Comparison of Writing Speed, Letter Size, and Upper Extremity Muscle Activation in Stroke Patients Using Two Writing Aids: Evaluation with the Jebsen–Taylor Hand Function Test
Source abstract
Abstract
Currently, writing aids for upper extremity rehabilitation in stroke patients are not developed with consideration of biomechanical characteristics, making it difficult to achieve proper support effects. Therefore, in this study, we conducted a comparative analysis to examine how the use of two types of writing aids affects writing speed, letter size, and upper extremity muscle activation based on hand function and electromyography assessments in 12 stroke patients. Hand function was assessed using the Jebsen–Taylor hand function test, while writing ability (writing speed and letter size) was measured using the Korean alphabet writing test. Muscle activity was recorded using surface electromyography from both the paralyzed side (PS) and nonparalyzed side (NPS). The results showed that writing speed was significantly slower and horizontal letter sizes were larger on the PS. Additionally, muscle activation patterns on the PS were significantly influenced by the design of the writing aids, suggesting that the aids’ design affects compensatory movements and muscle function. These findings emphasize the importance of personalized rehabilitation tools that cater to the individual needs of stroke patients. Future research will focus on developing customized writing aids based on biomechanical data to better support rehabilitation goals.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Stroke Rehabilitation and Recovery · Botulinum Toxin and Related Neurological Disorders · Musculoskeletal pain and rehabilitation
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Division of Biomedical Engineering, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Republic of Korea
Research Center of Healthcare and Welfare Instrument for the Aged, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si 54896, Republic of Korea
Funding
National Research Foundation of Korea (NRF)
References (42)
Show source-provided references
1. Rajati, F., Rajati, M., Rasulehvandi, R., and Kazeminia, M. (2023). Prevalence of stroke in the elderly: A systematic review and meta-analysis. Interdiscip. Neurosurg., 32.10.1016/j.inat.2023.101746 ↗
2. Stroke: Causes and clinical features10.1016/j.mpmed.2020.06.002 ↗
3. Heart disease and stroke statistics-2019 update: A report from the American Heart Association10.1161/CIR.0000000000000659 ↗
4. Comparative analysis of kinematics between elderly and adults with stroke at gait
5. Neural plasticity and bilateral movements: A rehabilitation approach for chronic stroke10.1016/j.pneurobio.2005.04.001 ↗
6. Pearce, J. (2004). Positive and negative cerebral symptoms: The roles of Russel Reynolds and Hughlings Jackson. J. Neurol. Neurosurg. Psychiatry, 75.10.1136/jnnp.2004.038422 ↗
7. Feldner, H.A., Papazian, C., Peters, K.M., Creutzfeldt, C.J., and Steele, K.M. (2021). Clinical use of surface electromyography to track acute upper extremity muscle recovery after stokre: A descriptive case study of a single patient. Appl. Syst. Innov., 4.10.3390/asi4020032 ↗
8. Gerth, S., Klassert, A., Dolk, T., Fliesser, M., Fischer, M.H., Nottbusch, G., and Festman, J. (2016). Is handwriting performance affected by the writing surface? Comparing preschoolers’, second graders’, and adults’ writing performance on a tablet vs. Paper. Front. Psychol., 7.10.3389/fpsyg.2016.01308 ↗
9. Biomechanical analyses of prolonged handwriting in subjects with and without perceived discomfort10.1016/j.humov.2015.06.008 ↗
10. Kim, S., Jung, J.Y., Yang, C.M., Lee, Y.G., and Kim, J.J. (2022). Development of an ergonomic writing assistive device for finger pain reduction in the elderly. Appl. Sci., 12.10.3390/app12030993 ↗
11. Štefanovič, B., Michalíková, M., Bednarčíková, L., Tóth, T., Hudák, R., and Živčák, J. (2021, January 21–23). KALEM- a writing aid for patients with upper limb tremor. Proceedings of the 2021 IEEE 19th World Symposium on Applied Machine Intelligence and Informatics (SAMI), Herl’any, Slovakia.10.1109/SAMI50585.2021.9378694 ↗
12. Development and assessment of a hand assist device: GRIPIT10.1186/s12984-017-0223-4 ↗
13. The relationship between hemiplegic upper extremity function and activities of daily living according to age in stroke patients10.4235/jkgs.2011.15.1.29 ↗
14. Guardati, L., Casamassima, F., Farella, E., and Benini, L. (2015, January 9–13). Paper, pen and ink: An innovation system and software framework to assist writing rehabilitation. Proceedings of the 2015 Design, Automation & Test in Europe Conference & Exhibition (DATE), Grenoble, France.10.7873/DATE.2015.0453 ↗
15. Acquired dysgraphia in adults following right or left-hemisphere stroke10.1590/S1980-57642014DN83000007 ↗
16. Effect of neurofeedback and electromyographic-biofeedback therapy on improving hand function in stroke patients10.1310/tsr2102-137 ↗
17. Systematic review of measures of impairment and activity limitation for persons with upper limb trauma and amputation10.1016/j.apmr.2017.01.015 ↗
18. Internal consistency and validity of the Jebsen-Taylor hand function test in an Italian population with hemiparesis
19. Culicchia, G., Nobilia, M., Asturi, M., Santilli, V., Paoloni, M., De Santis, R., and Galeoto, G. (2016). Cross-cultural adaptation and validation of the Jebsen-Taylor hand function test in an Italian population. Rehabil. Res. Pract., 2016.10.1037/t77090-000 ↗
20. A review of the handwriting assessment and characteristics of children with cerebral palsy
21. A comparative study of intrinsic hand muscle tension, wrist extensor activity, and hand function through hand intrinsic muscles facilitation program combined with wrist immolization splint in stroke patients
22. Hand grip and pinch strength: Effects of workload, hand dominance, age, and body mass index10.12669/pjms.291(Suppl).3535 ↗
23. Validity and responsiveness of the Jebsen-Taylor hand function test10.1016/j.jhsa.2009.09.008 ↗
24. Upper limb motor impairment after stroke10.1016/j.pmr.2015.06.008 ↗
25. Saturated muscle activation contributes to compensatory reaching strategies after stroke10.1152/jn.00732.2004 ↗
26. Compensatory strategies for reaching in stroke10.1093/brain/123.5.940 ↗
27. Motor impairment-related alterations in biceps and triceps brachii fascicle lengths in chronic hemiparetic stroke10.1177/1545968318792618 ↗
28. Compensatory motor control after stroke: An alternative joint strategy for object-dependent shaping of hand posture10.1152/jn.00936.2009 ↗
29. Electromyographic biofeedback improves upper extremity function: A randomized, single-blinded, controlled trial10.1016/j.physio.2020.02.002 ↗
30. Alsubiheen, A.M., Choi, W., Yu, W., and Lee, H. (2022). The effect of task-oriented activities training on upper-limb function, daily activities, and quality of life in chronic stroke patients: A randomized controlled trail. Int. J. Environ. Res. Public. Health, 19.10.3390/ijerph192114125 ↗
31. Handwriting performance versus arm forward reach and grasp abilities among post-stroke patients, a case-control study10.1080/10749357.2016.1183383 ↗
32. More than an alphabet: Linguistic features of Korean and their influences on Hangul word recognition10.1075/wll.00027.pae ↗
33. Grip force control during object manipulation in cerebral stroke10.1016/S1388-2457(03)00042-7 ↗
34. Language-specific dysgraphia in Korean patients with right brain stroke: Influence of unilateral spatial neglect10.3346/jkms.2015.30.3.323 ↗
35. Gerardin, E., Bontemps, D., Babuin, N.T., Herman, B., Denis, A., Bihin, B., Regnier, M., Leeuwerck, M., Deltombe, T., and Riga, A. (2022). Bimanual motor skill learning with robotics in chronic stroke: Comparison between minimally impaired and moderately impaired patients, and healthy individuals. J. Neuroeng. Rehabil., 19.10.1186/s12984-022-01009-3 ↗
36. Long-term recovery of upper limb motor function and self-reported health: Results from a multicenter observational study 1 year after discharge from rehabilitation10.1186/s42466-021-00164-7 ↗
37. Handwriting as an objective tool for Parkinson’s disease diagnosis10.1007/s00415-013-6996-x ↗
38. Gündüz, O.H., and Toprak, C.Ş. (2019). Hand Function: A Practical Guide to Assessment, Springer.
39. Weakness is the primary contributor to finger impairment in chronic stroke10.1016/j.apmr.2006.05.013 ↗
40. Relationships and responsiveness of six upper extremity function tests during the first six months of recovery after stroke10.1097/NPT.0b013e3181a33638 ↗
41. Stroke rehabilitation10.1016/S0140-6736(11)60325-5 ↗
42. Gerth, S., and Festman, J. (2023). Muscle activity during handwriting on a tablet: An electromyographic analysis of the writing process in children and adults. Children, 10.10.3390/children10040748 ↗