Interview with Kathleen Yancosek & Kristin Gulick

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Today, Tyler R. Tichelaar of Reader Views is pleased to interview Kristin Gulick and Kate Yancosek about their new book “Handwriting for Heroes: Learn to Write with Your Non-Dominant Hand in Six Weeks.”

Katie Yancosek is an officer in the Army Medical Specialist Corps. She graduated from Gannon University with a Bachelor’s of Science degree in occupational therapy and from Eastern Kentucky University with a Master’s of Science degree in occupational therapy. She is pursuing a Ph.D. in Rehabilitation Sciences at the University of Kentucky. She currently lives in Kentucky with her husband and two sons.

Kristin Gulick has been enjoying her practice as an Occupational Therapist for twenty-three years. She graduated from University of Puget Sound and began her practice working with children at Shriners Hospital in Portland, OR. Kristin’s career path led her to focus on rehabilitation of the upper extremity, and she became a certified hand therapist in 1996. Currently Kristin serves as the Director of Therapy Services at Advanced Arm Dynamics where she enjoys partnering with clients with upper limb loss in their rehabilitation.

Tyler:  Welcome Katie and Kristin. I’m very interested to talk to you today about your new book. To begin, would you tell us what made you decide to write a book about learning to write with your non-dominant hand?

Kristin:  This project truly came out of Katie’s dream and passion. I met Katie while I was working at Walter Reed Army Medical Center as part of a contract team providing upper limb prosthetic services for warriors returning from Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom. Katie and I found that our approaches and energy to providing occupational therapy are very complementary. I was honored when she asked whether I would like to be involved in this very needed project.

Tyler:  Is the book designed only for those who have lost use of their dominant hand, or would people who can currently write with their right-hand but just wants to learn to use the left-hand for whatever reason, also find the book beneficial?

Kristin:  This book will assist both those who need to change dominance or those who might want to change dominance. There have been a few instances where people using a prosthesis on their previously dominant side wanted to continue to use their dominant side and write with their prosthesis (not a typical situation, the majority of persons with dominant side limb loss will change dominance) and the workbook was helpful to them in that situation.

Tyler:  Most people are right-handed—does this book apply to left-handed people as well, for them to learn to write with their right-hands? Is there any difference for left-handed people in learning to use their non-dominant hands?

Katie:  This book applies to both right and left-handed writers. There is a difference in writing with your left hand versus your right hand. When writing with your left hand, your hand and arm can block your visual field of your document. This can lead one to position the left arm/hand in an awkward and biomechanically disadvantaged hooked wrist position. This can be avoided with proper paper positioning and a good pencil grip. There are also some pencil grips that are formed to encourage good pencil grip specifically for the right or left-handed person.

Tyler:  When you talk about good pencil grips, do you mean solely how the pencil is held, or are there also special pencils that can help people?

Katie:  There is a preferable/proper way to hold a pencil/pen that is the most efficient and effective, meaning that the least amount of effort is required and the finest performance is expected. There are also pencil “grippers” that are sold commercially that help facilitate that preferred grip pattern.

Tyler:  Katie and Kristin, do you have any information about why most people are right-handed or left-handed? Is there a scientific or biological reason why we aren’t all born to be ambidexterous to begin with?

Kristin:  Approximately 10% of the population is born left-handed, including some famous and talented people, such as Oprah Winfrey, Benjamin Franklin, Prince Charles, and Henry Ford to name a few. There have been studies that have proposed a genetic link to handedness (2007) and others that have proposed a hormonal effect on hemispheric development of the brain—the Geschwind theory.

Tyler:  What are some of the exercises or activities you discuss in the book to train a person to use the non-dominant hand?

Kristin:  Some of the activities are focused on further developing the stability of the wrist in extension to serve as a solid foundation for dynamic use of the radial side of the hand, while other activities are focused on further developing the fine motor coordination of what was previously the non-dominant stabilizing hand and is now to be the dominant manipulative hand.

Tyler: How is “Handwriting for Heroes” different from past practices to help people learn to use their non-dominant hands?

Kristin:  In my past practice I used to tell my clients to go to a local store and purchase a first grade primer or I would use programs developed for children with handwriting difficulties. These programs were designed and written for children not for adults. I always felt that offering programs designed for children was not supportive of the type of rehabilitation that I want to provide for adults.

Tyler:  Do the activities involve similar practices? For example, coloring—it uses specific muscles to color, and I know as an adult when I’ve tried to color, my arm got sore a lot sooner than when I was a child, so are some activities similar to what children would learn just to help the hand and arm muscles?

Katie:  There are subtle differences in which forearm and hand muscles are recruited and used during coloring versus writing, but both involve visual perception, fine motor dexterity, pinch strength, and of course, cognition.

Tyler:  What is the typical timeframe for people who want to learn to write with their non-dominant hands? Does the book provide a certain number of exercises to work through over a prescribed time?

Katie:  Yes, the book provides a daily practice schedule that continues daily over six full weeks. After this time, the person will be proficient, but just as any motor task, they will continue to make improvements over a longer time frame. The workbook definitely promotes deliberate practice and sets a firm foundation for handwriting skill. The idea is that once a baseline proficiency is established, the person will then be able to engage independently in handwriting tasks that are embedded in daily activities and occupations which are meaningful to the person.

Tyler:  What made you choose the title “Handwriting for Heroes”?

Kristin:  Katie is incredibly creative and had come up with a list. We wanted to honor the warriors who had gone forward in this and past conflicts and as a result had lost the use of a dominant limb and needed to retrain for handwriting. It was our experience with the warriors of Operation Iraqi Freedom and Operation Enduring Freedom that inspired us to pursue this project, although we truly hope that the project provides help for warrior and civilians alike, reaching a much broader population.

Tyler:  Do most people feel frustration during the process of trying to write with the non-dominant hand? What advice would you have for them?

Katie:  Yes, frustration is common, speaking from experience and from observation. As with learning any new skill, there are certain things that you can do to set yourself up for success…starting with knowing yourself, being gentle with yourself, practicing when you have dedicated time and giving yourself breaks when you feel frustration. It is also important to reward yourself. We have the workbook set up so that you can look back and see progress, so that on a frustrating day you can remember just how far you have come.

Tyler:  When a person completes the workbook, is the work done, or must people continue to practice, and if so, what do you advise as the next step?

Katie:  We advise that the person continues to write and to return to previously enjoyed activities that involved writing, such as crossword puzzles, letter writing, drawing, etc. Also, we know that life will demand a “to-do” list, a “grocery list” and a “fill-out-this-form” that will require independence in writing!

Tyler: By learning to write with the non-dominant hand, will a person also become better skilled at other tasks using the non-dominant hand?

Katie:  Writing is a fine motor skill as are the skills like tying and cutting. By practicing some of the activities given in the book, all fine motor skills should improve.

Tyler: Do people who have lost the use of their dominant hands tend to begin with learning to write again, or are their other activities used in physical therapy that come first? I imagine it depends on the individual?

Katie:  You are right; it does depend on the individual. Learning to write should be introduced into a rehabilitation program when it is appropriate physically and psychologically. People should be approached on an individual basis and their rehabilitation should be focused on their individual goals. For some there is urgency in learning to write, so that they can sign documents that are critical to the life they have that did not come to a halt when they were injured. Providing this skill early on can also provide a sense of control and capability that is often lost when someone is critically injured. For others, initially there may be more important goals and handwriting will be addressed later in their program.

Tyler:  What are some of the other beginning activities besides handwriting that people start with in trying to use the non-dominant hand?

Katie:  Generally people start with activities of daily living such as brushing teeth, brushing hair, dressing: buttoning/zipping/fastening/tying. They also need to prepare and eat food. There is an immediate demand for the “transfer” of hand skills, and concomitantly there is a demand to go from a bimanual (two-handed) to unimanual status. The person is simultaneously mastering one-handed functioning and a dominance transfer.

Tyler:  Katie and Kristen, is anything possible? Is there anything a person could not learn to do again, such as play the piano or swing a baseball bat?

Katie:  Given the adaptive equipment currently available and the limitless creativity within each person, we believe that YES anything is possible. There is generally an alternative approach to accomplishing a task. We have seen people develop lots of creative ways to accomplish tasks. I guess it’s true that “necessity is the mother of all invention.”

Tyler:  Is “Handwriting for Heroes” intended to be used with a therapist or in some larger form of instruction, or can it be used by itself?

Katie: This workbook is definitely designed for use by a therapist with a client or for use by a client independently or with a significant other. The tips provided and exercises were written in language to be helpful to the medical professional as well as the non-medical professional.

Tyler:  What kind of research did you do in writing this book?

Katie: Our bibliography includes the majority of our references. The content was derived from years of experience on both of our parts. My years of pediatric experience were invaluable. I also drew from further years of practice in providing rehabilitation for persons with significant upper limb trauma and upper limb amputation.

Tyler:  Have you had any responses either from the book itself or the methods you use in this book?

Katie:  As I have started to use it in my practice I have had many other therapists show enthusiasm for using it with their clients and further have shown enthusiasm asking about how to order it and offering suggestions about other groups who might benefit from using the book.

Tyler: Thank you, Katie and Kristin, for joining me today. Before we go, will you tell us about your website and what additional information may be found there for “Handwriting for Heroes: Learn to Write with Your Non-Dominant Hand in Six Weeks”?

Katie:  Our website is www.handwritingforheroes.com and should be checked regularly for updates and additional material and new research findings. Thanks.

Tyler:  Thank you, Katie and Kristen, for the interview. I hope your book gives hope and handwriting back to many people.

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