Task specific grip force control in writer's cramp.

OBJECTIVE: Writer's cramp is defined as a task specific focal dystonia generating hypertonic muscle co-contractions during handwriting resulting in impaired writing performance and exaggerated finger force. However, little is known about the generalisation of grip force across tasks others than writing. The aim of the study was to directly compare regulation of grip forces during handwriting with force regulation in other fine-motor tasks in patients and control subjects. METHODS: Handwriting, lifting and cyclic movements of a grasped object were investigated in 21 patients and 14 controls. The applied forces were registered in all three tasks and compared between groups and tasks. In addition, task-specific measures of fine-motor skill were assessed. RESULTS: As expected, patients generated exaggerated forces during handwriting compared to control subjects. However there were no statistically significant group differences during lifting and cyclic movements. The control group revealed a generalisation of grip forces across manual tasks whereas in patients there was no such correlation. CONCLUSION: We conclude that increased finger forces during handwriting are a task-specific phenomenon that does not necessarily generalise to other fine-motor tasks. SIGNIFICANCE: Force control of patients with writer's cramp in handwriting and other fine-motor tasks is characterised by individualised control strategies.

Writing kinematics and pen forces in writer's cramp: effects of task and clinical subtype.

OBJECTIVE: Writer's Cramp (WC) is defined as a task-specific form of focal-hand-dystonia generating hypertonic muscle co-contractions resulting in impaired handwriting. Little is known about kinematic and dynamic characteristics in handwriting in the different subtypes of WC. METHODS: In this study, kinematic and force analyses were used to compare handwriting capacity of 14 simple, 13 dystonic WC-patients and 14 healthy subjects. The effect of task-complexity was investigated using a simple repetitive writing-task, writing pairs of letters, a sentence and copying a text. RESULTS: In general, patients showed significant deficits in kinematic and force parameters during writing, but no consistent differences between the two subtypes of WC were found. The complexity of writing material modulated writing parameters in all groups, but less complex material did not ameliorate the patients' deficits relative to control subjects. CONCLUSIONS: The similarity of deficits in patients with simple and dystonic WC does not support the concept of a unitary progression of deficits causing a switch from simple to dystonic WC. Dystonic WC seems to be characterized by a spread of symptoms independent of severity. Obviously, the deficits concern elementary aspects of writing and are not modulated by more complex aspects. SIGNIFICANCE: Quantification of writing deficits by simple and short phrases with kinematic and force parameters can substantially improve the characterization of WC.