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Handwriting of the alcoholic.

Alcohol intoxication produces abnormal handwriting with manifestations that are thoroughly described in the literature of forensic science. A less known phenomenon is the peculiar handwriting changes found in alcoholics, especially individuals in the later stages of the disease. In addition to the two handwriting states of non-alcoholic drinkers (normal/sober and intoxicated) the alcoholic writer has a third state, handwriting done in withdrawal. Withdrawal is a state of tension resulting in handwriting characterized by irregularity, ataxia and tremor. This type of abnormal handwriting creates special problems of authentication requiring detailed background history and appropriate comparison specimens, but it can also be used to judge the writer's state of sobriety.

Alcoholic Intoxication↗

Extrapyramidal symptoms and their relationship to clinical efficacy under perphenazine treatment. A controlled prospective handwriting-test study in 22 acutely ill schizophrenic patients.

In order to verify the hypothesis of a strict relationship between clinical improvement and extrapyramidal side-effects, especially micrographia, twenty-two acutely ill schizophrenics were treated with perphenazine in a controlled prospective 28-day trial. During the study period, psychopathometric data, prolactin plasma levels, and handwriting samples were collected. According to the remission criteria fixed before the study began (both BPRS less than or equal to 25 and GAS greater than or equal to 80 points), 45.5% (10/22) of the total patient sample were classified as treatment responders. Handwriting tests were quantified in 21 patients. "Positive" handwriting results, i.e., a reduction of at least 13% in the overall area of 50% or more of the handwriting samples collected during the trial, were demonstrable in three of nine responders (33%) and nine of twelve nonresponders (75%). These results show that there is no positive correlation between clinical response and reduction in handwriting area. Consequently, the handwriting test is unable to predict clinical response. It is only one of a number of parameters with which to monitor the neurological side-effects of neuroleptic treatment. Outcome parameters show that psychopathological remission can be achieved with low neuroleptic dosages and few or virtually no extrapyramidal side-effects.

Acute Disease↗

The effect of conscious control on handwriting in children with attention deficit hyperactivity disorder.

Two experiments were performed regarding the effect of conscious control on handwriting fluency in healthy adults and ADHD children. First, 26 healthy students were asked to write a sentence under different conditions. The results indicate that automated handwriting movements are independent from visual feedback. Second, the writing performance of 12 children with ADHD was examined on their usual medication with methylphenidate and under placebo. In comparison to placebo, medication with methylphenidate resulted in a reduced fluency of handwriting. Automated handwriting movements could be elicited in children with ADHD on medication. The results suggest that both visual and mental control of handwriting movements affect the automation of handwriting movements. Furthermore, a simple training procedure was designed and performed in a case study of a boy with ADHD.

Adult↗

Dimensions of good and poor handwriting legibility in first and second graders: motor programs, visual-spatial arrangement, and letter formation parameter setting.

First and second graders who were good and poor handwriters completed three writing tasks: writing letters of alphabet in order from memory, letter copying in a passage, and composing on provided topics. A coding scheme was used to evaluate these dimensions of legibility: spacing between words and between letters within words, alignment (letter placement on lines), letter height, letter slant, reversals, added strokes, missing strokes, and missing letters. Although results were somewhat task dependent, most differences between good and poor handwriters involved poor handwriters generating more letters with added strokes, producing smaller letters, and exhibiting more variability in spacing and alignment. The good and poor handwriters did not differ on average performance in alignment of words on the baseline or in spacing of letters within words and spacing between words. Each of three dimensions of handwriting contributed uniquely to the handwriting of first and second graders: motor programs, visual-spatial arrangement on the written page, and letter formation parameter setting.

Chi-Square Distribution↗

Predicting handwriting performance of early elementary students with the developmental test of visual-motor integration.

The purpose of this study was to examine use of the Developmental Test of Visual-Motor Integration in predicting handwriting performance of early elementary students and the contribution of sex. An additional purpose was to examine whether successful completion of the first nine figures or the oblique cross from the test predicted handwriting. 101 children were tested at the beginning of their kindergarten year and again in the middle of the first-grade year on the Scale of Children's Readiness In PrinTing (SCRIPT). The VMI kindergarten scores did not significantly predict first-grade SCRIPT scores for the sample as a whole. When boys and girls were considered separately. VMI scores predicted handwriting SCRIPT scores for girls, but accounted for only 10% of the variance. Successful performance on the first nine VMI figures was significantly associated with handwriting for girls but not boys, while the oblique cross did not significantly predict handwriting performance. These results do not provide clear support for administration of the Developmental Test of Visual-Motor Integration during kindergarten as a tool to identify children at risk for handwriting difficulties.

Child↗

Cognitive facilitation associated with Chinese brush handwriting: the case of symmetric and asymmetric Chinese characters.

Chinese calligraphic handwriting involves a process of visual spatial structuring of the characters as well as the motor control of the brush to follow specific character configurations through a projection of the cognitive images of the character. Previous research has shown that Chinese calligraphic handwriting facilitates perceptual and cognitive abilities. Reading Chinese characters with geometric features also facilitates cognitive processing. This study investigated Chinese calligraphic handwriting effect on cognitive facilitation measured by responses to asymmetric and asymmetric Chinese characters. 11 participants performed Chinese calligraphic handwriting for 30 min. and had their reaction time and error rate taken before and after the writing session. The reaction time to asymmetric characters was significantly shortened after Chinese calligraphic handwriting. These results confirm the general Chinese calligraphic handwriting effect on cognitive facilitation, but the asymmetric characters seem to result in greater such effects than the symmetric characters.

Adult↗

Effectiveness of school-based occupational therapy intervention on handwriting.

OBJECTIVE: This study investigated the effects of school-based occupational therapy services on students' handwriting. METHOD: Students 7 to 10 years of age with poor handwriting legibility who received direct occupational therapy services (n = 29) were compared with students who did not receive services (n = 9) on handwriting legibility and speed and associated performance components. Visual-motor, visual-perception, in-hand manipulation, and handwriting legibility and speed were measured at the beginning and end of the academic year. The intervention group received a mean of 16.4 sessions and 528 min of direct occupational therapy services during the school year. According to the therapists, visual-motor skills and handwriting practice were emphasized most in intervention. RESULTS: Students in the intervention group showed significant increases in in-hand manipulation and position in space scores. They also improved more in handwriting legibility scores than the students in the comparison group. Fifteen students in the intervention group demonstrated greater than 90% legibility at the end of the school year. On average, legibility increased by 14.2% in the students who received services and by 5.8% in the students who did not receive services. Speed increased slightly more in the students who did not receive services. CONCLUSION: Students who received occupational therapy services demonstrated improved letter legibility, but speed and numeral legibility did not demonstrate positive intervention effects.

Analysis of Variance↗

Outcomes associated with a summer handwriting course for elementary students.

OBJECTIVE: The purpose of this study was to examine the benefits of a summer handwriting instruction course offered to community elementary-age students. METHODS: Twenty-six students participated in the study and attended instruction for 1 hour per day for 2 weeks. Pre- and posttesting with the Evaluation Tool of Children's Handwriting (ETCH) were conducted. Parents were also asked to rate their child's handwriting at pretest, posttest, and 3 months posttest. RESULTS: Participants made significant improvement in two subtests of the ETCH and in parent ratings between pretest and posttest. Parent ratings remained significantly improved 3 months posttesting. Additional results suggest that children who received special education during the previous school year improved their handwriting scores on the ETCH to a greater degree than those who did not receive special education. CONCLUSION: A new service delivery model for handwriting instruction has the potential to benefit students. Occupational therapists should consider offering handwriting training to students in the summer especially if deterioration of performance is anticipated.

Child↗

Effect of alcohol and Cannabis sativa consumption on handwriting.

This study reports on the separate effect of Cannabis sativa smoking and of alcohol consumption on handwriting performance in Cannabis users and in alcoholic volunteers, respectively. Handwriting samples were obtained prior to, during, and after 1 hr of Cannabis or alcohol consumption. Handwriting was evaluated for speed, letter forms, size, slant, and alignment. Cannabis sativa smoking exerted greater effect on handwriting than did alcohol drinking. This effect was noted during Cannabis smoking and lasted for 1 hr thereafter. Changes noted in handwriting performance test, which reflect involuntary muscular movement and tremor, suggest a differential CNS depressant action of the compounds used under the experimental trials listed. The results suggest possible forensic application, i.e., the use of handwriting for the purpose of signature comparison obtained under the influence of alcohol or under Cannabis intoxication.

Adult↗

A validation study of the influence of alcohol on handwriting.

The purposes of this article are to report experimental findings and to validate prior selected studies that examined handwriting comparisons and alcohol consumption. Subjects who participated in this experiment were given handwriting testing forms which were completed at assigned intervals throughout the testing period. The setting for the completion of the experiment was within a controlled environment with adult students attending the Breath Tests for Intoxication School for the use of blood alcohol concentration (BAC) instruments for law enforcement purposes. Handwriting data and pertinent information, BAC level and time, were recorded on the testing forms which were completed before, during, and after drinking. This study does not attempt to determine handwriting characteristics that can be predicted at various blood alcohol levels, but rather demonstrate, as noted in prior studies, if handwriting trends develop during or after the consumption of alcohol. The results of the handwriting comparisons, between and among test subjects, are discussed and applied to prior findings.

Adult↗

Changes in handwriting resulting from bilateral high-frequency stimulation of the subthalamic nucleus in Parkinson's disease.

High-frequency stimulation of the subthalamic nucleus (STN) is a promising therapeutic approach in patients with severely disabling Parkinson's disease (PD). Whereas STN stimulation improves the cardinal signs of PD, little is known about the effects of STN stimulation on fine manual skills like handwriting. Therefore, the present study investigated the changes in handwriting during bilateral STN stimulation in 12 patients with advanced PD. Dopaminergic medication was discontinued at least 12 hours before the study. The patients were asked to write a standardized sentence repetitively. Five samples of the patient's script were recorded during effective bilateral STN stimulation and 1 hour after both stimulators had been switched off. The movements of the tip of the pencil were recorded using a digitizing tablet. Handwriting movements were segmented into subsequent up- and down-strokes, and a stroke-based kinematic analysis of handwriting was performed. During high-frequency STN stimulation, handwriting movements became faster and smoother indicating a partial restoration of an "open-loop" automatic performance. In addition, STN stimulation gave rise to a significant increase in the mean vertical stroke length demonstrating a stimulation-related reduction in micrographia. The present data underscores the importance of the STN in "open-loop" performance of highly skilled sequential hand movements.

Aged↗

A quantitative evaluation of the AVITEWRITE model of handwriting learning.

Much sensory-motor behavior develops through imitation, as during the learning of handwriting by children. Such complex sequential acts are broken down into distinct motor control synergies, or muscle groups, whose activities overlap in time to generate continuous, curved movements that obey an inverse relation between curvature and speed. The adaptive vector integration to endpoint handwriting (AVITEWRITE) model of Grossberg and Paine (2000) [A neural model of corticocerebellar interactions during attentive imitation and predictive learning of sequential handwriting movements. Neural Networks, 13, 999-1046] addressed how such complex movements may be learned through attentive imitation. The model suggested how parietal and motor cortical mechanisms, such as difference vector encoding, interact with adaptively-timed, predictive cerebellar learning during movement imitation and predictive performance. Key psychophysical and neural data about learning to make curved movements were simulated, including a decrease in writing time as learning progresses; generation of unimodal, bell-shaped velocity profiles for each movement synergy; size scaling with isochrony, and speed scaling with preservation of the letter shape and the shapes of the velocity profiles; an inverse relation between curvature and tangential velocity; and a two-thirds power law relation between angular velocity and curvature. However, the model learned from letter trajectories of only one subject, and only qualitative kinematic comparisons were made with previously published human data. The present work describes a quantitative test of AVITEWRITE through direct comparison of a corpus of human handwriting data with the model's performance when it learns by tracing the human trajectories. The results show that model performance was variable across the subjects, with an average correlation between the model and human data of 0.89+/-0.10. The present data from simulations using the AVITEWRITE model highlight some of its strengths while focusing attention on areas, such as novel shape learning in children, where all models of handwriting and the learning of other complex sensory-motor skills would benefit from further research.

Attention↗

Computer-assisted handwriting instruction and visual/kinaesthetic feedback processes.

An evaluation of computer-assisted handwriting exercises which offer significant advantages over more conventional teaching techniques is described. Handwriting is considered as a skill that must be regulated by processes which at first are externally controlled but which become internalized as the learner becomes more proficient at the skill. Handwriting samples of lower-case alphanumeric characters were obtained from nine mentally retarded school children. After a training program spread over a period of four weeks (approximately 5 hours in total), the greatest improvement in handwriting ability occurred where the constraints of the computer-assisted handwriting exercises encouraged students to gradually transfer control of letter formation from computer-mediated cues to more internal ones. These results are discussed in terms of control functions and the acquisition of skilled behavior.

Adolescent↗

Brain correlates of fast and slow handwriting in humans: a PET-performance correlation analysis.

The present study examined the cerebral control of velocity during handwriting. We employed H215O positron emission tomography (PET) to measure the regional cerebral blood flow (rCBF) in 10 healthy subjects. Participants were required to write the German verb 'bellen' ('to bark') either at their normal speed (i.e. fast open-loop handwriting) or to write at approximately half of their normal speed without visual feedback. The second task required a continuous modification of the motor output according to the kinaesthetic feedback from the hand (i.e. slow closed-loop handwriting). Pencil movements were recorded during PET scanning and analysed off-line using a stroke-based analysing program. The mean number of inversions in velocity (NIV) per stroke was used to quantify the mode of motor control during each PET scan. A NIV of 1 indicates fast open-loop processing, whereas an increase in NIV reflects a shift towards slow closed-loop processing of handwriting. Foci in the left primary sensorimotor cortex, the right lateral premotor cortex, the left anterior parietal cortex, the left anterior putamen, the left rostral supplementary motor area and the right precuneus showed a graded increase in functional activation with the mean NIV per stroke, suggesting that this set of brain regions is particularly involved in the processing of slow closed-loop writing movements. No area showed a negative relationship between rCBF and the mean NIV per stroke, suggesting that fast open-loop handwriting is achieved by an optimized cooperation of the manual sensorimotor network rather than by a selective activation of a distinct network component.

Adult↗

Letters lost in space: hemispace dependent handwriting errors.

Although handwriting is a daily life activity commonly attributed to the left hemisphere in the majority of right-handers, it is also known to require attentional and spatial mechanisms that rely on right hemispheric processing. The underlying spatial organization of handwriting in patients with right brain damage remains unresolved. Here we show in a patient with circumscribed right superior parietal damage that handwriting systematically depends on the hand's position in space with respect to her body-midline. Most importantly, handwriting in contralesional space not only leads to spatial but also to language errors. This suggests that the right hemisphere's role in handwriting may surpass its generally assumed purely spatial contribution. We discuss our results in term of co-registration between both cerebral hemispheres in language processing.

Brain Damage, Chronic↗

Handwriting and attention in children and adults with attention deficit hyperactivity disorder.

Adverse effects of drug therapy on handwriting fluency attributed to increased attentional control have been observed in children with attention deficit hyperactivity disorder (ADHD). The writing performance of 8 children with ADHD was assessed using a digitizing tablet in a double-blind, placebo-controlled test. Participants wrote a phrase in cursive script both on and off stimulant medication writing normally, writing with eyes closed, and writing faster than normal. Medication reduced fluency of normal handwriting movements. When children with ADHD were instructed to write faster than normal or with eyes closed, however, more fluent and even automated movements resulted, even on medication. We also assessed 10 children with ADHD, 10 children without ADHD, 10 adults with ADHD, and 10 adults without ADHD. Participants with ADHD were assessed both on and off medication. Children with ADHD on medication were less fluent than children without ADHD. Without medication, Children with ADHD did not differ from children without ADHD; those on medication showed increased handwriting dysfluency. There was no significant difference between the adults. Both children and adults with ADHD could perform age-appropriate and automated handwriting movements. Children with ADHD on medication, however, gave more attention to the writing process, possibly hampering fluent handwriting movements.

Adult↗

Kinematic analysis of handwriting movements in patients with obsessive-compulsive disorder.

OBJECTIVES: Basal ganglia dysfunction is supposed to play a part in the pathophysiology of obsessive-compulsive disorder (OCD). A new computer aided technique for the analysis of hand movements, allowing the detection of subtle motor performance abnormalities, was applied in this study of patients with OCD and healthy controls. METHODS: Using a digitising graphic tablet, hand motor performance was studied in 22 unmedicated patients with OCD and compared with 22 healthy controls. All subjects drew superimposed concentric circles with both the right and the left hand, in addition to writing a given sentence, their personal signature, and letter sequences in four different sizes. Kinematic parameters were calculated to quantify hand motion. RESULTS: Patients with OCD had significant impairments of handwriting performance, reflected by lower peak velocity (sentence t=3.6; p=0.001; signature t=2.8; p=0.01) and micrographia (sentence t=3.4; p=0.002; signature t=2.5; p=0.02), compared with controls and shortened acceleration phases per stroke (sentence t=2.4; p=0.02; signature t=4.1; p=0.000). By contrast, in repetitive drawing, patients with OCD had higher peak velocity than healthy controls (group x task interaction p<0.01). There were no significant differences in left and right hand performance between groups. Patients with early versus late age of onset differed in handwriting parameters, such as handwriting consistency. Greater severity of obsessions and compulsions correlated with increasingly poor handwriting performance in patients with OCD. CONCLUSIONS: A subtle motor dysfunction in OCD can be detected with a digitising tablet. The findings show handwriting impairments in patients with OCD, in line with the assumption that basal ganglia dysfunction is part of OCD pathophysiology. Repetitive motor pattern performance was not impaired, but rather tended to be even better in patients with OCD than in controls. The findings also support the concept that patients with OCD with early versus late age of onset differ in pathophysiological mechanisms and basal ganglia dysfunction.

Adolescent↗

Handwriting performance in the absence of visual control in writer's cramp patients: initial observations.

BACKGROUND: The present study was aimed at investigating the writing parameters of writer's cramp patients and control subjects during handwriting of a test sentence in the absence of visual control. METHODS: Eight right-handed patients with writer's cramp and eight healthy volunteers as age-matched control subjects participated in the study. The experimental task consisted in writing a test sentence repeatedly for fifty times on a pressure-sensitive digital board. The subject did not have visual control on his handwriting. The writing performance was stored on a PC and analyzed off-line. RESULTS: During handwriting all patients developed a typical dystonic limb posture and reported an increase in muscular tension along the experimental session. The patients were significantly slower than the controls, with lower mean vertical pressure of the pen tip on the paper and they could not reach the endmost letter of the sentence in the given time window. No other handwriting parameter differences were found between the two groups. CONCLUSION: Our findings indicate that during writing in the absence of visual feedback writer's cramp patients are slower and could not reach the endmost letter of the test sentence, but their level of automatization is not impaired and writer's cramp handwriting parameters are similar to those of the controls except for even lower vertical pressure of the pen tip on the paper, which is probably due to a changed strategy in such experimental conditions.

Adult↗