Full Length Article| Volume 35, ISSUE 4, P558-568, October 2022

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The relationship between muscle activation and handwriting quality with non-native grip styles

Published:March 30, 2021DOI:


      • 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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      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 There is only one best answer for each question.
      • # 1.
        There are ________ recognized common handwriting grip styles
        • a.
        • b.
        • c.
        • d.
      • # 2.
        The most commonly taught grip style is the
        • a.
        • b.
        • c.
        • d.
      • # 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
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.