Relearning of Writing Skills in Parkinson's Disease After Intensive Amplitude Training

• Published in: Movement disorders 2016-08, Vol.31 (8), p.1209-1216
• Main Authors: Nackaerts, Evelien, Heremans, Elke, Vervoort, Griet, Smits-Engelsman, Bouwien C.M., Swinnen, Stephan P., Vandenberghe, Wim, Bergmans, Bruno, Nieuwboer, Alice
• Format: Article
• Language: English
• Subjects: Aged; Automation; Female; Handedness; Handwriting; Humans; Learning - physiology; Male; Memory; memory consolidation; micrographia; Middle Aged; motor learning; Motor skill; Motor skill learning; Motor Skills - physiology; Motor task performance; Movement disorders; Neurodegenerative diseases; neurological rehabilitation; Neurological Rehabilitation - methods; Outcome Assessment (Health Care); Parkinson Disease - physiopathology; Parkinson Disease - rehabilitation; Parkinson's disease; Relearning; Retention; Skills; Transfer (Psychology) - physiology; Writing
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.26565

ABSTRACT Background Micrographia occurs in approximately 60% of people with Parkinson's disease (PD). Although handwriting is an important task in daily life, it is not clear whether relearning and consolidation (ie the solid storage in motor memory) of this skill is possible in PD. The objective was to conduct for the first time a controlled study into the effects of intensive motor learning to improve micrographia in PD. Methods In this placebo‐controlled study, 38 right‐handed people with PD were randomized into 2 groups, receiving 1 of 2 equally time‐intensive training programs (30 min/day, 5 days/week for 6 weeks). The experimental group (n = 18) performed amplitude training focused at improving writing size. The placebo group (n = 20) received stretch and relaxation exercises. Participants' writing skills were assessed using a touch‐sensitive writing tablet and a pen‐and‐paper test, pre‐ and posttraining, and after a 6‐week retention period. The primary outcome was change in amplitude during several tests of consolidation: (1) transfer, using trained and untrained sequences performed with and without target zones; and (2) automatization, using single‐ and dual‐task sequences. Results The group receiving amplitude training significantly improved in amplitude and variability of amplitude on the transfer and automatization task. Effect sizes varied between 7% and 17%, and these benefits were maintained after the 6‐week retention period. Moreover, there was transfer to daily life writing. Conclusions These results show automatization, transfer, and retention of increased writing size (diminished micrographia) after intensive amplitude training, indicating that consolidation of motor learning is possible in PD. © 2016 International Parkinson and Movement Disorder Society