Handwriting Rehabilitation in Parkinson Disease: A Pilot Study

Ziliotto, Adriana; Cersósimo, María G.; Micheli, Federico

doi:10.5535/arm.2015.39.4.586

Cited by 16 publications

(7 citation statements)

References 15 publications

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“…For instance, in healthy persons, movement speed was found to increase with rising amplitude [ 16 , 36 ]. In contrast, the findings of the current and other studies on handwriting demonstrate that in patients with PD, velocity was found to saturate when amplitude increases ( Fig 4 , middle panel) [ 37 – 39 ]. The lack of concomitant increase in velocity (or velocity saturation) after amplitude training may be explained by a motor control impairment, affecting the speed-amplitude relation in patients with PD ( Fig 4 , middle panel).…”

Section: Discussioncontrasting

confidence: 95%

Handwriting training in Parkinson’s disease: A trade-off between size, speed and fluency

et al. 2017

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BackgroundIn previous work, we found that intensive amplitude training successfully improved micrographia in Parkinson’s disease (PD). Handwriting abnormalities in PD also express themselves in stroke duration and writing fluency. It is currently unknown whether training changes these dysgraphic features.ObjectiveTo determine the differential effects of amplitude training on various hallmarks of handwriting abnormalities in PD.MethodsWe randomized 38 right-handed subjects in early to mid-stage of PD into an experimental group (n = 18), receiving training focused at improving writing size during 30 minutes/day, five days/week for six weeks, and a placebo group (n = 20), receiving stretch and relaxation exercises at equal intensity. Writing skills were assessed using a touch-sensitive tablet pre- and post-training, and after a six-week retention period. Tests encompassed a transfer task, evaluating trained and untrained sequences, and an automatization task, comparing single- and dual-task handwriting. Outcome parameters were stroke duration (s), writing velocity (cm/s) and normalized jerk (i.e. fluency).ResultsIn contrast to the reported positive effects of training on writing size, the current results showed increases in stroke duration and normalized jerk after amplitude training, which were absent in the placebo group. These increases remained after the six-week retention period. In contrast, velocity remained unchanged throughout the study.ConclusionWhile intensive amplitude training is beneficial to improve writing size in PD, it comes at a cost as fluency and stroke duration deteriorated after training. The findings imply that PD patients can redistribute movement priorities after training within a compromised motor system.

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Section: Discussioncontrasting

confidence: 95%

Handwriting training in Parkinson’s disease: A trade-off between size, speed and fluency

et al. 2017

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“…Three studies, including 1 Level 1b RCT with low risk of bias ( Collett et al, 2017 ), tested the effect of handwriting training on handwriting function ( Nackaerts et al, 2016 ; Ziliotto et al, 2015 ). The interventions had different treatment components (e.g., hand exercises, writing with external cues); ranged in intensity, frequency, and duration (e.g., 30–90 min sessions, 1–5×/wk, over 6 wk to 6 mo); and had different delivery methods (e.g., workbook, in person).…”

Section: Resultsmentioning

confidence: 99%

Occupational Therapy Interventions for Instrumental Activities of Daily Living for Adults With Parkinson’s Disease: A Systematic Review

Foster

Carson

Archer

et al. 2021

The American Journal of Occupational Therapy

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Importance: Instrumental activities of daily living (IADLs) are important for independence, safety, and productivity, and people with Parkinson’s disease (PD) can experience IADL limitations. Occupational therapy practitioners should address IADLs with their clients with PD. Objective: To systematically review the evidence for the effectiveness of occupational therapy interventions to improve or maintain IADL function in adults with PD. Data Sources: MEDLINE, CINAHL, PsycINFO, OTseeker, and Cochrane databases from January 2011 to December 2018. Study Selection and Data Collection: Primary inclusion criteria were peer-reviewed journal articles describing Level 1–3 studies that tested the effect of an intervention within the scope of occupational therapy on an IADL outcome in people with PD. Three reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings: Twenty-two studies met the inclusion criteria and were categorized into four themes on the basis of primary focus or type of intervention: physical activity, specific IADL-focused, cognitive rehabilitation, and individualized occupational therapy interventions. There were 9 Level 1b, 9 Level 2b, and 4 Level 3b studies. Strong strength of evidence was found for the beneficial effect of occupational therapy–related interventions for physical activity levels and handwriting, moderate strength of evidence for IADL participation and medication adherence, and low strength of evidence for cognitive rehabilitation. Conclusions and Relevance: Occupational therapy interventions can improve health management and maintenance (i.e., physical activity levels, medication management), handwriting, and IADL participation for people with PD. Further research is needed on cognitive rehabilitation. This review is limited by the small number of studies that specifically addressed IADL function in treatment and as an outcome. What This Article Adds: Occupational therapy intervention can be effective in improving or maintaining IADL performance and participation in people with PD. Occupational therapy practitioners can address IADL function through physical activity interventions, interventions targeting handwriting and medication adherence, and individualized occupational therapy interventions.

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“…2) Decreasing size of letters: perpendicular gage (millimeters) of the first and the last in the term and tendency to small letters 3) Tremor of writing and Lack of control to punctuate characters 4) Not adhering to the line. 6) Force of the pressure of writing (Adriana Ziliotto et al, 2015).…”

Section: Methodsmentioning

confidence: 99%

Implications of Handwriting in Movement Disorders Among Neurological Patients in Fayoum Governorate, Egypt.

Mwaheb¹,

Rashed²,

El-khatib

et al. 2022

The Egyptian Journal of Forensic Sciences and Applied Toxicolog

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Background: Common cumulative neurological diseases and their effects on motor control in general and handwriting in particular. This research aims to introduce the fundamental aspects of common neurological disease as the basis for understanding why and how handwriting changes in the presence of disease. Methods: This is the prospective research which study changes of handwriting over 30 neurological patients as (Parkinsonism disease, Essential tremor, and Ataxia) Fayoum Governorate. Results: Among the study group, the mean age was (55.4±15.8) years, with 22 (73.3%) were males and 8(26.7%) were females. The present study documents that among all neurological cases included in the study, (10%) of them show the moderate change in neglecting some letters, tendency to small letters, and lack of control to punctuate characters. As regards tremor, 50% had moderate to high change. Not adhering to the line of printed moderate change represents 16.7%, and 6.7% shows the moderate change in pressure of writing. Also, this research illustrated that inbetween parkinsonism cases (30%) of they show the moderate change in neglecting some letters, lack of control to punctuate characters and not to adhere to the line of printed, also 10% moderate change in the tendency to small letters. As regards tremor, 90% had moderate to high change. Conclusion: Rehabilitation programs for handwriting problems in neurology disease patients are likely to be helpful. More extensive randomized studies are needed to confirm these results.

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Handwriting Rehabilitation in Parkinson Disease: A Pilot Study

Cited by 16 publications

References 15 publications

Handwriting training in Parkinson’s disease: A trade-off between size, speed and fluency

Handwriting training in Parkinson’s disease: A trade-off between size, speed and fluency

Occupational Therapy Interventions for Instrumental Activities of Daily Living for Adults With Parkinson’s Disease: A Systematic Review

Implications of Handwriting in Movement Disorders Among Neurological Patients in Fayoum Governorate, Egypt.

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