Handwriting Interventions for People With Parkinson's
Handwriting Interventions for People With Parkinson's
Background: Problems with handwriting are frustrating and debilitating and affect the
 majority of people with Parkinson's. Manifest as micrographia it is a distinctive feature of
 the condition characterised by small handwriting and/or a progressive reduction in size
 through a sentence[2] coupled with a reduction in writing speed and legibility.

 In Parkinson's impaired automaticity is thought to contribute to handwriting deficits and
 attention has been shown to improve both 'consistent' (small handwriting) and 'progressive'
 (progressive reduction in letter size through a sentence) aspects of the symptom. Moreover,
 recent interventional studies indicate handwriting may be improved through practice. This
 study is investigating a novel handwriting practice stimulus to improve symptoms of
 micrograpthia

 Question: Is a diverging line cued handwriting intervention potentially more effective at
 improving symptoms of mircograpthia than a parallel line cued handwriting intervention in
 people with Parkinson's?

 Specifically, an assessor blind randomised controlled exploratory trial will:

 1. Estatimate the effect of the intervention on measures of: Handwriting amplitude
 (consistent and progressive reduction), hand writing performance and percieved
 handwriting difficulties.

 2. Explore the appropriateness of these outcome measures

 3. Explore the approriateness of eligibilty criteria

 4. Explore intervention fidelity

 5. Explore participants views of the intervention

 Design: A phase II exploratory randomised controlled trial of a handwriting intervention with
 an active comparator control group and blinded assessments

 Setting: The intervention will be carried out at home

 Sample size: This study is not designed to determine efficacy. The aim to recruit a total of
 50 people (25 people per group) in order to estimate the effects on outcome measures and
 achieve the aims of this exploratory trial.

 Assessment: Participants will be asked to follow their usual Parkinson's medication regime
 and if they have ON and OFF periods, assessments will be carried out during ON state.

 Duration and follow-up: the assessment is schedule 0Weeks (baseline), 6weeks (end
 intervention) and 12weeks (follow up). Assessments will be carried out by a researcher blind
 to trial arm allocation using all outcome measures.
Inclusion Criteria:

 -  Over 18 years old

 -  Diagnosis of idiopathic Parkinson's disease

 -  A score of ≤3 on the Hoehn and Yahr scale

 -  Self-reported problem with handwriting (≥1 UPDRSII, 2.7)

 -  Able to communicate in Italian

 -  Following a stable medication regimen (no changes in the last 2 weeks and anticipated
 changes for the course of the study).

 Exclusion Criteria:

 -  Severe depression or psychosis (history of),

 -  reduced cognition that would preclude active involvement or capacity to consent
 (according to stages outlined in metal capacity act (ie trigger, information, existing
 diagnosis, functional test))

 -  Orthopaedic, neurological or other condition that significantly impairs hand function,

 -  Pregnancy