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The handwriting on the wall: more limits on medicare payments.
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Euthanasia: the handwriting on the wall.
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Handwriting is on the wall for trial lawyers.
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[Peculiar handwriting disorders in maladie des tics].
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[One of Freud's last letters. Date. Addressee. His handwriting].
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[Alterations in handwriting after consumption of alcohol].
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Malpractice insurance. The handwriting on the wall.
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HEW's handwriting on tomorrow's walls.
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[Sloppy handwriting... a visit to the doctor?].
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[An up to now unknown handwriting in the Mulomedicina Chironis of the Basel University Library].
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Brain dopamine and kinematics of graphomotor functions.
Three experiments were performed in an attempt to achieve a better understanding of the effect of dopamine on handwriting. In the first experiment, kinematic aspects of handwriting movements were compared between healthy participants and patients with Parkinson's disease (PD) on their usual dopaminergic treatment and following withdrawal of dopaminergic medication. In the second experiment, the writing performance of healthy participants with a hyperechogenicity of the substantia nigra as detected by transcranial sonography (TCS) was compared with the performance of healthy participants with low echogenicity of the substantia nigra. The third experiment examined the effect of central dopamine reduction on kinematic aspects of handwriting movements in healthy adults using acute phenylalanine and tyrosine depletion (APTD). A digitising tablet was used for the assessment of handwriting movements. Participants were asked to perform a simple writing task. Movement time, distance, velocity, acceleration and measures of fluency of handwriting movements were measured. The kinematic analysis of handwriting movements revealed that alterations of central dopaminergic neurotransmission adversely affect movement execution during handwriting. In comparison to the automatic processing of handwriting movements displayed by control participants, participants with an altered dopaminergic neurotransmission shifted from an automatic to a controlled processing of movement execution. Central dopamine appears to be of particular importance with regard to the automatic execution of well-learned movements.
Fine motor deficiencies in children diagnosed as DCD based on poor grapho-motor ability.
A sample of 125 children from grades 4 and 5 of two normal Dutch primary schools were investigated regarding the incidence of handwriting problems and other fine motor disabilities. Handwriting quality was assessed with the concise assessment method for children's handwriting (BHK) and the school questionnaire for teachers (SQT). Two groups of 12 children each were formed, one group of good writers and a group of poor writers selected from the lower performance range. The latter group was investigated in depth by assessing general and fine motor ability using the Movement Assessment Battery for Children (M-ABC test) and the Motor Performance School Readiness Test (MSRT). We hypothesised that poor handwriting is part of a wider neuromotor condition characterised by faster and cruder movements, lack of inhibition of co-movements and poor co-ordination of fine motor skills. To test the theory kinematic measures of drawing movements were collected on the flower-trail-drawing item of the M-ABC test. Moreover, the experimental group of poor writers received physiotherapy during a three-month period and was tested for handwriting proficiency after therapy and again nine months later. The results revealed that 34% of the group of 125 children displayed handwriting problems. The analysis confirmed that serious handwriting problems are accompanied by fine motor deficits. We suggest that in these children an enhanced level of neuromotor noise is compensated for by enhanced phasic stiffness of the limb system. This results in higher movement velocity and fewer velocity peaks. In the children who received physiotherapy the quality of handwriting improved.
The Clifford Irving hoax of the Howard Hughes autobiography.
The problem was to determine whether Howard R. Hughes, Edith Irving, or Clifford Irving wrote the questioned material Exhibits Q-1 through Q-35. The findings were as follows. 1. Howard R. Hughes was eliminated as the possible writer of the questioned handwriting on Exhibits Q-1 through Q-35. Although there were pictorial resemblances between Hughes' handwriting and the questioned material enumerated above, significant characteristic differences were also present which unequivocally eliminated him as the writer. 2. Edith Irving was identified as the writer of the "Edith Sommer for deposit only" endorsement on Exhibit Q-11. 3. Edith Irving also very probably wrote the "Hanne Rosenkrantz" on Exhibit Q-27 through Q-34, but the questioned writings were restricted to the examination of poor quality photocopies which did not provide proper basis for the handwriting comparison. 4. There were indications that Edith Irving also may have written the questioned endorsement "H. R. Hughes" on Exhibit Q-3 and the questioned signatures "H. R. Hughes" on Exhibits Q-4, Q-5, Q-6, Q-7, and Q-35, by simulating the handwriting of Howard R. Hughes on those questioned exhibits. She could not be identified, however, based on the available handwriting specimens obtained from the federal grand jury on 8 Feb. 1972. 5. Clifford Irving was identified as the writer of the questioned material on Exhibits Q-1, Q-2, Q-8, Q-9, Q-12a and Q-13a and Q-13b, Q-14, Q-15a through Q-15c, Q-16a and Q-16b, Q-22a through Q-22i, Q-23, Q-24, Q-25, and Q-26. A study of the questioned handwriting with the known handwriting of Howard R. Hughes revealed a definite attempt on the part of Irving to simulate the handwriting of Hughes, having seen Hughes' writing in earlier issues of Time-Life.
Does training improve writer's cramp? An evaluation of a behavioral treatment approach using kinematic analysis.
Patients with writer's cramp (WC) show uncontrollable muscle co-contractions of agonists and antagonists and unusual postures of the upper limb during writing; their handwriting is inefficient and exhausting. Currently the treatment of choice is to inject botulinum toxin in selective hand muscles. However, this treatment has two drawbacks: it is short-lasting and may be associated with adverse side effects. An alternative behavioral treatment, namely, the handwriting training developed by Mai and coworkers, was carried out and evaluated in 50 patients with WC. A digitizing tablet was used to record the handwriting movements before and after training, and then again after a follow-up period. The results indicate the efficacy of the handwriting training. Speed and smoothness of the handwriting increased during the training with effects observed after an extended follow-up period. Handwriting training leads to significant improvements, but does not bring handwriting performance to normal levels. This training should be considered as an alternative or supplement to the traditional treatment with botulinum toxin or other programs based on neuroplasticity.
How to assess motor impairment in writer's cramp.
Writer's cramp is a task-specific hand dystonia affecting handwriting. Clinical scores such as the Arm Dystonia Disability Scale (ADDS) or Writer's Cramp Rating Scale (WCRS) as well as kinematic analysis of handwriting movements have been used to assess functional impairment in affected patients. In 21 patients with writer's cramp and healthy controls, we analyzed the kinematics of writing and cyclic drawing movements. We rated the severity of dystonia using the ADDS and WCRS and correlated the clinical scores with movement kinematics. Mean stroke frequency was significantly reduced in dystonic patients. Drawing movements showed more frequently a decrease in stroke frequency than handwriting movements. During circle drawing, mean vertical peak velocity was more variable in patients relative to controls, indicating an impaired ability to reproduce the same kinematic pattern over time. An increase in vertical writing pressure was only observed during handwriting but not during circle drawing and may reflect a compensatory effort to stabilize the pencil. Kinematic measures and individual ADDS and WCRS scores did not correlate with each other. The lack of correlation is not surprising as ADDS, WCRS, and kinematic analysis probe different aspects of motor impairment. The ADDS characterizes how dystonia affects a set of fine manual tasks, whereas the WCRS scores the manifestation of dystonia during handwriting. Therefore, the clinical scores and kinematic analysis of handwriting provide complementary insights into motor impairment. Future studies need to address which combination of clinical scores and kinematic measures are most appropriate to quantify impairment in writer's cramp.
Is writer's cramp caused by a deficit of sensorimotor integration?
Writer's cramp is a highly specific movement disorder in which handwriting is impaired while most other manual skills are often unaffected. On the basis of abnormal findings in experiments measuring the control of grip forces, it has been suggested that writer's cramp is caused by a deficit of sensorimotor integration. The aim of our study was to determine whether there is a functional link between sensory deficits, abnormalities in the control of grip force, and handwriting disorders. We compared the grip force and handwriting performance of writer's cramp patients with that of control subjects and with that of a stroke patient suffering a purely somatosensory deficit of his dominant hand (patient S1). We found that: (1) writer's cramp patients and patient S1 had elevated grip-force levels; (2) training reduced the grip force to near-normal levels in all writer's cramp patients but not in S1; (3) effortful writing performance also induced increased grip-force levels in healthy subjects; and (4) patient S1 had normal handwriting movements. These findings suggest that the elevated pretraining gripforce levels of writer's cramp patients might be a consequence of their effortful writing style and do not reflect a deficit of sensorimotor integration. Moreover, the good handwriting performance of patient S1 shows that a severe somatosensory deficit is not a sufficient condition for a handwriting disorder. These findings disagree with the sensorimotor explanation of writer's cramp.
Comparison of pencil-grip patterns in first graders with good and poor writing skills.
The purpose of this study was to compare nondysfunctional children with and without handwriting difficulties for an examination of grip and hand preference. Additionally, in the group of children with handwriting difficulties, the children with decreased proprioceptive-kinesthetic finger awareness were compared with the children without such a decrease. The results suggest that children with handwriting difficulties may demonstrate a lower grip score than children without handwriting problems. In addition, among children with poor handwriting, those with decreased proprioceptive-kinesthetic finger awareness may demonstrate a lower grip score than those with good proprioceptive-kinesthetic awareness. Children with poor hand-writing also show less hand preference than those with good handwriting.