Handwriting speed and size in individuals with Parkinson’s disease compared to healthy controls: the possible effect of cueing

Raudmann, Mari; Taba, Pille; Medijainen, Kadri

doi:10.12697/akut.2014.20.04

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…Mann–Whitney U test has shown that our findings are in line with earlier finding who found that PD patients sketched the spiral slower than the healthy subjects. Our findings are also in line with earlier finding, which shows kinematic feature; speed, and pen-pressure are reduced in PD compared with CG ( 14 , 28 ).…”

Section: Discussionsupporting

confidence: 94%

Distinguishing Different Stages of Parkinson’s Disease Using Composite Index of Speed and Pen-Pressure of Sketching a Spiral

et al. 2017

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The speed and pen-pressure while sketching a spiral are lower among Parkinson’s disease (PD) patients with higher severity of the disease. However, the correlation between these features and the severity level (SL) of PD has been reported to be 0.4. There is a need for identifying parameters with a stronger correlation for considering this for accurate diagnosis of the disease. This study has proposed the use of the Composite Index of Speed and Pen-pressure (CISP) of sketching as a feature for analyzing the severity of PD. A total of 28 control group (CG) and 27 PD patients (total 55 participants) were recruited and assessed for Unified Parkinson’s Disease Rating Scale (UPDRS). They drew guided Archimedean spiral on an A3 sheet. Speed, pen-pressure, and CISP were computed and analyzed to obtain their correlation with severity of the disease. The correlation of speed, pen-pressure, and CISP with the severity of PD was −0.415, −0.584, and −0.641, respectively. Mann–Whitney U test confirmed that CISP was suitable to distinguish between PD and CG, while non-parametric k-sample Kruskal–Wallis test confirmed that it was significantly different for PD SL-1 and PD SL-3. This shows that CISP during spiral sketching may be used to differentiate between CG and PD and between PD SL-1 and PD SL-3 but not SL-2.

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Section: Discussionsupporting

confidence: 94%

Distinguishing Different Stages of Parkinson’s Disease Using Composite Index of Speed and Pen-Pressure of Sketching a Spiral

et al. 2017

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“…These results demonstrated that lined paper was unsuccessful in normalizing handwriting size when participants with PD were required to write fast and/or large despite using pen and paper. Previous research has demonstrated that in persons with PD lined paper does not improve word width [21,27]. In our study, persons with PD also wrote letters that were smaller in width during all of the conditions.…”

Section: Discussioncontrasting

confidence: 39%

“…However, it has been shown that when asked to write fast, persons with PD can write just as quickly as HOAs [17,18]. When using lined paper, persons with PD write slower [10,21,27]. In our study, persons with PD wrote at statistically similar albeit slower pace (movement time, letters competed), suggesting that both HOAs and persons with PD modified the speed at which they wrote in a similar manner.…”

Section: Discussionmentioning

confidence: 39%

Handwriting at Different Paces and Sizes With Visual Cues in Persons With Parkinson’s Disease

Zaman

Stegemöller

2018

J Neurol Res

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Background: Persons with Parkinson's disease (PD) typically have small handwriting, especially when writing faster and/or larger. However, visual cues can help persons with PD increase their handwriting size. This study tested if lined paper would improve handwriting in persons with PD, even when writing faster and/or larger. Secondarily, we wanted determine if persons with PD perceived handwriting as stressful, and if perceived stress was associated with writing performance. Methods: The study included 22 subjects with Parkinson's disease and 11 age-gender-matched controls. Participants completed eight trials (2 × 2 × 2) of printing a "P" and "d", at a comfortable speed and also as fast as possible in two different sizes (1, 2 cm). The participants wrote with a ballpoint pen on lined paper. Bipolar electromyography (EMG) sensors recorded muscle activity from the index finger extensor (extensor digitorum communis (EDC)) and flexor (first dorsal interosseous (FDI)). Participants completed all of the trials for a particular pace (conditions were randomized) before completing all the trials of the other pace (order was counterbalanced). Results: Handwriting height was smaller for persons with PD when required to write fast. There was also a trend for patients with PD to write slower and have smaller peak pen accelerations, but these were not statistically significant. Persons with PD found handwriting to be more stressful than healthy older adults did; and perceived stress negatively correlated with letter height and EMG activity. Conclusions: Our study found that visual cues did not normalize handwriting height in persons with PD when writing large and/or fast. Persons with PD find handwriting to be stressful, and stress may negatively influence their handwriting.

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“…This technology can identify PD patients at an early stage of the disease course and can monitor its progression (9, 10). It has been shown that stroke size, velocity, and peak acceleration are impaired in PD (11, 12), and that kinematic features are more sensitive than size for detecting early PD (13).…”

Section: Introductionmentioning

confidence: 99%

A Kinematic Study of Progressive Micrographia in Parkinson's Disease

et al. 2019

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Progressive micrographia is decrement in character size during writing and is commonly associated with Parkinson's disease (PD). This study has investigated the kinematic features of progressive micrographia during a repetitive writing task. Twenty-four PD patients with duration since diagnosis of <10 years and 24 age-matched controls wrote the letter “ e ” repeatedly. PD patients were studied in defined off states, with scoring of motor function on the Unified Parkinson's Disease Rating Scale Part III. A digital tablet captured x-y coordinates and ink-pen pressure. Customized software recorded the data and offline analysis derived the kinematic features of pen-tip movement. The average size of the first and the last five letters were compared, with progressive micrographia defined as >10% decrement in letter stroke length. The relationships between dimensional and kinematic features for the control subjects and for PD patients with and without progressive micrographia were studied. Differences between the initial and last letter repetitions within each group were assessed by Wilcoxon signed-rank test, and the Kruskal-Wallis test was applied to compare the three groups. There are five main conclusions from our findings: (i) 66% of PD patients who participated in this study exhibited progressive micrographia; (ii) handwriting kinematic features for all PD patients was significantly lower than controls ( p < 0.05); (iii) patients with progressive micrographia lose the normal augmentation of writing speed and acceleration in the x axis with left-to-right writing and show decrement of pen-tip pressure ( p = 0.034); (iv) kinematic and pen-tip pressure profiles suggest that progressive micrographia in PD reflects poorly sustained net force; and (v) although progressive micrographia resembles the sequence effect of general bradykinesia, we did not find a significant correlation with overall motor disability, nor with the aggregate UPDRS-III bradykinesia scores for the dominant arm.

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Handwriting speed and size in individuals with Parkinson’s disease compared to healthy controls: the possible effect of cueing

Cited by 8 publications

References 14 publications

Distinguishing Different Stages of Parkinson’s Disease Using Composite Index of Speed and Pen-Pressure of Sketching a Spiral

Distinguishing Different Stages of Parkinson’s Disease Using Composite Index of Speed and Pen-Pressure of Sketching a Spiral

Handwriting at Different Paces and Sizes With Visual Cues in Persons With Parkinson’s Disease

A Kinematic Study of Progressive Micrographia in Parkinson's Disease

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