Contribution of Tactile and Kinesthetic

Perceptions to Handwriting in Taiwanese

Children in First and Second Grade
Tzu-Ying Yu, PhD, OT; Jim Hinojosa, PhD, OT, FAOTA; Tsu-Hsin Howe, PhD, OTR;
Gerald T. Voelbel, PhD
key words: proprioception, child development, psychomotor performance

ABSTRACT

This study examined the contribution of tactile and kinesthetic perceptions to handwriting
legibility and speed of 177 Taiwanese children in first and second grade. Five standardized
instruments assessed tactile and kinesthetic perceptions using handwriting legibility and speed
as outcome measures. Fine motor coordination, mental processing speed, age, and gender were
measured and served as covariates. Pearson correlations and regression analyses examined the
relationship between handwriting and tactile and kinesthetic perceptions. Handwriting speed
and legibility both significantly correlated with tactile perception, kinesthetic perception, and
covariates. Results from the regression analysis supported tactile and kinesthetic perceptions
as being significant predictors of both handwriting speed (F (6,170) = 25.87, p < .001, R2 =
.477) and legibility (F (6,170)= 11.043, p < .001, R2 = .280). Tactile perception contributed
more to handwriting speed and legibility than kinesthetic perception. Tactile and kinesthetic
perception should be assessed when evaluating handwriting. When children have difficulty
writing quickly or legibly, professionals should assess children’s tactile and kinesthetic abilities.

T actile and kinesthetic perceptions influence

a child’s movement and motor execution
through neurophysiologic mechanisms
(Gandevia, Butler, Hodges, & Taylor, 2002; Noback,
Strominger, Demarest, & Ruggiero, 2005). While
writing, a child’s central nervous system carries both
tactile and kinesthetic perceptions to the somato-
sensory cortex, which processes tactile and kines-
thetic perceptions and transfers this information to
the motor cortex. The motor cortex is then able to
regulate motor control based on these perceptions so
that the child can perform fine-tuned motor control
of his or her hands and fingers for efficient writ-
ing (Goodwin & Wheat, 2004; Noback et al., 2005).
As a child writes, the nervous system constantly
receives sensory information from the child’s hands
and fingers and uses this information to adjust and
correct the hand’s trajectory. The synthesis of tac-
tile and kinesthetic perception information during
writing provides essential feedback to a child about
touch, pressure, orientation, and position of hands
(Gardner, 1988; Goodwin & Wheat, 2004).
Furthermore, tactile and kinesthetic perceptions
provide a child with the information needed to
grasp and manipulate a pencil while writing (Cer-
mak, 2005; Ziviani & Wallen, 2005). During the task
of writing, a child perceives tactile information from
the hands and fingers about shapes, sizes, textures,
and pressure that allows the child to manipulate the
pencil and paper effectively. Kinesthetic perception

Tzu-Ying Yu, PhD, OT, is Assistant Professor, Department of Occupational Therapy, I-Shou University, Kaohsiung City, Taiwan.
Jim Hinojosa, PhD, OT, FAOTA, is Professor, Tsu-Hsin Howe, PhD, OTR, is Assistant Professor, and Gerald T. Voelbel, PhD, is
Professor, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York.
Originally submitted June 30, 2011. Accepted for publication November 15, 2011. Posted online December 19, 2011.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Tzu-Ying Yu at tyy207@nyu.edu.
This manuscript was accepted under the editorship of Jane Case-Smith, EdD, OTR/L, FAOTA.
doi: 10.3928/15394492-20111209-02

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provides a child with information about positions
and movements of the hand and fingers so they can
be adjusted to produce legible writing (Goodwin &
Wheat, 2004; Noback et al., 2005).
Prior studies have determined that handwrit-
ing quality and speed is influenced by develop-
mental factors, which were used in this study as
covariates. Specifically, age (Graham, Weintraub,
Berninger, & Schafer, 1998; Hamstra-Bletz & Blote,
1990; Rueckriegel et al., 2008), gender (Graham et al.,
1998; Weintraub, Drory-Asayag, Dekel, Jokobovits,
& Parush, 2007), fine motor coordination (Volman,
Van Schendel, & Jongmans, 2006; Feder et al., 2005;
Tseng & Chow, 2000; van Hoorn, Maathuis, Peters, &
Hadders-Algra, 2010), and mental processing speed
(Floyd, McGrew, & Evans, 2008; McCutchen, 2000)
have all been verified as influences on handwriting
quality and speed.
In contrast, limited research has examined the re-
lationship between tactile and kinesthetic perceptions
and handwriting. These studies have examined the
relationship between handwriting and tactile percep-
tions by assessing in-hand manipulation (Cornhill
& Case-Smith, 1996; Feder et. al., 2005), finger iden-
tification (Feder et al., 2005; Parush, Lifshitz, Yoch-
man, & Weintraub, 2010), and handwriting pressure
(Khalid, Yunus, & Adnan, 2010; Wann, 1991). Feder
et al. and Cornhill and Case-Smith observed that tac-
tile perception measured by finger identification and
in-hand manipulation significantly correlated with
handwriting legibility in both children born prema-
turely and typically developing children. Feder et al.
(2005) also reported a significant correlation between
finger identification and in-hand manipulation with
slow handwriting speed. However, no associations
between tactile perception and handwriting legibil-
ity or speed were found in other studies (Parush et
al., 2010; Ziviani, Hayes, & Chant, 1990). Khalid et al.
(2010) and Wann (1991) examined handwriting pres-
sure as a component of tactile perception. Khalid et
al. concluded that both too much pressure and not
enough pressure negatively influenced children’s
handwriting. These findings confirmed Wann’s kine-
matic study of 11 adults that found that modulation
of handwriting pressure affected handwriting speed.
Weintraub and Graham (2000) and Preminger,
Weiss, and Weintraub (2004) investigated the rela-
tions between kinesthetic perception and hand-
writing. Findings from both studies supported that
handwriting legibility is related to kinesthetic per-
ceptions. Occupational therapists (Benbow, 2005;
Rosenblum, Goldstand, & Parush, 2006; Sudsawad,
Trombly, Henderson, & Tickle-Degnen, 2002) have
asserted that kinesthetic perception influences pen-
88
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cil grip and the motor control of writing tools. Laszlo
and Bairstow (1983) demonstrated that kinesthetic
training improved drawing in children with kines-
thetic perceptual deficits and teachers reported that
their handwriting improved in the classroom. Zivi-
ani et al. (1990) verified that kinesthetic perception
contributed to handwriting legibility in children
with myelomeningocele, concluding that kinesthetic
perception influences motor control of handwriting.
Occupational therapists assume that tactile and
kinesthetic perceptual abilities exert a significant
influence on children’s development of skilled
movements such as handwriting (Amundson, 1992;
Benbow, 2005; Feder & Majnemer, 2007). However,
there is a lack of empirical evidence to support this
theoretical postulate. Thus, this study examined the
contribution of tactile and kinesthetic perceptions to
handwriting legibility and speed in typically devel-
oping first and second grade children with devel-
opmental factors including age, gender, fine motor
coordination, and mental processing speed as co-
variates. We hypothesized that while controlling for
developmental factors associated with handwriting,
tactile and kinesthetic perceptions influence hand-
writing speed and handwriting legibility.
Method
Sample
A power analysis for multiple regression (Faul,
Erdfelder, Lang, & Buchner, 2007) determined a mini-
mum sample size of 130 was needed to achieve a
power of 0.9 and to detect a small to medium effect
size of 0.1 with a level of .05. The first author recruited
from two public elementary schools in Taiwan where
there are no children with special needs. Both schools
use a curriculum established by the Ministry of Edu-
cation. In Taiwan, children with special needs attend
special education schools. A description of the study
and invitations for the children’s participation were
sent to 390 students’ parents. Parents of 239 children
returned signed consent forms. Sixty-two children
did not meet the inclusion criteria (3 had hand inju-
ries and 59 did not meet the English requirements).
No child whose parents had agreed to allow him or
her to take part refused to participate.
The inclusion criteria were: (1) attended first or
second grade; (2) had been taking English classes for
1 year and could write the 26 letters of the English al-
phabet; (3) reported by the teacher to be typically de-
veloping; and (4) received written permission from
parents or legal guardians and received children’s
assents for participating in the study. The study was
approved by the University Committee on Activities
Involving Human Subjects.
Copyright © American Occupational Therapy Foundation
Instrumentation
The first author tested all children and asked each
child directly for assent before testing. Predeter-
mined random sequence testing took 25 to 35 min-
utes for each child in a private and quiet room. Prior
to the data collection, the first author established
acceptable inter-rater reliability and scoring pro-
cedures with experienced researchers who use the
tests frequently.
The Minnesota Handwriting Assessment–manu-
script version (Reisman, 1999) is a norm-referenced
instrument that assesses both handwriting legibil-
ity and speed of children in first and second grade
based on copying 34 letters in 2.5 minutes. It has
excellent inter-rater (r = .90 to .99) and intra-rater
(r = .47 to .94) reliability (Feder & Majnemer, 2003),
and good content validity (Reisman, 1999). In this
study, raw scores were used to measure legibility
and speed was measured by counting the number of
letters completed in 2.5 minutes.
The Tactual Performance Test (Reitan & Wolf-
son, 1985) assesses tactile perception by evaluating
ability of a child (5 to 8 years of age) to recognize
the shape of an object through active manipulation
while blindfolded. The Tactual Performance Test re-
quires a child to fit six blocks into the proper spaces
in 15 minutes under three test conditions: (1) with
the dominant hand; (2) with the non-dominant
hand; and (3) using both hands. The child’s score
is the average time (in seconds) taken to complete
the three trials. Shorter completion time indicates
better tactile perception. Internal reliability is ac-
ceptable (range: .61 to .90) (Charter, 2001a, 2001b,
2001c) and the intra-rater reliability is moderate (r
= .76) (Schludermann, Schludermann, Merryman, &
Brown, 1983).
The Imitating Hand Positions Subtest of the NEPSY-
II (Korkman, 1998) assesses neuropsychological devel-
opment in children aged 3 to 12 years and has a high
reliability (r > .80) and validity (Brooks, Sherman, &
Strauss, 2010; Korkman, 1998). It assesses kinesthetic
perception by having a child imitate 12 different hand
and finger positions with each hand as modeled by the
examiner. Scoring is 1 point for each correct response
for a maximum of 24, with a low score indicative of
poor kinesthetic perception.
The Grooved Pegboard Test (Klove, 1963; Mat-
thews & Klove, 1964) measures fine motor coordina-
tion (Trites, 1989) and has good reliability (r = .80 to
.81) (Knights & Moule, 1968) and concurrent validity
(Knights et al., 1991). For the child version of the test
(5 to 8 years of age), the child is instructed to pick
up a peg from a container and place it into one of
the holes of a pegboard (10 pegs in total). The child
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completes the task twice using each hand and the
test is scored using the total time in seconds. Shorter
completion time indicates better fine motor coordi-
nation.
The Coding Subtest of the Wechsler Intelligence
Scale for Children-IV (WISC-Coding) (Wechsler,
2003) measures mental processing speed and has
good reliability (r = .85) (Wechsler, 2003) and va-
lidity (Donders & Janke, 2008; Launey, Carroll, &
Van Horn, 2007; Wechsler, 2003). In this study, the
WISC-Coding A was administered to children be-
tween 6 and 7 years of age and the WISC-Coding B
was administered to 8-year-old children. The WISC-
Coding A and B are time-limited tasks that require a
child to recognize which symbol is associated with
a matched geometric shape or number and to draw
the symbol in its corresponding box or shape. The
standard scores of the WISC-Coding A and B were
used in the analyses. A low score suggests slow men-
tal processing speed, which means slow information
processing and interpretation of stimuli (Marshall,
Forstot, Callies, Peterson, & Schenck, 1997).
Data Analysis
First, univariate analyses were conducted on
background information and developmental factors
associated with handwriting. Second, Pearson cor-
relations were used to determine the associations
between all variables. Third, hierarchical multiple
regression models were used to test the contribution
of tactile and kinesthetic perceptions to handwriting
legibility and speed. In the regression, handwriting
legibility and speed were the dependent variables
and tactile and kinesthetic perceptions were the
predictor variables. The covariates were age, gen-
der, fine motor coordination, and mental processing
speed. Normality, linearity, and multicollinearity
were examined prior to data analysis. All data were
analyzed using SPSS-PC 16.0 software (Norusis,
2008).
Results
One hundred seventy-seven children, consisting
of 93 boys (52.5%) and 84 girls (47.5%), participated
in this cross-sectional study. Eighty-eight (52.5%)
were in the first grade and 89 in the second grade
(50.3%). Student ages ranged from 72 to 107 months
(mean = 93 months, standard deviation [SD] = 10.39
months) with 47 (26.6%) aged 6 years, 47 (26.6%)
aged 7 years, and 83 (46.8%) aged 8 years. Almost all
children were right handed (n = 171, 96.6%). Pear-
son correlations were used to examine the associa-
tions between handwriting and main outcome vari-
89
 Table 1
Multiple Regression Analyses of the Contribution of the Tactile and Kinesthetic Perceptions in Handwriting Speed (N = 177)a
Model 1 Model 2
2
R R2
Predictors ␤ t p R2 Change Predictors R2 Change
Block 1 (covariates)
Age .44 6.78 < .001 Age
Gender .02 0.27 .79 Gender
.355**b .355**b .355**,b .355**,b
GPT .10 1.51 .13 GPT
WISC-Coding Test .13 2.32 .02 WISC-Coding Test
Block 2
TPT -.37 -5.63 < .001 .464** .11** IHP .38** .025**
Block 3
IHP .12 2.04 .04 .477** .013* TPT .477** .097**
2
Final model R = .477, F = 25.87, p < .001
GPT = Grooved Pegboard Test; WISC = Weschler Intelligence Scale for Children; TPT = Tactual Performance Test; IHP = Imitation Hand Positions Test.
a
Dependent variable = Minnesota Handwriting Assessment–Handwriting Speed.
b
Included covariates.
*p < .05. **p < .01, indicated significant predictor.

ables (tactile and kinesthetic perceptions), as well
as developmental factors. Results indicate that both
handwriting speed and legibility significantly corre-
lated with tactile perception (r = .52 and .41, p < .01),
kinesthetic perception (r = .30 and .36, p < .01), age
(r = .56 and .34, p < .01), fine motor coordination (r =
.33 and .22, p < .01), and mental processing speed (r
= .27 and .16, p < .01).
Contributions of Tactile and Kinesthetic
Perceptions to Handwriting Performance
Two hierarchical regression models on handwrit-
ing speed determined the respective contributions
of tactile and kinesthetic perceptions. In the regres-
sion model, the covariates were entered into the first
block. Tactile perception and kinesthetic perception
were entered into the second and third blocks, re-
spectively, to determine kinesthetic perception’s
prediction of handwriting speed when controlling
for covariates and tactile perception. Then, model 2
was conducted with the covariates in the first block
but with the order of entering the predictor variables
into the second and third blocks reversed; that is,
kinesthetic perception and tactile perception were
entered into the second and third blocks, respec-
tively, to determine tactile perception’s prediction
of handwriting speed when controlling for devel-
opmental factors and kinesthetic perception. Table
1 summarizes the contribution of tactile and kines-
thetic perceptions to handwriting speed. The results
also indicated that tactile perception contributes to
handwriting speed relatively more than kinesthetic
perception.
The same procedure of regression models was
conducted to obtain the respective contributions of
tactile and kinesthetic perceptions to handwriting
legibility. The dependent variable was handwriting
legibility as measured by the Minnesota Handwrit-
ing Assessment–manuscript version. The indepen-
dent variables were the predictor variables and the
covariates (age, gender, fine motor coordination,
and mental processing speed). Table 2 shows that
the regression model was found to be significant in
predicting handwriting legibility (F (6,170) = 11.043,
p < .001, R2 = .280) with developmental factors to-
gether explaining 28.0% of the variance. Table 2 also
presents the predictors that significantly contributed
to the prediction of handwriting legibility. It shows
that tactile perception (t = -4.09, p < .001), kinesthetic
perception (t = 3.65, p < .001), and age (t = 2.85, p
= .005) significantly contributed to the prediction of
handwriting legibility. Similar to handwriting speed,
the results indicated that tactile perception contrib-
uted relatively more than kinesthetic perception to
handwriting legibility.
Discussion
This study confirms that both tactile and kines-
thetic perceptions correlate significantly with hand-
writing speed and legibility. It also confirms that tac-
tile and kinesthetic perceptions significantly predict

90 Copyright © American Occupational Therapy Foundation

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 Table 2
Multiple Regression Analyses of the Contribution of the Tactile and Kinesthetic Perceptions in Handwriting Legibility (N = 177)
Model 1 Model 2
2
R R2
Predictors ␤ t p R2 Change Predictors R2 Change
Block 1 (covariates)
Age .22 2.85 .005 Age
Gender .05 .70 .48 Gender
.133**,b .133**,b .133**,b .133**,b
GPT .09 1.13 .26 GPT
WISC-Coding Test .05 .78 .44 WISC-Coding Test
Block 2
TPT -.32 -4.09 < .001 .224** .091** IHP .210** .077**
Block 3
IHP .25 3.65 < .001 .280** .056** TPT .280** .071**
2
Final model R = .280, F = 11.043, p < .001
GPT = Grooved Pegboard Test; WISC = Weschler Intelligence Scale for Children; TPT = Tactual Performance Test; IHP = Imitation Hand Positions Test.
a
Dependent variable = Minnesota Handwriting Assessment–Handwriting Speed.
b
Included covariates.
*p < .05. **p < .01, indicated significant predictor.

handwriting speed and legibility and account for
variance in handwriting performance. Although the
findings support a correlation between tactile and
kinesthetic perception and handwriting, they cannot
be interpreted to suggest causality. The findings only
support an association between tactile and kinesthet-
ic perceptions and handwriting speed and legibility.
In addition, the study reveals that tactile perception
contributes more to the outcomes of handwriting
speed and legibility than kinesthetic perception for
typically developing children between the ages of 6
and 8 years.
Theoretically, sensory-perceptual stimuli con-
tribute to motor performance and control (Cermak,
2005; Noback et al., 2005). These findings provide ad-
ditional empirical evidence to support the theoreti-
cal postulate that tactile and kinesthetic perceptions
from hands and fingers during writing are associat-
ed with the motor control and motor programming
required for legible and fast handwriting. The find-
ings indicate that children in first and second grade
rely on both tactile and kinesthetic perceptions while
writing. Thus, the findings provide evidence sup-
porting the theoretical postulate described as the
feedback loop of tactile and kinesthetic perceptions
in children’s handwriting.
This study’s findings were consistent with those
of previous studies (Cornhill & Case-Smith, 1996;
Feder et al., 2005), but were different than those
reported by Ziviani et al. (1990) and Parush et al.
(2010), who found no association between tactile
perception and handwriting legibility or speed in
older children with handwriting difficulties. In an-
other study of older children, Chang (1997) found
no correlation between handwriting legibility and
speed and tactile perception in 30 typically develop-
ing children in third grade. Based on her findings,
she suggested that older children depend less on
tactile perception for their handwriting legibility
than younger children do. The discrepancy between
previous studies and this current study can be ex-
plained by the different populations, the different
measure used, or the possibility that children at
various ages might rely on tactile and kinesthetic
perception to different degrees while handwriting.
In this study, the participants were first and second
grade students who were learning handwriting and
may have needed to rely more on tactile and kin-
esthetic perception to write faster and more legibly.
When children learn how to write, they have to pay
close attention to the feeling from their hand and fin-
ger positions and touch sense to grasp the writing
tools appropriately. Younger writers who engage in
writing tasks develop motor control in their hands
and fingers over time.
An important finding in this study was that the
6- to 8-year-old children relied on tactile perception
more than kinesthetic perception for both writing
speed and legibility. This finding suggests that chil-
dren’s legible handwriting involves tactile discrimi-
nation of the objects through manipulation (i.e.,
tactile perception) more than the ability to perceive

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the hand position and movement (i.e., kinesthetic
perception). These findings corroborate previous
research (Cornhill & Case-Smith, 1996; Feder et al.,
2005; Khalid et al., 2010; Wann, 1991) supporting that
factors of tactile perception, such as in-hand manip-
ulation, finger identification, or handwriting pres-
sure, influence handwriting legibility and speed.
One interesting observation about the research
sample is that they had “very good” fine motor
coordination with mean scores on the Grooved
Pegboard Test two standard deviations above the
mean of the norms for American children. They also
scored 1 standard deviation above the mean of the
norms for American children on mental processing
speed (WISC-Coding Test). Better performance on
the WISC-Coding Test suggests that these Taiwanese
children efficiently recognized morphological forms
and could proficiently execute the hand movements.
Prior studies (Chow & Henderson, 2003; Hender-
son & Sugden, 1992; Hsu, Cherng, Yu, & Cheng-Sea,
2004) support that Chinese children perform signifi-
cantly better on manual dexterity tasks than Ameri-
can children. Other researchers (Li, 2002; Tseng,
1998) hypothesized that Chinese children develop
better manual dexterity as they are encouraged to
engage in academic activities, like handwriting and
drawing, at a younger age. Future studies should
explore whether the contributions of tactile and kin-
esthetic perceptions to handwriting in Chinese chil-
dren in Taiwan can be generalized to other regions
of the world or other cultures.
Limitations and Directions for Further Research
The results of the study must be interpreted with
caution due to the restricted age range and the char-
acteristics of the sample population of Taiwanese
children. Future studies should examine kinesthetic
and tactile as a function of age. These studies would
lead to an understanding of the contributions of tac-
tile and kinesthetic perceptions to handwriting at
different times in children’s development.
Clinical Implications
Professionals often assume that the tactile and
kinesthetic perceptual abilities of children exert a
significant influence on their development of skilled
movements needed for handwriting. These study
findings demonstrate that tactile and kinesthetic
perceptions contribute to handwriting speed and
legibility. The findings suggest that professionals
should pay close attention to children’s tactile abil-
ity to perceive the shape, size, texture, and pressure
exerted on objects through manual and in-hand ma-
nipulations when children are having difficulty writ-
92
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ing quickly. In addition, this study again supported
that the covariates age, fine motor coordination, and
mental processing speed were factors significantly
associated with handwriting speed and legibility. In
summary, results support that professionals should
assess tactile perception and kinesthetic perception
as part of evaluation of children’s handwriting.
Acknowledgments
This article is based on research conducted by the first
author in partial fulfillment of the requirements for the
Doctorate of Philosophy in Occupational Therapy in the
Steinhardt School of Culture, Education, and Human De-
velopment at New York University. The authors thank all
of the children who participated in the study. Presented at
the World Federation of Occupational Therapists (WFOT)
XV Congress, May 4, 2010, Santiago, Chile, and the 11th
Occupational Therapy Annual Conference, April 9, 2011,
Taipei City, Taiwan. Supported by Dean’s Grants for Stu-
dent Research, New York University, 2009-2010.
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