Effects of Modified Pen Grip and Handwriting Training on Writer's Cramp

Abstract Baur B, Fürholzer W, Jasper I, Marquardt C, Hermsdörfer J. Effects of modified pen grip and handwriting training on writer's cramp. Objective To evaluate the use of a modified pen grip and subsequent handwriting training in patients with writer's cramp (WC). Design Handwriting performance with normal and modified pen grip was examined once in healthy controls and repeatedly in patients with WC (2 baseline tests before training, directly after training, after a 3-month follow-up). Setting Ambulatory care for motor writing disorders. Participants Patients with WC (n=26) and healthy controls (n=14). Intervention Seven sessions of handwriting training with various motor exercises were conducted by an occupational therapist. During training, the patients always used a modified pen grip (stabilized between index and middle finger). Main Outcome Measures Writing frequency and fluency, grip force on the pen, writing pressure, Fahn dystonia scale, visual analog scales for impairment and pain. Results Patients with WC showed increased writing pressure and grip force before training. Using the modified pen grip caused in both patients with WC and controls a decrease in pressure and grip force. Handwriting training resulted in a further improvement of both parameters in patients with WC. Grip force reduction remained stable over follow-up. Conclusions Results suggest that patients with WC benefit from the use of the modified pen grip in combination with handwriting training.