Modified pen grip in the treatment of writer’s cramp

Abstract

Writer’s Cramp (WC) is a focal, action-related dystonia, which induces hypertonic co-contractions and severely impairs handwriting. One behavioral treatment approach is the handwriting training developed by Mai and Marquardt (1999), [Mai, N., & Marquardt, C. (1999). Schreibtraining in der neurologischen Rehabilitation. In EKN-Materialien für die Rehabilitation. Dortmund: Borgmann] which includes among various motor exercises the use of a modified pen grip (stabilized between index and middle finger). This pen grip has proven particularly successful in clinical practice. The current study aims at elucidating the immediate effects of the modified pen grip on writing in 23 WC patients and 11 healthy controls. All participants wrote a sentence with their usual and also with the modified pen grip. Movement and pressure were recorded with a digitizing tablet. Pressure, movement time for the whole sentence, script size and writing fluency were analyzed. When writing with their usual pen grip, pressure in the WC patients was elevated, and writing speed was decreased compared to healthy controls. Changing over to the modified pen grip reduced the pressure significantly in WC patients and controls, but left other aspects of their writing unaffected. This shows that the use of the modified pen grip is an effective way to normalize pen pressure in WC patients, thereby providing the best conditions for the training of speed and fluency.