- •Females have lower range in legibility scores in comparison to males.
- •Lateral grips generated greater upper trapezius activity than the DT grip style.
- •The LQ grip style generated longer stroke durations than the DT grip style.
This study aimed to explore the differences in muscle activity, handwriting legibility, and consistency when using the 4 primary handwriting grip styles: dynamic quadrupod (DQ), dynamic tripod, lateral quadrupod (LQ) and lateral tripod.
Study Design and Methods
Thirty-four 18-22-year-old participants completed a handwriting legibility test on paper as well as consistency and metrics tests using both surface electromyography and a digital writing tablet. Electromyography was used to measure the activity of 6 muscles associated with handwriting, and the tablet measured stroke duration, length, velocity, and pen pressure. Subjects used each grip style with all protocols and scores were normalized to their native grip. Significance was set at P < .05.
Females had a lower range in legibility scores than males by 3.5% ± 1.7% (p = .046, d = 0.713), but grip style did not impact legibility. The upper trapezius (UT) was more active in the lateral tripod and LQ grips compared to DQ by 16.8% ± 5.2% and by 13.8% ± 5.2%, (p = .007, p = .012, respectively, partial η2 = 0.188). The stroke duration was greater in the LQ grip style than dynamic tripod and DQ grip styles (p = .008, p = .023, respectively; partial η2 = 0.123).
Lateral grip styles involve more whole-arm, stabilizing movements while dynamic grip styles require fine dexterous movements. Furthermore, females are likely to be able to employ any grip with minimal effect on legibility. For a patient needing guidance in rehabilitation, understanding the differences in grips could aid selection of the optimum grip style to employ based on their muscular control deficits.
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- Handwriting development, competency, and intervention.Dev Med Child Neurol. 2007; 49: 312-317
- Handwriting impairments in people with parkinson's disease and freezing of gait.Neurorehabil Neural Repair. 2016; 30 (Accessed date 02/05/2019): 911-919https://doi.org/10.1177/1545968316642743
- Handwriting performance versus arm forward reach and grasp abilities among post-stroke patients, a case-control study.Top Stroke Rehabil. 2017; 24 (Accessed date 02/05/2019): 5-11https://doi.org/10.1080/10749357.2016.1183383
- Ergonomic factors influencing handwriting performance.Work. 1998; 11: 295-305
- Consistency of handwriting movements in dementia of the Alzheimer's type: A comparison with Huntington's and Parkinson's diseases.J Int Neuropsychol Soc. 1999; 5 (Accessed date 01/26/2019): 20-25https://doi.org/10.1017/S135561779951103X
- Minimal clinically important difference of grip and pinch strength in women with thumb carpometacarpal osteoarthritis when compared to healthy subjects.Rehabil Nurs. 2014; 0: 1-8https://doi.org/10.1002/rnj.196
- A review of factors that influence adult handwriting performance.Aust Occup Ther J. 2011; 58: 321-328
- Effectiveness of school-based occupational therapy intervention on handwriting.Am J Occup Ther. 2002; 56 (Accessed date 04/01/2019): 1725https://doi.org/10.5014/ajot.56.1.17
- Handwriting rehabilitation in parkinson disease: A pilot study.Ann Rehabil Med. 2015; 39 (http://synapse.koreamed.org/search.php?where=aview&id=10.5535/arm.2015.39.4.586&code=1041ARM&vmode=FULL 01/31/2019): 586-591https://doi.org/10.5535/arm.2015.39.4.586
- Effect of pencil grasp on the speed and legibility of handwriting in children.Am J Occup Ther. 2012; 66 (Accessed date 01/29/2019): 718-726https://doi.org/10.5014/ajot.2012.004515http://proxy.foley.gonzaga.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=23106992&site=ehost-live
- Effect of pencil grip on handwriting speed and legibility.Educ Rev. 1986; 38: 247-257
- Writing forces associated with four pencil grasp patterns in grade 4 children.Am J Occup Ther. 2013; 67 (Accessed date 01/31/2019): 218-227https://doi.org/10.5014/ajot.2013.005538
- Effects of modified pen grip and handwriting training on writer's cramp.Arch Phys Med Rehabil. 2009; 90 (Accessed date 01/30/2019): 867-875https://doi.org/10.1016/j.apmr.2008.10.015
- An electromyographic analysis of two handwriting grasp patterns.J Electromyogr Kinesiol. 2013; 23 (Accessed date 04/01/2019): 838-843https://doi.org/10.1016/j.jelekin.2013.04.004
- Determining the effectiveness of pencil grips: An electromyographical analysis.Occup Ther Health Care. 1999; 12 (Accessed date 02/14/2019): 4762https://doi.org/10.1080/J003v12n01_04
- Sex differences in motor performance and motor learning in children and adolescents: An increasing male advantage in motor learning and consolidation phase gains.Behav Brain Res. 2009; 198 (Accessed date 09/25/2021): 165-171https://doi.org/10.1016/j.bbr.2008.10.033
- Men and women differ in the neural basis of handwriting.Hum Brain Mapp. 2020; 41 (Accessed date 09/25/2021): 2642-2655https://doi.org/10.1002/hbm.24968
- Comparison of muscle activation during dominant hand wrist flexion when writing.J Phys Ther Sci. 2013; 25 (Accessed date 01/26/2019): 1529-1531https://doi.org/10.1589/jpts.25.1529
- Interrater reliability of a new handwriting assessment battery for adults.Am J Occup Ther. 2008; 62 (Accessed date 04/01/2019): 595-599https://doi.org/10.5014/ajot.62.5.595
- Analysis of proximal and distal muscle activity during handwriting tasks.Am J Occup Ther. 2007; 61 (Accessed date 01/26/2019): 392-398http://proxy.foley.gonzaga.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=17685171&site=ehost-live
- Multi-model approach to characterize human handwriting motion.Biol Cybern. 2016; 110 (Accessed date 01/29/2019): 17-30https://doi.org/10.1007/s00422-015-0670-6
- Recognition of handwriting from electromyography.PLoS One. 2009; 4 (Accessed date 01/31/2019): e6791https://doi.org/10.1371/journal.pone.0006791
- Adaptive control design for human handwriting process based on electromyography signals.Complexity. 2020; 2020 (Accessed date 12/07/2020): 1-14https://doi.org/10.1155/2020/5142870
- Myoelectronic signal-based methodology for the analysis of handwritten signatures.Hum Mov Sci. 2017; 55 (Accessed date 2/14/2019): 18-30https://doi.org/10.1016/j.humov.2017.07.002
- Handwriting analysis in children and adolescents with hemophilia: A pilot study.J Clin Med. 2020; 9 (Accessed date 12/07/2020): 3663https://doi.org/10.3390/jcm9113663
- Cram's introduction to surface electromyography.2nd ed. Jones and Bartlett, Sudbury, Mass2011
- Invariants in handwriting: The information contained in a motor program.Graphonomics: Contemporary research in handwriting. 37. Elsevier Science & Technology, North-Holland1986: 305-315 (Accessed date 01/29/2019)
- Tele-evaluation and intervention among adolescents with handwriting difficulties – computerized penmanship evaluation tool (ComPET) implementation.in: Proceedings of the 7th International Conference on Disability Virtual Reality and Associated Technologies. 2008: 143-149
- Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs.Psychol Methods. 2002; 7 (Accessed date 04/01/2019): 105-125https://doi.org/10.1037/1082-989X.7.1.105
- Statistical power analysis for the behavioral sciences.2nd ed. Lawrence Erlbaum Associates, 1988
- Pencil grasp and children's handwriting legibility during different length writing tasks.Am J Occup Ther. 2001; 55 (Accessed date 01/29/2019): 175-183https://doi.org/10.5014/ajot.55.2.175
- Legibility of doctors' handwriting is as good (or bad) as everyone else's.Qual Saf Health Care. 2006; 15 (Accessed date 01/31/2019): 445https://doi.org/10.1136/qshc.2006.018911
- Genetic and environmental influences on writing and their relations to language and reading.Ann of Dyslexia. 2013; 63 (Accessed date 01/31/2019): 25-43https://doi.org/10.1007/s11881-011-0055-z
- Sensorimotor control of contact force.Curr Opin Neurobiol. 2008; 18 (Accessed date 01/31/2019): 565-572https://doi.org/10.1016/j.conb.2008.11.006
- Design and evaluation approach for increasing stability and performance of touch pens in screen handwriting tasks.Appl Ergon. 2006; 37 (Accessed date 04/01/2019): 319-327https://doi.org/10.1016/j.apergo.2005.06.010
- Handwriting and spelling instruction for students with learning disabilities: a review.Learn Disabil Q. 1999; 22 (Accessed date 02/05/2019): 78-98https://doi.org/10.2307/1511268
- Chapter 10 handwriting movement control.Handbook of perception and action. 2. 1996: 561-613https://doi.org/10.1016/S18745822(06)80013-7 (Accessed date 04/01/2019)
- Basic and supplementary sensory feedback in handwriting.Front Psychol. 2015; 6 (Accessed date 04/01/2019): 1https://doi.org/10.3389/fpsyg.2015.00169/full
JHT Read for Credit
Quiz: # 905
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.There are ________ recognized common handwriting grip styles
- # 2.The most commonly taught grip style is the
- # 3.Most reports claim that grip style
- a.is affected by ethnic cultural norms
- b.affects both speed and legibility
- c.does not affect legibility
- d.affects legibility, but not speed
- # 4.Muscle activation was investigated when
- a.patients with diagnosed hand conditions were instructed to use a style which is not their native style
- b.normal subjects were instructed to use a style which is not their native style
- c.normal subjects and patients were instructed to use their native style but in their non-dominant hand
- d.normal subjects did not reveal their native style and were allowed to pick any style
- # 5.While there are broad differences in motor activity across different grip styles, all styles are capable of producing “normal handwriting”. Thus, patients with selective motor limitations should be able to be taught an alternative style which is more compatible with their in tact motor capabilities
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Published online: March 30, 2021
Accepted: March 17, 2021
Received in revised form: December 21, 2020
Received: December 6, 2019
Conflict of interest: The authors disclose no financial or personal conflicts of interest.
© 2021 Elsevier Inc. All rights reserved.