Comprehension of handwriting development: Pen-grip kinetics in handwriting tasks and its relation to fine motor skills among school-age children.

BACKGROUND/AIM: Numerous tools have been developed to evaluate handwriting performances by analysing written products. However, few studies have directly investigated kinetic performances of digits when holding a pen. This study thus attempts to investigate pen-grip kinetics during writing tasks of school-age children and explore the relationship between the kinetic factors and fine motor skills. METHODS: This study recruited 181 children aged from 5 to 12 years old and investigated the effects of age on handwriting kinetics and the relationship between these and fine motor skills. The forces applied from the digits and pen-tip were measured during writing tasks via a force acquisition pen, and the children's fine motor performances were also evaluated. RESULTS: The results indicate that peak force and average force might not be direct indicators of handwriting performance for normally developing children at this age. Younger children showed larger force variation and lower adjustment frequency during writing, which might indicate they had poorer force control than the older children. Force control when handling a pen is significantly correlated with fine motor performance, especially in relation to the manual dexterity. CONCLUSIONS/SIGNIFICANCE OF THE STUDY: A novel system is proposed for analysing school-age children's force control while handwriting. We observed the development of force control in relation to pen grip among the children with different ages in this study. The findings suggested that manipulation skill may be crucial when children are establishing their handwriting capabilities.

The associations among hand dexterity, functional performance, and quality of life in diabetic patients with neuropathic hand from objective- and patient-perceived measurements.

PURPOSE: To comprehend the associations among the dexterity and functional performance of the hands and quality of life in diabetic patients with neuropathic hands, via objective- and patient-perceived measurements. METHODS: The study participants were 144 diabetes patients who received objective evaluations, including the Purdue pegboard test, electrophysiological testing in sensory amplitude of the median nerve, and self-administrated measurements, including the Michigan Hand Outcomes Questionnaire (MHQ) and Diabetes-39 (D-39). Pearson's and Spearman's correlation tests were conducted to assess the relationships among hand neuropathy, hand dexterity and functions, and quality of life. RESULTS: The results show that the amplitude of the sensory nerve action potential of the median nerve was positively correlated with hand dexterity (r = 0.28-0.43; p < 0.01) and the total score of MHQ (r = 0.24-0.33; p < 0.01). Objective hand dexterity had mild to moderate relationships with most of the MHQ results, but only weak associations with some dimensions of the D-39 results. The MHQ results were negatively correlated with the D-39 scores, with mild to moderate relationships in the domains of energy/mobility and anxiety. CONCLUSIONS: In comparison with diabetic feet, neuropathic diabetic hands are an easily neglected problem, with insufficient empirical evidence in the literature to indicate its impact on functional performance and quality of life. This study showed that lesions related to neural functioning in the diabetic hand may negatively influence dexterity and functional hand performance and thus also affect the quality of life.

The effect of task complexity on handwriting kinetics.

BACKGROUND.: Knowledge regarding the relationship between writing kinetics and the difference among writing tasks is limited. PURPOSE.: This study examined the differences in handwriting performance when doing tasks with different levels of challenge from both temporal and kinetic perspectives among children in four different age groups. METHOD.: The cross-sectional design introduced a force-acquisition pen to detect differences of pen grip and writing kinetics among 170 school-age children doing writing tasks at different difficulty levels. Data were obtained on the force information of the digits and pen tip and the kinetic parameters to examine the coordination-and-control mechanism between the digits and pen. Statistical analyzes were carried out to indicate the differences in writing performance among groups and tasks. FINDINGS.: Statistical differences in the pen-grip forces, force fluctuation, and force ratio between grip and pen-tip forces were found when performing different writing tasks and among different age groups. IMPLICATIONS.: The study provides an alternative method to explore how writing performance among school-age children can vary according to the difficulty of the writing tasks.

Do we underestimate influences of diabetic mononeuropathy or polyneuropathy on hand functional performance and life quality?

AIMS/INTRODUCTION: The purpose of the present study was to identify whether there are differences in hand dexterity, hand functional performance and quality of life between diabetes patients with mononeuropathy and polyneuropathy of their hands to further present the importance regarding the impacts of diabetic neuropathic deficits on patients' functional capacity. MATERIALS AND METHODS: The neurological deficits of 127 patients with type 2 diabetes were examined by electrophysiological tests for the median and ulnar nerves, and were stratified into the diabetic mononeuropathy, diabetic polyneuropathy and non-diabetic neuropathy groups by sensory amplitude of these nerves. The Purdue pegboard test, Michigan Hand Outcomes Questionnaire, and Diabetes-39 were carried out to understand patients' hand dexterity, functional hand performance and quality of life, respectively. RESULTS: The results showed significant differences in all subtests of the Purdue pegboard test among the three groups. Furthermore, aesthetics, patient's satisfaction of the Michigan Hand Outcomes Questionnaire and diabetes control, sexual functioning, energy, and mobility of the Diabetes-39 also showed significant differences among the three groups. CONCLUSIONS: The present study shows the patients with polyneuropathy suffer from more negative impacts on hand functional performance and quality of life than those with mononeuropathy and without neuropathy. These findings might assist both patients and clinicians in better realizing the impacts of neuropathic hands, and planning suitable strategies of intervention or health education to prevent declines in hand functions.