Abstract
BackgroundThe assessment and treatment of writer’s cramp is complicated due to the variations in the forces and angles of involved joints. Additionally, in some cases compensatory movements for cramp relief further complicates assessment. Currently these variables are subjectively measured with clinical scales and visual assessments. This subjectivity makes it difficult to successfully administer interventions such as Botulinum toxin injection or orthotics resulting in poor efficacy and significant side effects.MethodA multi-sensor system was used to record finger and wrist forces along with deviation angles at the wrist, elbow and shoulder while 9 patients with writer's cramp performed a series of standardized tasks on surfaces inclined at different angles. Clinical, kinetic, and kinematic information regarding cramping was collected.ResultsFirst, four tasks appeared to best predict cramp occurrence. Second, unique biomechanical profiles emerged for patients regarding force, angles and cramp severity. Third, cluster analyses using these features showed a clear separation of patients into two severity classes. Finally, a relationship between severity and kinetic-kinematic information suggested that primary cramping versus compensatory movements could be potentially inferred.ConclusionsThe results demonstrate that using a set of standardized tasks and objective measures, individual profiles for arm movements and applied forces associated with writer’s cramp can be generated. The clinician can then accurately target the biomechanics specifically, whether it is with injection or other rehabilitative measures, fulfilling an important unmet need in the treatment of writer’s cramp.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-016-0122-0) contains supplementary material, which is available to authorized users.
Highlights
The assessment and treatment of writer’s cramp is complicated due to the variations in the forces and angles of involved joints
A relationship between severity and kinetic-kinematic information suggested that primary cramping versus compensatory movements could be potentially inferred
The results demonstrate that using a set of standardized tasks and objective measures, individual profiles for arm movements and applied forces associated with writer’s cramp can be generated
Summary
The assessment and treatment of writer’s cramp is complicated due to the variations in the forces and angles of involved joints. In some cases compensatory movements for cramp relief further complicates assessment. These variables are subjectively measured with clinical scales and visual assessments. This subjectivity makes it difficult to successfully administer interventions such as Botulinum toxin injection or orthotics resulting in poor efficacy and significant side effects. Writer’s cramp is a task-specific focal hand dystonia that negatively impacts handwriting ability. The involvement of multiple joints, in combination with the presence of compensatory movements makes it difficult to assess this disorder visually. Current standardized assessment tools such as the Arm Dystonia Disability Scale (ADDS) and the Delrobaei et al Journal of NeuroEngineering and Rehabilitation (2016) 13:15
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