The Effect of a Visual Memory Training Program on Chinese Handwriting Performance of Primary School Students with Dyslexia in Hong Kong


This study investigated the effect of a visual memory training program on Chinese handwriting performance among primary school students with dyslexia in Hong Kong. Eight students of Grade 2 to 3 who were diagnosed with dyslexia were recruited. All participants received six sessions of training, which composed of 30-minute computerized game-based visual memory training and 30-minute Chinese character segmentation training. Visual perceptual skills and Chinese handwriting performance were assessed before and after the training, as well as three weeks after training using the Test of Visual Perceptual Skills (3rd edition) (TVPS-3) and the Chinese Handwriting Analysis System (CHAS). In comparing the pre- and post-training results, paired t-tests revealed significant improvements in visual memory skills, as well as handwriting speed, pause time and pen pressure after the training. There was no significant improvement in handwriting accuracy or legibility. The improved visual memory and handwriting performance did not show a significant drop at the follow-up assessments. This study showed promising results on a structured program to improve the Chinese handwriting performance, mainly in speed, of primary school children. The improvements appeared to be well-sustained after the training program. There is a need to further study the long-term effect of the program through a randomized controlled trial study.

Share and Cite:

Li-Tsang, C. , Wong, A. , Tse, L. , Lam, H. , Pang, V. , Kwok, C. and Lin, M. (2015) The Effect of a Visual Memory Training Program on Chinese Handwriting Performance of Primary School Students with Dyslexia in Hong Kong. Open Journal of Therapy and Rehabilitation, 3, 146-158. doi: 10.4236/ojtr.2015.34020.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Tseng, M.H. and Chow, S.M.K. (2000) Perceptual-Motor Function of School-Age Children with Slow Handwriting Speed. American Journal of Occupational Therapy, 54, 83-88.
[2] Feder, K.P. and Majnemer, A. (2007) Handwriting Development, Competency and Intervention. Developmental Medicine and Child Neurology, 49, 312-317.
[3] Ingesson, S.G. (2007) Growing Up with Dyslexia: Interviews with Teenagers and Young Adults. School Psychology International, 28, 574-591.
[4] Stampoltzis, A. and Polychronopoulou, S. (2009) Greek University Students with Dyslexia: An Interview Study. European Journal of Special Needs Education, 24, 307-321.
[5] American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th Edition, (DSM-5). American Psychiatric Association, Washington DC.
[6] Ashraf, M. and Majeed, S. (2011) Prevalence of Dyslexia in Secondary School Students in Lahore. Pakistan Journal of Psychological Research, 26, 73-85.
[7] Chan, D.W., Ho, C.S.H., Tsang, S.M., Lee, S.H. and Chung, K.K.H. (2007) Prevalence, Gender Ratio and Gender Differences in Reading-Related Cognitive Abilities Among Chinese Children with Dyslexia in Hong Kong. Educational Studies, 33, 249-265.
[8] Ho, C.S.H., Chan, D.W.O., Lee, S.H., Tsang, S.M. and Luan, V.H. (2004) Cognitive Profiling and Preliminary Subtyping in Chinese Developmental Dyslexia. Cognition, 91, 43-75.
[9] Huang, H.S. and Hanley, J.R. (1995) Phonological Awareness and Visual Skills in Learning to Read Chinese and English. Cognition, 54, 73-98.
[10] Siok, W.T. and Fletcher, P. (2001) The Role of Phonological Awareness and Visual-Orthographic Skills in Chinese Reading Acquisition. Developmental Psychology, 37, 886-899.
[11] Wilmer, J.B., Richardson, A.J., Chen, Y. and Stein, J.F. (2004) Two Visual Motion Processing Deficits in Developmental Dyslexia Associated with Different Reading Skills Deficits. Journal of Cognitive Neuroscience, 16, 528-540.
[12] Koyama, M.S., Stein, J.F., Stoodley, C.J. and Hansen, P.C. (2011) Functional MRI Evidence for the Importance of Visual Short-Term Memory in Logographic Reading. European Journal of Neuroscience, 33, 539-548.
[13] Chow, S.M.K., Choy, S.W. and Mui, S.K. (2003) Assessing Handwriting Speed of Children Biliterate in English and Chinese. Perceptual and Motor Skills, 96, 685-694.
[14] Lam, S.S.T., Au, R.K.C., Leung, H.W.H. and Li-Tsang, C.W.P. (2011) Chinese Handwriting Performance of Primary School Children with Dyslexia. Research in Developmental Disabilities, 32, 1745-1756.
[15] Tan, L.H., Feng, C.M., Fox, P.T. and Gao, J.H. (2001) An fMRI Study with Written Chinese. NeuroReport, 12, 83-88.
[16] Ferguson, C.J., Cruz, A.M. and Rueda, S.M. (2008) Gender, Video Game Playing Habits and Visual Memory Tasks. Sex Roles, 58, 279-286.
[17] Poon, K.W., Li-Tsang, C.W.P., Weiss, T.P.L. and Rosenblum, S. (2010) The Effect of a Computerized Visual Perception and Visual-motor Integration Training Program on Improving Chinese Handwriting of Children with Handwriting Difficulties. Research in Developmental Disabilities, 31, 1552-1560.
[18] Luck, S.J. and Hollingworth, A. (2008) Visual Memory. Oxford University Press, New York.
[19] Fougnie, D. (2008) The Relationship between Attention and Working Memory. In: Johansen, N.B., Ed., New Research on Short-Term Memory, Nova Science Publishers, Hauppage, 1-45.
[20] Riggs, K.J., McTaggart, J., Simpson, A. and Freeman, R.P. (2006) Changes in the Capacity of Visual Working Memory in 5- to 10-Year-Olds. Journal of Experimental Child Psychology, 95, 18-26.
[21] Hu, W., Lee, H.L., Zhang, Q., Liu, T., Geng, L.B., Seghier, M.L., Shakeshaft, C., Twomey, T., Green, D.W., Yang, Y.M. and Price, C.J. (2010) Developmental Dyslexia in Chinese and English Populations: Dissociating the Effect of Dyslexia from Language Differences. Brain, 133, 1694-1706.
[22] Pashler, H. (1988) Familiarity and Visual Change Detection. Perception and Psychophysics, 44, 369-378.
[23] Angelone, B.L., Levin, D.T. and Simons, D.J. (2003) The Relationship between Change Detection and Recognition of Centrally Attended Objects in Motion Pictures. Perception, 32, 947-962.
[24] Luck, S.J. and Vogel, E.K. (1997) The Capacity of Visual Working Memory for Features and Conjunctions. Nature, 390, 279-281.
[25] Chen, Y.P., Allport, D.A. and Marshall, J.C. (1996) What Are the Functional Orthographic Units in Chinese Word Recognition: The Stroke or the Stroke Pattern? Quarterly Journal of Experimental Psychology: Section A, 49, 1024-1043.
[26] Pak, A.K.H., Cheng-Lai, A., Tso, I.F., Shu, H., Li, W. and Anderson, R.C. (2005) Visual Chunking Skills of Hong Kong Children. Reading and Writing, 18, 437-454.
[27] Chen, H., Chang, L., Choiu, Y., Sung, Y. and Chang, K. (2011) Chinese Orthography Database and Its Application in Teaching Chinese Characters. Bulletin of Educational Psychology, 43, 269-290.
[28] Rosenblum, S. and Livneh-Zirinski, M. (2008) Handwriting Process and Product Characteristics of Children Diagnosed with Developmental Coordination Disorder. Human Movement Science, 27, 200-214.
[29] Berninger, V.W., Nielsen, K.H., Abbott, R.D., Wijsman, E. and Raskind, W. (2008) Writing Problems in Developmental Dyslexia: Under-Recognized and Under-Treated. Journal of School Psychology, 46, 1-21.
[30] Martin, N.A. (2006) Manual of the Test of Visual Perceptual Skills (TVPS-3). 3rd Edition, American Therapy Publications, CA.
[31] Mcfall, S.A, Deitz, J.C. and Crowe, T.K. (1993) Test-Retest Reliability of the Test of Visual Perceptual Skills with Children with Learning Disabilities. American Journal of Occupational Therapy, 47, 819-824.
[32] Li-Tsang, C.W.P., Wong, A.S.K., Leung, H.W.H., Cheng, J.S., Chiu, B.H.W., Tse, L.F.L. and Chung, R.C.K. (2013) Validation of the Chinese Handwriting Analysis System (CHAS) for Primary School Students in Hong Kong. Research in Developmental Disabilities, 34, 2872-2883.
[33] Cheng, S.J. (2010) Developmental and Validation of a Chinese Handwriting Assessment Tool (CHAT) for Primary School Students. M.Sc. Dissertation, The Hong KongPolytechnic University, Hong Kong.
[34] Li-Tsang, C.W.P., Au, R.K.C., Chan, M.H.Y., Chan, L.W.L., Lau, G.M.T., Lo, T.K. and Leung, H.W.H. (2011) Handwriting Characteristics among Secondary Students with and without Physical Disabilities: A Study with a Computerized Tool. Research in Developmental Disabilities, 32, 207-216.
[35] Education Bureau of HKSAR (2008) Chinese Language Curriculum and Assessment Guide for Primary School Students. Chinese Language Education Section, Curriculum Development Institute, Education Bureau of HKSAR, Hong Kong.
[36] Gao, Z., Yin, J., Xu, H., Shui, R. and Shen, M. (2011) Tracking Object Number or Information Load in Visual Working Memory: Revisiting the Cognitive Implication of Contralateral Delay Activity. Biological Psychology, 87, 296-302.
[37] Olivers, C.N. and Eimer, M. (2011) On the Difference between Working Memory and Attentional Set. Neuropsychologia, 49, 1553-1558.
[38] Zimmer, H.D., Popp, C., Reith, W. and Krick, C. (2012) Gains of Item-Specific Training in Visual Working Memory and Their Neural Correlates. Brain Research, 1466, 44-55.
[39] Shapiro, K.L. and Miller, C.E. (2011) The Role of Biased Competition in Visual Short-term Memory. Neuropsychologia, 49, 1506-1517.
[40] Poon, W.Y. and Hong, P.M. (2003) A Study of the Chinese Characters Recommended for the Subject of Chinese Language in Primary Schools. Hong Kong Baptist University Language Centre, Hong Kong.
[41] Goodale, M.A. and Milner, A.D. (1992) Separate Visual Pathways for Perception and Action. Trends in Neurosciences, 15, 20-25.
[42] O’Herron, P. and Von der Heydt, R. (2009) Short-Term Memory for Figure-Ground Organization in the Visual Cortex. Neuron, 61, 801-809.
[43] Benbow, M. (1995) Principles and Practices of Teaching Handwriting. In: Henderson, A. and Pehoski, C., Eds., Hand Function in the Child, Mosby, St. Louis, 255-281.
[44] Alston, J. and Taylor, J. (1987) Handwriting: Theory, Research, and Practice. Croom Helm, New York.
[45] Amundson, S.J. (2001) Prewriting and Handwriting. In: Case-Smith, C., Ed., Occupational Therapy for Children, Mosby, St. Louis, 545-570.
[46] Bonney, M.A. (1992) Understanding and Assessing Handwriting Difficulty: Perspectives from the Literature. Australian Occupational Therapy Journal, 39, 7-15.
[47] Carlson, K. and Cunningham, J. (1990) Effect of Pencil Diameter on the Graphomotor Skill of Preschoolers. Early Childhood Research Quarterly, 5, 279-293.
[48] Cornhill, H. and Case-Smith, J. (1996) Factors That Relate to Good and Poor Handwriting. American Journal of Occupational Therapy, 50, 732-739.
[49] Johnson, D.J. and Carlisle, J.F. (1996) A Study of Handwriting in Written Stories of Normal and Learning Disabled Children. Reading and Writing, 8, 45-59.
[50] Maeland, A.F. (1992) Handwriting and Perceptual-Motor Skills in Clumsy, Dysgraphic, and “Normal” Children. Perceptual and Motor Skills, 75, 1207-1217.
[51] Tseng, M.H. and Murray, E.A. (1994) Differences in Perceptual Motor Measures in Children with Good and Poor Handwriting. Occupational Therapy Journal of Research, 14, 19-36.
[52] Klein, S., Guiltner, V., Sollereder, P. and Ying, C. (2011) Relationships between Fine-Motor, Visual-Motor, and Visual Perception Scores and Handwriting Legibility and Speed. Physical and Occupational Therapy in Pediatrics, 31, 103-114.
[53] Karlsdottir, R. and Stefansson, T. (2002) Problems in Developing Functional Handwriting. Perceptual and Motor Skills, 94, 623-662.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.