Hi there. It's me responding as an OT again!
From my standpoint, when a parent brings in a child and has concerns about handwriting these are the things I look at:
1)vision - I screen for near point focusing/convergence problems and other developmental vision issues that warrant a referral to an optometrist
2)overall motor coordination - I check for signs of dyspraxia and motor coordination issues that can be one source of handwriting issues. This includes bilateral motor coordination, the ability to cross midline, how the pencil is held, etc. Both gross and fine motor abilities assessed.
3) eye/hand and visual motor integration skills - standardized assessments (Beery Developmental Test of Visual-Motor Integration, aka VMI) and informal observations. Important to separate out whether there is a visual issue, motor issue or both. The VMI has vision and motor subtests to help isolate which is the problem
4)perceptual skills - how is visual information interpreted. It is one thing to *see* it but another to understand it. Again, there are standardized assessments for this area of function. It's important to see if there is laterality and directionality developed (understanding of r/l and top/bottom, etc). Other skills are also included in this testing (figure ground, visual closure, and others).
5) quality of handwriting and effort for handwriting - is it labored, difficult, slow, etc all the time or only at certain levels of challenge. Is it easy to do some parts of writing but not others? Are the letters formed and spaced properly on the page? Lots and lots of stuff to look at informally.
I believe that dysgraphia is considered a learning disorder of written expression. Sometimes the dysgraphia is linked to generalized dyspraxia. So treating the dyspraxia for the whole body really helps with the handwriting. But sometimes the issue is more left brain dysfunction and then harder to treat. An OT can't actually diagnose dysgraphia, that needs to come from a psychologist.
Good luck as you look at what is going on and what can help. I'm sure you'll find some answers. Accomodation and/or intervention are both helpful, so you should look at both options. The important thing is that she be able to produce the written work in the easiest, least stressful manner possible.
