Abstract
Background: Oral therapies and chemodenervation procedures are often unrewarding in the treatment of focal, task-specific hand disorders such as writer’s cramp or primary writing tremor (PWT).Methods: A portable writing orthotic device (WOD) was evaluated on 15 consecutively recruited writer’s cramp and PWT subjects. We measured overall impairment at baseline and after 2 weeks of at-home use with the Writer’s Cramp Rating Scale (range = 0–8, higher is worse) and writing quality and comfort with a visual analog scale (range = 0–10).Results: Compared to regular pen, the WOD improved the Writer’s Cramp Rating Scale scores at first-test (p = 0.001) and re-test (p = 0.005) as well as writing quality and device comfort in writer’s cramp subjects. Benefits were sustained at 2 weeks. PWT subjects demonstrated no improvements.Conclusion: WODs exploiting a muscle-substitution strategy may yield immediate benefits in patients with writer’s cramp.
Highlights
Focal task-specific hand dystonia results from involuntary activation of antagonistic pairs of muscles of the hand, wrist, and elbow during the fine finger movements of handwriting (Ceballos-Baumann et al, 1997)
Oral therapies and chemodenervation procedures are often unrewarding in the treatment of focal, task-specific hand disorders such as writer’s cramp or primary writing tremor (PWT)
Two patients failed to complete study because of lack of adaptability to the writing orthotic device (WOD) and two patients were lost to follow-up
Summary
Focal task-specific hand dystonia (writer’s cramp, WC) results from involuntary activation of antagonistic pairs of muscles of the hand, wrist, and elbow during the fine finger movements of handwriting (Ceballos-Baumann et al, 1997). Studies have shown that WC patients may have abnormal homuncular organization of tactile sensory perception (Bara-Jimenez et al, 1998). Abnormal sensory tactile perception may elicit hyperactivation of motor areas involved in finger movement. Though studies have confirmed the clinical efficacy of BTX, its use is limited because of high cost and common adverse side effects, excessive weakness limiting gross and fine-motor hand functions other than handwriting (Poungvarin, 1991; Wissel et al, 1996). Oral therapies and chemodenervation procedures are often unrewarding in the treatment of focal, task-specific hand disorders such as writer’s cramp or primary writing tremor (PWT)
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