title: Effects of modified pen grip and handwriting training on writer's cramp.
abstract: OBJECTIVE
  To evaluate the use of a modified pen grip and subsequent handwriting training in patients with writer's cramp (WC).
  
  
  METHODS
  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).
  
  
  METHODS
  Ambulatory care for motor writing disorders.
  
  
  METHODS
  Patients with WC (n=26) and healthy controls (n=14).
  
  
  METHODS
  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).
  
  
  METHODS
  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.
authors.affiliation: Clinical Neuropsychology Research Group, Klinikum München-Bogenhausen, Munich, Germany. Barbara.Baur@extern.lrz-muenchen.de
authors.forename: Barbara
authors.initials: B
authors.lastname: Baur
authors.forename: Waltraud
authors.initials: W
authors.lastname: Fürholzer
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jasper
authors.forename: Christian
authors.initials: C
authors.lastname: Marquardt
authors.forename: Joachim
authors.initials: J
authors.lastname: Hermsdörfer
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D020821:Dystonic Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D004576:Electromyography; D005260:Female; D006225:Hand; D018737:Hand Strength / Q000502:physiology*; D006236:Handwriting; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011312:Pressure; D011336:Probability; D011379:Prognosis; D020127:Recovery of Function; D012016:Reference Values; D016896:Treatment Outcome