The effect of lower body stabilization and different writing tools on writing biomechanics in children with cerebral palsy

► Lower body stabilization improves trunk posture in CP during handwriting activity. ► A pencil with assigned grip height corrects excessive shoulder leaning during writing. ► A pencil with biaxial design improves head, shoulder, trunk and pelvic alignment. ► A pencil with biaxial design does not improve the upper extremity muscle exertion. ► Positioning is essential for the remediation of handwriting difficulties in children with CP.