Comparison of Cursive Handwriting Instruction Programs Among Students Without Identified Problems

The purpose of this study was to compare the effects of cursive handwriting programs in improving letter legibility and form in third-grade students without identified handwriting problems. Four months into the school year, cursive handwriting was assessed for a sample of convenience of 50 third-grade students. Subsequently, students received instruction for 10–15 minutes daily for 6 weeks using either Handwriting without Tears, Loops and Other Groups programs, or, as a control condition, continued instruction in the Zaner-Bloser program. Student handwriting for all programs improved from pretest to posttest. Posttest comparisons indicated no significant differences between programs. The results suggest that the method of handwriting instruction has a limited short-term impact on cursive letter legibility and form for children without handwriting problems.     

Handwriting characteristics among secondary students with and without physical disabilities: a study with a computerized tool

The purpose of the present study was to investigate the handwriting characteristics of secondary school students with and without physical disabilities (PD). With the use of a computerized Chinese Handwriting Assessment Tool (CHAT), it was made possible to objectively assess and analyze in detail the handwriting characteristics of individual students. Fifty participants (age range: 15-19-years-old) were recruited from one mainstream secondary school and 20 participants (age range: 17-24-years-old) were recruited from two secondary schools for students with PD. They were asked to perform three consecutive handwriting tasks: copying 90 characters using the computerized CHAT, an English passage copying task, and a Chinese passage copying task. The data indicated that students with PD were significantly slower in copying both Chinese and English characters in passages when compared to the typical students. Significant differences in the measures of writing speed, air/ground time ratio, standard deviation of speed, standard deviation of size per character, and number of stroke errors measured by the CHAT were found between the two groups of students. Further analysis on the data of typical students indicated no significant difference in handwriting speed among students of different classes (i.e. arts or science) on copying Chinese and English passages, and on individual Chinese words (from CHAT). The academic results of students also showed no significant correlation with their handwriting speed measured by the three writing tasks. To conclude, the CHAT system was able to identify a number of characteristics of handwriting on students with and without PD. It was suggested that the CHAT should further be developed into an objective evaluation tool to explore the handwriting characteristics of the students with a wider range of disabilities in the future, and to make recommendations to arrange special examination arrangements (SEA) for students with physical disabilities or other special needs.     

Changes in kinetics and kinematics of handwriting during a prolonged writing task in children with and without dysgraphia

Handwriting difficulties or dysgraphia have a profound impact on children's psychosocial development, and yet, 10-30% of school-aged children are reported to experience difficulties mastering this skill. Several studies have examined the nature and biomechanical underpinnings of handwriting difficulties in children with and without dysgraphia. While the majority of these studies have considered short handwriting activities involving a sentence or a paragraph, handwriting quality and speed are reported to vary with the length of the writing task. Further, it is suggested that the biomechanics of handwriting also evolve over extended writing periods, and that these changes may be distinct between children with and without dysgraphia. The nature and specificity of these biomechanical alterations remain unknown. To address this knowledge gap, we examined changes in writing speed, grip forces on the pen barrel, and normal forces on the writing surface, over the course of a 10-min writing task, in a large cohort of 4th grade children with and without dysgraphia. Horizontal stroke speed, grip force and normal force increased over time while vertical stroke speed decreased in all children. These biomechanical changes may be attributable to physical and psychological fatigue and the corresponding compensatory processes invoked by the motor system.     

The role of cutaneous sensation in the motor function of the hand.

We studied the effect of abolishing cutaneous sensation (by infiltrating local anaesthetic around the median nerve at the wrist) on the ability of 10 healthy volunteers (a) to maintain a submaximal isometric pinch-grip force for 30 s without visual feedback, and (b) to perform a fine finger-manipulation 'handwriting' task. Blocking cutaneous sensation had no effect on ability to maintain pinch force, suggesting that muscle afferents have the major role in force-control feedback. However, a near-linear fall in force, present with or without block (mean slope=-1.3+/-0.2% s(-1)), which cannot be attributed to motor fatigue, reveals a shortcoming of the afferent feedback system. Blocking cutaneous sensation did impair ability to perform the more demanding writing task, as judged by an 18+/-6% increase in the length of the path between target points, a 22+/-9% increase in the duration of the movement and a 63+/-24% in 'normalised averaged rectified jerk', an averaged time-derivative of acceleration (all significantly nonzero, P < 0.04). These experiments demonstrate the relative importance of muscular and cutaneous afferent feedback on two aspects of hand performance, and provide a way to quantify the deficit resulting from the lack of cutaneous sensation.     

Handwriting performance versus arm forward reach and grasp abilities among post-stroke patients,a case-control study

Background: Evidence-based studies regarding deficits in handwriting performance relative to hand reaching and grasping after a stroke are lacking.

Objective: To evaluate the extent of damage to handwriting skills compared to arm reach and grasp task among post-stroke patients.

Methods: Eighteen patients and 19 healthy subjects were recruited to this case-control study. Patients were evaluated 15.2 days (±6.5) after the stroke using a Computerized Penmanship Evaluation Tool, surface Electromyography and Fugl-Meyer assessment. This study compared motor deficits in hand reaching and grasping and in handwriting between stroke patients and healthy subjects. Damage to handwriting performance relative to hand reaching and grasping skills was also evaluated.

Results: Significant differences were found between groups in handwriting performance (p < 0.05). The performance of the trapezius, biceps, and triceps muscles can predict 63.5% of the variance in the ability to write a short sentence (p < 0.023). Pen pressure can predict 74.9% of the hand motor performance from Fugl-Meyer assessment (p < 0.05). Handwriting was more damaged than was the pattern of activation of the proximal muscles of the shoulder and arm (p < 0.05). FM scores were highly, negatively correlated with the in-air writing time across tasks (r = ?0.819, p < 0.004).

Conclusions: This study confirms the clinical observation that dexterity skills are more damaged than are arm forward reach after a stroke. However, these differences in motor performance were not significant in mildly disabled patients, demonstrating the feasibility of handwriting rehabilitation in these patients. Therefore, we modestly recommend focusing on handwriting rehabilitation of the hemiparetic upper extremity in mildly impaired patients after a stroke.     

A new method to record and control for 2D-movement kinematics during functional magnetic resonance imaging (fMRI)

The recording of movement kinematics during functional magnetic resonance imaging (fMRI) experiments is complicated due to technical constraints of the imaging environment. Nevertheless, to study the functions of brain areas related to motor control, reliable and accurate records of movement trajectories and speed profiles are needed. We present a method designed to record and characterize the kinematic properties of drawing- and handwriting-like forearm movements during fMRI studies by recording pen stroke trajectories. The recording system consists of a translucent plastic board, a plastic pen containing fiber optics and a halogen light power source, a CCD camera, a video monitor and a PC with a video grabber card. Control experiments using a commercially available digitizer tablet have demonstrated the reliability of the data recorded during fMRI. Since the movement tracking signal is purely optical, there is no interaction with the MR (echoplanar) images. Thus, the method allows to obtain movement records with high spatial and temporal resolution which are suitable for the kinematic analysis of hand movements in fMRI studies.     

护理记录书写中的问题分析及对策

为适应新的《医疗事故处理条例》，减少病历缺陷引起的医患纠纷，对出院病历护理记录书写质量进行检查。发现存在医护间记录不符、护理记录自身矛盾、涂改、遗漏、随意记录、字迹潦草、记录不规范等缺陷。提出加强护理人员法律教育，提高自我保护意识；加强医护间沟通，保持医疗护理记录的一致性；成立科室三级护理记录质控网络，加强护理记录过程中的质量控制；加强护士专业技术、文字书写等能力的培养，提高护理记录书写水平。     

Effects of sertraline on kinematic aspects of hand movements in patients with obsessive–compulsive disorder

Rationale Movement disorders such as disturbances of fine motor co-ordination are a frequent phenomenon in patients with obsessive–compulsive disorder (OCD).Objectives Our aim was to investigate changes of hand-motor dysfunction in OCD patients under the influence of 10-week treatment with sertraline and behaviour therapy.Methods We examined the performance of 40 patients satisfying DSM-IV criteria for OCD before and under this therapy using a digitising tablet and kinematic analysis of handwriting and drawing movements. Forty healthy controls were also tested (test–retest interval: 10 weeks).Results The speed of drawing was significantly lower in OCD patients than in controls (mean±standard deviation=197.03±113.26 mm/s for patients and 182.48±189.61 mm/s for controls; P=0.01). After 10 weeks of therapy, this parameter normalised in patients (from 197.03±113.26 mm/s to 163.66±101.92 mm/s; P=0.001).Conclusions Hand-motor dysfunction (especially bradykinesia) improves with a serotonin-enhancing therapy in OCD patients.     

When practice does not make perfect: well-practiced handwriting interferes with the consolidation phase gains in learning a movement sequence

Results obtained in patients with schizophrenia have shown that antipsychotic drugs may induce motor learning deficits correlated with the striatal type-2 dopamine receptors (D₂R) occupancy. Other findings suggest that the role of the striatum in motor learning could be related to a process of “chunking” discrete movements into motor sequences. We therefore hypothesized that a D₂R blocking substance, such as raclopride, would affect motor learning by specifically disrupting the grouping of movements into sequences. Two monkeys were first trained to perform a baseline-overlearned sequence (Seq. A) drug free. Then, a new sequence was learned (Seq. B) and the overlearned sequence was recalled OFF-drug (Seq. A recall OFF-drug). The effect of raclopride was then assessed on the learning of a third sequence (Seq. C), and on the recall of the overlearned sequence (Seq. A recall ON-drug). Results showed that performance related to the overlearned sequence remained the same in the three experimental conditions (Seq. A, Seq. A recall OFF-drug, Seq. A recall ON-drug), whether the primates received raclopride or not. On the other hand, new sequence learning was significantly affected during raclopride treatment (Seq. C), when compared with new sequence learning without the effect of any drug (Seq. B). Raclopride-induced disturbances consisted in performance fluctuations, which persisted even after many days of trials, and prevented the monkeys from reaching a stable level of performance. Further analyses also showed that these fluctuations appeared to be related to monkeys’ inability to group movements into single flowing motor sequences. The results of our study suggest that dopamine is involved in the stabilization or consolidation of motor performances, and that this function would involve a chunking of movements into well-integrated sequences.     

Feasibility study: Effect of hand resistance exercise on handwriting in Parkinson's disease and essential tremor

Study Design

A single group, repeated measures design was used.