Objective: To determine whether handwriting exercise could improve writing skill and fine manual function in Parkinson’s disease (PD).

Background: PD patients frequently experience micrographia, difficulty writing and signing, which can potentially impact a quality of life. Short-term training with visual cues and feedback such as treadmill walking and cycling exercise have been shown to be beneficial in PD.

Method: This was a single-center, single-blinded, randomized controlled trial, assessing the efficacy of a 4-week handwriting exercise using our newly developed handwriting practice book. The primary endpoint was an improvement in speed to complete the handwriting test. The secondary endpoints were the accuracy of the writing performance (i.e. how well the line of the patients’ handwriting passed through each dot of the letters), patient’s subjective rating scale of their handwriting and UPDRS part III motor scores.

Results: Of a total of 46 subjects, 23 were randomly assigned to the handwriting exercise group. After 4 weeks of exercise, the mean time using for completing the test was significantly lower in the exercise group, compared to control (143.43±34.02 vs. 175±48.88 seconds, p=0.015). The mean time using for completing the handwriting test was reduced from the baseline after the 4-week period by 16.16% in the exercise group, while increased by 3.63% in the control group (p<0.001). The time using for completing the handwriting test was improved in all patients except one (95.65%), whereas only 7 patients in the control group (30.43%) showed improvement, however, to a lesser degree. The change in accuracy of the writing performance was not significantly different between both groups. Patients in the exercise group also felt that their writing skills were improved as shown by the subjective rating scale (exercise vs. control group 2.78±0.42 vs. 2.08±0.60 scores, p<0.001). UPDRS part III scores, especially on hand function were shown more improvement in the exercise group (-17.95±14.25% vs. -3.15±9.14%, p<0.001).

Conclusion: The 4-week handwriting exercise using our handwriting practice book appears to be able to promote an improvement on writing speed and fine manual function. The optimal duration, frequency of handwriting exercise, quantity and characteristic of the letters in the handwriting practice book, and benefits in other languages merit further studies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-handwriting-exercise-on-functional-outcome-in-parkinsons-disease-a-randomized-controlled-trial/