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PubMed2005

Phase-dependent and task-dependent modulation of stretch reflexes during rhythmical hand tasks in humans.

Phase-dependent and task-dependent modulation of reflexes has been extensively demonstrated in leg muscles during locomotory activity. In contrast, the modulation of reflex responses of hand muscles during rhythmic movement is poorly documented. The objective of this study was to determine whether comparable reflex modulation occurs in muscles controlling finger motions during rhythmic, fine-motor tasks akin to handwriting. Twelve healthy subjects performed two rhythmic tasks while reflexes were evoked by mechanical perturbations applied at various phases of each task. Electromyograms (EMGs) were recorded from four hand muscles, and reflexes were averaged during each task relative to the movement phase. Stretch reflexes in all four muscles were found to be modulated in amplitude with respect to the phase of the rhythmic tasks, and also to vary distinctly with the tasks being conducted. The extent and pattern of reflex modulation differed between muscles in the same task, and between tasks for the same muscle. Muscles with a primary role in each task showed a higher correlation between reflex response and background EMG than other muscles. The results suggest that the modulation patterns observed may reflect optimal strategies of central-peripheral interactions in controlling the performance of fine-motor tasks. As with comparable studies on locomotion, the phase-dependency of the stretch reflexes implies a dynamically fluctuating role of proprioceptive feedback in the control of the hand muscles. The clear task-dependency is also consistent with a dynamic interaction of sensory feedback and central programming, presumably adapted to facilitate the successful performance of the different fine-motor tasks.

Adult↗
PubMed2004

From parallel sequence representations to calligraphic control: a conspiracy of neural circuits.

Calligraphic writing presents many challenges for motor control, including: learning and recall of stroke sequences; critical timing of stroke onsets and durations; fine control of grip and contact forces; and letterform invariance under size scaling, which entails fine control of stroke directions and amplitudes during recruitment and derecruitment of musculoskeletal degrees of freedom. Experimental and computational studies in behavioral neuroscience have progressed toward explaining the learning, planning, and control exercised in tasks that share features with calligraphic writing and drawing. This article highlights component operations ranging from parallel sequence representations to fine force control. Treated in succession are: competitive queuing models of sequence representation, performance, learning, and recall; letter size scaling and motor equivalence; cursive handwriting models in which sensory-motor transformations are performed by circuits that learn inverse differential kinematic mappings; and fine-grained control of timing and transient forces by circuit models that learn to solve inverse dynamics problems.

Biomechanical Phenomena↗
PubMed2004

Factors predicting improvement in motor disability in writer's cramp treated with botulinum toxin.

OBJECTIVE: To identify factors predicting improvement in motor disability in writer's cramp treated with botulinum toxin (BTX). METHODS: 47 patients with writer's cramp were treated with BTX and were evaluated by the same neurologists at initial referral, after each BTX injection, and when the effect of BTX was maximal at the time of the study. Patients and examiners simultaneously and independently rated the efficacy of BTX injections. Self assessment was a global clinical impression of the impact of treatment on writing quality, writing speed, writing errors, and legibility of handwriting; for objective assessment, the examiners used the Burke-Fahn-Marsden (BFM) scale. RESULTS: On the BFM scale, there was a significant improvement (p<0.0001) in both severity and disability scores. Patients with a pronation/flexion pattern of dystonia showed the best and the most sustained improvement. Primary writing tremor was little improved. There was a correlation between the self assessment score and the Burke-Fahn-Marsden score. Benefit was maintained over time CONCLUSIONS: These results have implications for the identification of patients most likely to benefit from BTX injections.

Adult↗
PubMed1994

Micrographia associated with a parietal lobe lesion in multiple sclerosis.

The occurrence of micrographia in a 52 year old women two years after an isolated episode of painful sensory disturbance led to the diagnosis of multiple sclerosis. Her handwriting returned to normal after a course of intravenous methylprednisolone. Previous reports of movement disorders occurring in the context of multiple sclerosis are briefly reviewed. The finding on MRI studies of an enhancing lesion in the dominant parietal white matter supports Kinnier Wilson's suggestion that the anatomical origin of micrographia lies in the cerebral hemisphere rather than the corpus striatum.

Brain Diseases↗
PubMed1998

Piracetam relieves symptoms in progressive myoclonus epilepsy: a multicentre, randomised, double blind, crossover study comparing the efficacy and safety of three dosages of oral piracetam with placebo.

OBJECTIVE: To compare the efficacy, tolerability, and safety of three daily dosage regimens of oral piracetam in patients with progressive myoclonus epilepsy. METHODS: Twenty patients (12 men, eight women), aged 17-43 years, with classical Unverricht-Lundborg disease were enrolled in a multicentre, randomised, double blind trial of crossover design in which the effects of daily doses of 9.6 g, 16.8 g, and 24 g piracetam, given in two divided doses, were compared with placebo. The crossover design was such that patients received placebo and two of the three dosage regimens of piracetam, each for two weeks, for a total treatment period of six weeks and thus without wash out between each treatment phase. The primary outcome measure was a sum score representing the adjusted total of the ratings of six components of a myoclonus rating scale in which stimulus sensitivity, motor impairment, functional disability, handwriting, and global assessments by investigators and patients were scored. Sequential clinical assessments were made by the same neurologist in the same environment at the same time of day. RESULTS: Treatment with 24 g/day piracetam produced significant and clinically relevant improvement in the primary outcome measure of mean sum score (p=0.005) and in the means of its subtests of motor impairment (p=0.02), functional disability (p=0.003), and in global assessments by both investigator (p=0.002) and patient (p=0.01). Significant improvement in functional disability was also found with daily doses of 9.6 g and 16.8 g. The dose-effect relation was linear and significant. More patients showed clinically relevant improvement with the highest dosage and, in individual patients, increasing the dose improved response. Piracetam was well tolerated and adverse effects were few, mild, and transient. CONCLUSIONS: This study provides further evidence that piracetam is an effective and safe medication in patients with Unverricht-Lundborg disease. In addition, it shows that a dose of 24 g is highly beneficial, more effective than lower doses and that a dose-effect relation exists. There is considerable variation in optimal individual dosage.

Activities of Daily Living↗
PubMed1999

Recognition of handwritten similar Chinese characters by self-growing probabilistic decision-based neural network.

Recognition of similar (confusion) characters is a difficult problem in optical character recognition (OCR). In this paper, we introduce a neural network solution that is capable of modeling minor differences among similar characters, and is robust to various personal handwriting styles. The Self-growing Probabilistic Decision-based Neural Network (SPDNN) is a probabilistic type neural network, which adopts a hierarchical network structure with nonlinear basis functions and a competitive credit-assignment scheme. Based on the SPDNN model, we have constructed a three-stage recognition system. First, a coarse classifier determines a character to be input to one of the pre-defined subclasses partitioned from a large character set, such as Chinese mixed with alphanumerics. Then a character recognizer determines the input image which best matches the reference character in the subclass. Lastly, the third module is a similar character recognizer, which can further enhance the recognition accuracy among similar or confusing characters. The prototype system has demonstrated a successful application of SPDNN to similar handwritten Chinese recognition for the public database CCL/HCCR1 (5401 characters x200 samples). Regarding performance, experiments on the CCL/HCCR1 database produced 90.12% recognition accuracy with no rejection, and 94.11% accuracy with 6.7% rejection, respectively. This recognition accuracy represents about 4% improvement on the previously announced performance. As to processing speed, processing before recognition (including image preprocessing, segmentation, and feature extraction) requires about one second for an A4 size character image, and recognition consumes approximately 0.27 second per character on a Pentium-100 based personal computer, without use of any hardware accelerator or co-processor.

China↗
PubMed2002

Genotype correlation with fine motor symptoms in patients with Wilson's disease.

Wilson's disease, an autosomal recessive disorder of copper metabolism, is caused by about 200 different mutations of the ATP7B gene. Using a genotype-phenotype correlation, 36 patients were examined to see whether the disorder of the automatic handwriting movement depends on the genotype. The findings of this study indicated that no such link exists. Neither the profile of the impairment of the fine motor parameters nor the severity and frequency of pathological findings were different among the three genotype groups (homozygous for H1069Q, compound homozygous for H1069Q and other mutations). By contrast, fine motor disorders were found to correlate with the clinical symptoms recorded when therapy began. The pathophysiology of the basal ganglia and the cerebellar loop therefore cannot be directly attributed to the genotype of the mutation in the ATP7B gene.

Adenosine Triphosphatases↗
PubMed2003

Snoring, intermittent hypoxia and academic performance in primary school children.

Sleep-disordered breathing is associated with impaired attention and neurocognitive deficits. We assessed the association of snoring and intermittent hypoxia with poor academic performance in third grade school children (1,144 children). Snoring frequency and intermittent hypoxia were investigated using parental questionnaire and nocturnal home pulse oximetry. Intermittent hypoxia was specified as desaturation events of 90% or less pulse oximeter saturation. Poor academic performance was defined as grade 4-6 on a six-point scale (i.e., approximately the lowest quintile grades) in mathematics, science, reading, spelling, and/or handwriting in the most recent school report. Snoring "always" was significantly associated with poor academic performance in mathematics (odds ratio; 95% confidence interval: 3.6; 1.3-10.1), science (4.3; 1.3-14.6), and spelling (3.5; 1.2-10.3). Snoring "frequently" was also significantly associated with poor academic performance in mathematics (2.4; 1.3-4.7) and spelling (2.0; 1.04-3.8). A significant relationship between snoring and poor academic performance was also found in children without intermittent hypoxia, whereas intermittent hypoxia did not show an independent association with poor academic performance. Thus, habitual snoring (i.e., snoring frequently or always) was associated with poor academic performance in these primary school children.

Achievement↗
PubMed1977

Parkinson's disease, depression, and ECT: a review and case study.

The author reviews the association between Parkinson's disease and depression and presents evidence to support the hypothesis that depression may be not only reactive but biochemically related to the disease. A psychotically depressed patient with parkinsonism responded positively to ECT as shown by improvement on a depression rating scale, two extrapyramidal rating scales, and handwriting samples. The beneficial effect on parkinsonian signs occurred before the improvement in depression, which suggests that ECT has a specific antiparkinsonian effect. Possible explanations for this observation based on biochemical theories of depression are discussed.

Basal Ganglia Diseases↗
PubMed1997

Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder.

OBJECTIVE: The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder. METHOD: This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects' family members and others. Handwriting samples were also examined. Data were analyzed qualitatively. RESULTS: Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases. CONCLUSIONS: This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.

Adult↗
PubMedDate not supplied

Teaching expressive writing to students with learning disabilities: research-based applications and examples.

This article presents research-based examples of effective instructional approaches for improving the quality of the content of stories and essays written by students with learning disabilities. We also describe recent research on handwriting and spelling (transcription skills) and show how instruction in these areas affects overall writing quality. Examples of instructional approaches that improve writing quality are taken from experimental studies included in a recent meta-analysis by Gersten and Baker (2001) conducted on writing intervention research. A common goal in these studies was to teach students with learning disabilities how to organize writing tasks, generate ideas about the writing topics, and produce final written products that were coherent and organized. In this article, our goal is to illustrate how findings from these studies can be implemented in both general and special education settings.

Child↗
PubMedDate not supplied

Writing instruction in kindergarten: examining an emerging area of research for children with writing and reading difficulties.

This review examines the literature on how to teach kindergarten children with reading and writing difficulties how to write. Specifically, research on handwriting instruction, spelling instruction, and composition writing is discussed. Due to the limited number of empirical studies on writing that included kindergarten students with diagnosed reading and writing difficulties, selected studies conducted with the full range of kindergarten children, as well as studies conducted in the early elementary grades, are presented to highlight future directions for research.

Child↗
PubMed2006

Look-alike, sound-alike oncology medications.

Confusing medication names and packaging may cause or contribute to potentially harmful medication errors. The names of several chemotherapy and supportive agents can look or sound like the names of other chemotherapy agents or unrelated medications and can be inadvertently interchanged, or mixed up. Poor handwriting, abbreviations of medication names, unclear verbal medication orders, memory lapses, and the large volume of medications currently in use are risk factors for look-alike, sound-alike medication errors. Risk reduction strategies include being aware of medications that look or sound like other medications, installing pop-up alerts in computer systems, prescribing medications by their generic and trade names, placing eye-catching labels and warning stickers on storage bins, storing medications in nonadjacent areas, and advising patients to be alert for potential mix-ups with look-alike, sound-alike medications.

Abbreviations as Topic↗
PubMed2006

Effect of modality on spelling words varying in linguistic demands.

The purpose of this study was to determine the extent to which spelling accuracy is influenced by response modality. A spelling list consisting of 40 words that varied in linguistic complexity was administered to students in Grades 2 through 6. Each student completed three tasks: (a) a words-per-minute measure to determine keyboarding proficiency, (b) spelling a word list via handwriting, and (c) spelling a word list on a computer. Independent variables included response modality, linguistic complexity, and grade level. Dependent measures included the percent words spelled correctly. Keyboarding proficiency was included as a covariate. Modality rarely affected spelling accuracy, regardless of the linguistic complexity of the target words. These findings suggest that spelling knowledge draws on modality-free, lexical representations stored in long-term memory. Further, they suggest that computer-based instruments are a viable option for spelling assessment.

Adolescent↗
PubMed2006

Early development of language by hand: composing, reading, listening, and speaking connections; three letter-writing modes; and fast mapping in spelling.

The first findings from a 5-year, overlapping-cohorts longitudinal study of typical language development are reported for (a) the interrelationships among Language by Ear (listening), Mouth (speaking), Eye (reading), and Hand (writing) in Cohort 1 in 1st and 3rd grade and Cohort 2 in 3rd and 5th grade; (b) the interrelationships among three modes of Language by Hand (writing manuscript letters with pen and keyboard and cursive letters with pen) in each cohort in the same grade levels as (a); and (c) the ability of the 1st graders in Cohort 1 and the 3rd graders in Cohort 2 to apply fast mapping in learning to spell pseudowords. Results showed that individual differences in Listening Comprehension, Oral Expression, Reading Comprehension, and Written Expression are stable developmentally, but each functional language system is only moderately correlated with the others. Likewise, manuscript writing, cursive writing, and keyboarding are only moderately correlated, and each has a different set of unique neuropsychological predictors depending on outcome measure and grade level. Results support the use of the following neuropsychological measures in assessing handwriting modes: orthographic coding, rapid automatic naming, finger succession (grapho-motor planning for sequential finger movements), inhibition, inhibition/switching, and phonemes skills (which may facilitate transfer of abstract letter identities across letter formats and modes of production). Both 1st and 3rd graders showed evidence of fast mapping of novel spoken word forms onto written word forms over 3 brief sessions (2 of which involved teaching) embedded in the assessment battery; and this fast mapping explained unique variance in their spelling achievement over and beyond their orthographic and phonological coding abilities and correlated significantly with current and next-year spelling achievement.

Age Factors↗
PubMed1982

Primary writing tremor: a selective action tremor.

Progressive difficulty in handwriting due to jerking movements precipitated by the act of writing beginning between the ages of 8 to 54 is reported in six patients. There was no rest tremor, but three had mild postural tremor. Specific muscle activity (especially pronation of the wrist or abduction of the fingers) elicited the tremors that persisted as long as the evocative posture or muscle activity was maintained. None had a family history of tremors, but two had a history suggestive of hypoxia at birth. Unlike benign essential tremor, the movements did not respond to propranolol HCl, but most patients were benefited both acutely and chronically by centrally active anticholinergic agents.

Adolescent↗
PubMed1991

Preclinical Parkinson's disease: detection of motor and nonmotor manifestations.

The advent of possible protective therapies for Parkinson's disease has created a need for methods of diagnosing the disease before the clinical features become fully evident. As a number of motor and nonmotor manifestations of the disease emerge months to years before a diagnosis can be made, a battery of clinical tests might be sufficient to identify individuals at an earlier stage than is currently possible using the standard history and physical examination. A list of questions regarding possible risk factors, specific symptoms, and observations of family members could be combined in a self-administered questionnaire that might identify individuals with a high probability of early, but otherwise undiagnosable, Parkinson's disease. Identification of subtle motor features is another possible screening method. For example, handwriting and speech are commonly affected prior to diagnosis; thus, automated analysis of these motor actions might also provide detection of incipient disease.

Handwriting↗
PubMed2000

It ain't what you say.... legibility and clarity of treatment records.

The content of treatment records is irrelevant if it cannot be understood. This is a report of a clinical audit project that aimed to assess the readability of records, and set standards to be maintained throughout the practice for handwriting and use of abbreviations.

Abbreviations as Topic↗