterion standard for the fine motor control skills that underpin handwriting, suitable for rehabilitation research and practice.