Why do we use weighted pencils in therapy?

My post last week about how to make a weighted pencil received an incredible number of views and comments. Thank you all for the support and feedback! In case you missed it, click here to check it out.

Now I would like to pose this question to all of the occupational therapists out there, why DO we use weighted pencils (or crayons or markers)? And if we believe this strategy is effective (which we must, or we wouldn't be doing it), then why aren't we challenging our beliefs by creating a hypothesis, collecting data, and documenting our results?

Thank you to 101 OT Ideas for asking about research relating to the use of weighted pencils. I first did a web search using Google scholar and all I located was an article describing a Handwriting Club that mentioned the use of a weighted pencil holder. I'm not sure what a weighted pencil holder is, and the article didn't look at the outcome of specific sensory strategies. However, it is an interesting read if you're considering starting a handwriting club or handwriting camp. Click here to check it out.

I then did a ProQuest search and didn't find anything related to weighted pencils, although I did find some articles about the use of multisensory strategies for handwriting. This included strategies such as writing on a chalkboard, writing letters in sand, using whole arm movements for "sky writing", and tracing letters on various textures. The studies did not include the use of weighted pencils. I found one article from 2000 that looked at the use of weights in therapy:

Feder, K., Majnemer, A., & Synnes, A. (2000). Handwriting: Current trends in occupational therapy practice. The Canadian Journal of Occupational Therapy, 67, 197-204.

• In this study, pediatric occupational therapists were interviewed regarding the treatment approaches used for children with handwriting difficulties. In addition, the OTs interviewed were asked about their use of weights in therapy. Sixty-eight percent reported that they use weights, for reasons such as poor sensory awareness. This article went on to say that there is little research to support the use of weights, yet many therapists are doing so. It's almost 12 years later, and there is still little to no research to support the use of weights, yet many therapists, myself included, are doing so.

[Side note: ProQuest is a full-text online database provided as a benefit for members of the Occupational Therapy Association of California. If you don't live in California, you should lobby for your state association to offer a similar benefit!]

I also did a search on AJOT (American Journal of Occupational Therapy). Again, I didn't find anything specific to weighted pencils, but I did find the following articles of interest.

American Occupational Therapy Association (2009). Providing occupational therapy using sensory integration theory and methods in school-based practice. American Journal of Occupational Therapy, 63, 823-842.

• This document by AOTA discusses the use of sensory integration theory in school-based practice. While weighted pencils are not specifically addressed or researched, the use of a weighted pencil is listed as an intervention in a case study presented in this document. If the use of a weighted pencil is listed in a document by AOTA, then this is clearly an intervention that is used frequently and its effectiveness should be further studied.

Woodward, S. & Swinth, W. (2002). Multisensory approach to handwriting remediation: Perceptions of school-based occupational therapists. American Journal of Occupational Therapy, 56, 305-312

•  This study used a questionnaire to identify the types of multisensory strategies that occupational therapists are using for handwriting remediation. No research was completed on the effectiveness of any of the strategies. The use of wrist weights was identified as a strategy used for proprioceptive input.

It seems clear to me that the use of weighted pencils is an intervention that occupational therapists frequently use, but with little research to support the intervention. I'm not exactly sure how to go about collecting data on something like the use of a weighted pencil. I'm currently only using this strategy with one student, and I'm not using the weighted pencil in isolation of other interventions. If this student improves, is it because of the weighted pencil, the visual motor activities, the daily handwriting practice in his classroom (which research has found to be a very effective intervention), or some other factor?

I am highly interested in diving into this topic further and collecting data on the use of weighted writing utensils. If anyone has any thoughts about how to do this, please leave a comment below, or contact me at AbbyPediatricOT [AT] gmail [dot] com.