Patients often notice the difference in their handwriting themselves and a neurologist can confirm the diagnosis by the size of the handwriting in a writing test. Software that measures the size, speed, fluency, and duration of writing is available to provide accurate measurement of writing characteristics.
Causes of micrographia
The basal ganglia, a structural network containing nerve cells located deep in the brain, regulates motor skills such as the movement and coordination of the arms and legs. Damage to the basal ganglia affects most motor functions, including writing.
Research has shown a strong correlation between micrographia and bradykinesia, another characteristic symptom of Parkinson’s disease. Slow movement, or bradykinesia, can affect the movement of arms and fingers, leading to writing difficulty. Tremors and muscle contractions reported in Parkinson’s disease can also lead to micrographia.
Types of micrographia
There are two common types of micrographia: constant or consistent micrographia and progressive micrographia.
In constant micrographia, the handwriting is consistently small within a sentence; in progressive micrographia, the patient’s handwriting gradually becomes smaller during writing.
According to research, constant micrographia is a direct result of the improper function of the basal ganglia. In progressive micrographia, connectivity in other parts of the brain, such as the cerebellum and cortex, is involved.
Management of micrographia
Micrographia manifests differently among patients; some may have time periods where micrographia may be more or less pronounced.
It is recommended that patients practice at least one page of writing every day. An occupational therapist can evaluate and suggest adjustments that can improve the patient’s writing ability. Some modifications include:
- Use of a weighted pen with a rubber grip to overcome tremors and provide a better grasp;
- A non-slip mat under the paper;
- Paying attention to posture while writing;
- Writing in big letters, as small movements are more difficult. Exaggerated writing with big strokes can be helpful;
- Avoiding cursive writing and trying printing instead.
Relaxation and stretching exercises for the upper body can help relieve tension and improve writing.
It is important to note that exercise must only be performed in consultation with a physiotherapist or occupational therapist specializing in Parkinson’s disease. Occupational therapists may also recommend assistive devices that can help reduce shaking and improve handwriting.
Although there is no cure for micrographia, Parkinson’s disease treatments containing levodopa — a medication that helps the brain produce the neurotransmitter dopamine — has been shown to alleviate constant micrographia in some patients by improving the function of the basal ganglia.
According to a recent study, handwriting training can also help alleviate micrographia and improve connectivity in the part of the brain that controls writing. The study evaluated the impact of visual cues-based writing training in patients with early-stage Parkinson’s disease.
There were 27 patients in the six-week study. They were randomly divided into two groups — one that received writing training and one that did not. Patients who did not receive writing training focused on general relaxation to reduce tension in the arms and shoulders.
The writing training focused on progressive exercises designed to maintain handwriting with the help of visual aids. Both groups received treatment five times a week for 30 minutes. The goal of the study was to improve writing ability by alleviating tension in the hands.
Writing assessment was performed before the start of treatment (baseline) and after six weeks. The test was administered inside and outside an MRI machine to evaluate changes in the brain during testing.
Researchers found that writing training significantly increased the size of patients’ handwriting. Moreover, MRIs showed improved connectivity in the areas of the brain responsible for vision and movement learning in those who received the training.
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