Significance of finger forces and kinematics during handwriting in writer’s cramp

Muscular hyperactivity during handwriting, irregular and jerky scripts, as well as awkward and slowed pen movements are the cardinal symptoms of writer’s cramp. Accordingly, impaired kinematics and increased force have been reported in writer’s cramp. However, the relationship between these symptoms has rarely been investigated. In addition, measurements of finger forces have been restricted to the vertical pen pressure. In the present study, the pen of a graphic tablet was equipped with a force sensor matrix to measure also the grip force produced against the pen barrel despite highly variable pen grips of the patients. Kinematics of writing movements, vertical pen pressure, and grip force were compared in 27 patients with writer’s cramp and normal control writers during writing of a test sentence. As expected, all measures revealed a significantly worse writing performance in the patients compared to the control subjects. Exaggerated forces were more frequent than abnormal kinematics, and evidenced by prolonged movement times and reduced writing frequencies. Correlations were found neither between kinematics and force measures nor between the two forces. Interestingly, patients relaxed the grip force during short periods of non-writing by the same relative amount as control subjects. The finding of a large heterogeneity of performances patterns in writer’s cramp may reflect the variability of dystonic symptoms as well as the highly variable compensatory strategies of individual patients. Measurements of finger force and in particular of the grip force are valuable and important descriptors of individual impairment characteristics that are independent of writing kinematics.