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.

4590张门急诊处方书写及用药质量分析

目的调查本院在执行新的《处方管理办法》过程中的门急诊处方质量。方法随机抽查分析2007年5—10月本院门急诊处方4590张。结果我院处方合格率为90．9％，其中书写不合格处方占不合格处方90．43％，不合理用药处方占不合格处方9．57％。结论本院门急诊用药基本合理，但也存在一些问题，应组织全院医生认真学习《处方管理办法》，提高处方质量，保障患者的用药安全。     

学优生与学差生在自然和考试情景中的手书变化特点

目的 探讨学优生和学兰生在自然和考试情景下的手书变化特点.方法 取中学生40名,学优生和学差生各20名,采用WACOM-2005-1型数码写字板,设置考试情景,对考试情景中的签名手书运动变化进行动力学分析.结果 在考试的情景中,学优生手书速度加快,加速度变化幅度较小,结束阶段的压力显著降低,中间断续点显著减少;学差生手书速度加快,加速度变化幅度较大,其他无显著变化.结论 在考试情景中,学优生的手书变化大于学差生.     

The ANKLe score: an audit of otolaryngology emergency clinic record keeping

INTRODUCTION

Accurate and legible medical records are essential to good quality patient care. Guidelines from The Royal College of Surgeons of England (RCSE) state the content required to form a complete medical record, but do not address legibility. An audit of otolaryngology emergency clinic record keeping was performed using a new scoring system.

PATIENTS AND METHODS

The Adjusted Note Keeping and Legibility (ANKLe) score was developed as an objective and quantitative method to assess both the content and legibility of case notes, incorporating the RCSE guidelines. Twenty consecutive otolaryngology emergency clinic case notes from each of 7 senior house officers were audited against standards for legibility and content using the ANKLe score. A proforma was introduced to improve documentation and handwriting advice was given. A further set of 140 notes (20 notes for each of the 7 doctors) was audited in the same way to provide feedback.

RESULTS

The introduction of a proforma and advice on handwriting significantly increased the quality of case note entries in terms of content, legibility and overall ANKLe score.

CONCLUSIONS

Accurate note keeping can be improved by the use of a proforma. The legibility of handwriting can be improved using simple advice. The ANKLe score is an objective assessment tool of the overall quality of medical note documentation which can be adapted for use in other specialties.     

Kinematic analysis of dopaminergic effects on skilled handwriting movements in Parkinson’s disease

Summary. Patients with Parkinson’s disease (PD) exhibit impairments in the execution of highly practiced and skilled motor actions such as handwriting. The analysis of kinematic aspects of handwriting movements has demonstrated that size, speed, acceleration and stroke duration are affected in PD. Although beneficial effects of dopaminergic therapy in regard to execution of movements have been reported, the effects of pharmacological therapy on these measures have not been examined in detail. The present study has compared kinematic aspects of handwriting movements of 27 healthy subjects and 27 patients with PD both on their usual dopaminergic treatment and following withdrawal of dopaminergic medication. Healthy subjects were matched with PD patients according to age, sex, handedness and education level. A digitising tablet was used for the assessment of handwriting movements. Subjects were asked to perform a simple writing task. Movement time, distance, velocity, acceleration and measures of fluency of handwriting movements were measured. Compared with healthy subjects, the kinematics of handwriting movements in PD patients were markedly disturbed following withdrawal of dopaminergic medication. Although dopaminergic treatment in PD patients resulted in marked improvements in the kinematics of handwriting movements, PD patients did not reach an undisturbed level of performance. The results suggest that dopamine medication results in partial restoration of automatic movement execution.     

Handwriting features of children with developmental coordination disorder – Results of triangular evaluation

Developmental coordination disorders (DCD) is one of the most common disorders affecting school-aged children. The study aimed to characterize the handwriting performance of children with DCD who write in Arabic, based on triangular evaluation.Participants included 58 children aged 11–12 years, 29 diagnosed with DCD based on the DSM-IV criteria and the M-ABC, and 29 matched typically developed controls. Children were asked to copy a paragraph on a sheet of paper affixed to a digitizer supplying objective measures of the handwriting process. The handwriting proficiency screening questionnaire (HPSQ) was completed by their teachers while observing their performance and followed by evaluation of their final written product.Results indicated that compared to controls, children with DCD required significantly more on-paper and in-air time per stroke while copying. In addition, global legibility, unrecognizable letters and spatial arrangement measures of their written product were significantly inferior. Significant group differences were also found between the HPSQ subscales scores. Furthermore, 82.8% of all participants were correctly classified into groups based on one discriminate function which included two handwriting performance measures.These study results strongly propose application of triangular standardized evaluation to receive better insight of handwriting deficit features of individual children with DCD who write in Arabic.     

The written language performance of children with Attention Deficit Hyperactivity Disorder in Taiwan

Poor writing is common in children with Attention Deficit Hyperactivity Disorder (ADHD). However, the writing performance of children with ADHD has been rarely formally explored in Taiwan, so the purpose of this study was to investigate writing features of children with ADHD in Taiwan. There were 25 children with ADHD and 25 normal children involved in a standardization writing assessment – Written Language Test for Children, to assess their performance at the dictation, sentence combination, adding/deducting redical, cloze and sentence making subtests. The results showed that except for the score of the sentence combining subtest, the score of children with ADHD was lower than the normal student in the rest of the subtests. Almost 60% of ADHD children's scores were below the 25th percentile numbers, but only 20% for normal children. Thus, writing problems were common for children with ADHD in Taiwan, too. First, children with ADHD performed worse than normal children on the dictation and cloze subtests, showing the weaker abilities of retrieving correct characters from their mental lexicon. Second, children with ADHD performed worse on the adding/deducting redical subtest than normal children did. Finally, at the language level, the score of children with ADHD on the sentence combination subtest was not lower than normal children, implicating their normal grammatic competence. It is worth mentioning that Taiwanese children with ADHD ignore the details of characters when they are writing, a finding that is common across languages.     

Visual profile of children with handwriting difficulties in Hong Kong Chinese

The purpose of this study was to find out the visual profiles of children with handwriting difficulties (HWD) in Hong Kong Chinese. Forty-nine children with HWD (mean age 8.4 ± 1.1 years) and 27 controls (mean age 7.7 ± 0.7 years) were recruited. All subjects received eye examination and vision assessment included ocular health, refraction, accommodative functions, binocularity, visual perception (by Gardner reversal frequency test: recognition subtest; Test of visual perceptual skills (non-motor)-revised) and motor skills (by The Beery-Buktenica developmental test of visual motor integration; Detroit test of motor speed and precision). Higher percentages of tropia and phoria (of magnitude >6 prism dioptres) were found in children with HWD of 6.1% and 14.3% respectively. After adjusted for the effect of age, children with HWD showed significantly worse accommodative facility, directionality, visual discrimination, visual spatial relation, visual form constancy, visual sequential memory, visual figure ground, visual closure and visual motor integration. Studies reported the visual functions of children with HWD were mostly concerned with alphabetic languages, while studies concerning Chinese HWD were relatively less. This study provided the visual profiles of children with Chinese HWD. Based on the visual profile, further study is indicated to investigate the effect of optometric interventions on the assessment and remediation for children with HWD.