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.