Abstract
Handwriting is a complex human activity that engages a blend of cognitive and visual motor skills. Current understanding of the neural correlates of handwriting has largely come from lesion studies of patients with impaired handwriting. Task-based fMRI studies would be useful to supplement this work. To address concerns over ecological validity, previously we developed a fMRI-compatible, computerized tablet system for writing and drawing including visual feedback of hand position and an augmented reality display. The purpose of the present work is to use the tablet system in proof-of-concept to characterize brain activity associated with clinically relevant handwriting tasks, originally developed to characterize handwriting impairments in Alzheimer’s disease patients. As a prelude to undertaking fMRI studies of patients, imaging was performed of twelve young healthy subjects who copied sentences, phone numbers, and grocery lists using the fMRI-compatible tablet. Activation maps for all handwriting tasks consisted of a distributed network of regions in reasonable agreement with previous studies of handwriting performance. In addition, differences in brain activity were observed between the test subcomponents consistent with different demands of neural processing for successful task performance, as identified by investigating three quantitative behavioral metrics (writing speed, stylus contact force and stylus in air time). This study provides baseline behavioral and brain activity results for fMRI studies that adopt this handwriting test to characterize patients with brain impairments.
Highlights
Handwriting is a complex everyday skill that requires a combination of cognition, language processing, kinematics, motor planning, eye-hand coordination and visual-motor integration (Reisman, 1993; Rosenblum et al, 2003)
The fastest time for a subject to complete one writing task was 14 s, and only the first 14 s of each handwriting task was subsequently analyzed for all subjects. This choice simplified the fMRI analysis because it ensured that all subjects were engaged in task performance during the time designated in the analysis model for the task condition, removing the need to model effects of subject-specific completion time across the allotted 35 s time window for tablet interactions
The observed brain activity across all tasks showed good consistency with the previous fMRI literature, which to date has involved handwriting tasks implemented with less ecological validity
Summary
Handwriting is a complex everyday skill that requires a combination of cognition, language processing, kinematics, motor planning, eye-hand coordination and visual-motor integration (Reisman, 1993; Rosenblum et al, 2003) Given this set of complex dependencies, it is not surprising that handwriting performance can be affected by many different brain impairments including Alzheimer’s disease (AD) (Platel et al, 1993; Croisile, 1999; Slavin et al, 1999; Schröter et al, 2003; Werner et al, 2006), developmental learning difficulties (Rosenblum et al, 2003), schizophrenia (Tigges et al, 2000), cerebrovascular disease (Auerbach and Alexander, 1981; Otsuki et al, 1999) and traumatic brain injury (Yorkston et al, 1997). Patients with lesions of the GMFA, a region of the MiFG close to the SFG, have shown impaired handwriting with preserved reading skills as well as intact simple motor functions (e.g., finger tapping) (Roux et al, 2009)
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