Parkinson Disease
Conditions
Keywords
Handwriting, Micrographia
Brief summary
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.
Interventions
BEHAVIORALHandwriting Practice
Self-directed home handwriting practice daily for 6 weeks
Sponsors
European Parkinson's Therapy Centre
Oxford Brookes University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Assessor Blind to group allocation
Intervention model description
A phase II exploratory randomised controlled trial of a handwriting intervention with an active comparator control group and blinded assessments
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Micrograpthia: Area of 'el' 8 character text sequence writing task | 6 weeks | Area (maximum height x maximum width) of handwritten cursive 'elelelel' character sequence measured to the nearest of 0.5mm |
| Self-reported problem with handwriting: Item 2.7 on the Movement Disorders Society Unified Parkinson's Rating Scale | 6 weeks | A scale from 0-4 (0: normal: no problems, 4: severe: most or all words cannot be read) asking 'Over the past week, have people usually had trouble reading your handwriting?' |
| Writing speed: Time taken to write an Italian proverb | 6 weeks | Time taken to the nearest 10th second to hand write the sentence (written across one line): 'Chi lascia la via vecchia per la nuova, sa quello che lascia ma non sa quello che trova' |
| Writing amplitude: Area of the both 'lascia' contained in an Italian proverb | 6 weeks | Area (maximum height x maximum width) of 'lascia' contained in handwritten sentence: 'Chi lascia la via vecchia per la nuova, sa quello che lascia ma non sa quello che trova'. Measured to the nearest 0.5mm |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Legibility of Free writing | 6 weeks | Ratio between total number of words written and total number of legible words written during a 5 minutes of free writing task: A reflection on the day |
| Micrograpthia: Area of 'el' 8 character text sequence writing task | 12 weeks | Area (maximum height x maximum width) of handwritten cursive 'elelelel' character |
| Writing amplitude: Area of the both 'lascia' contained in an Italian proverb | 12 weeks | Area (maximum height x maximum width) of 'lascia' contained in handwritten sentence: 'Chi lascia la via vecchia per la nuova, sa quello che lascia ma non sa quello che trova'. Measured to the nearest 0.5mm |
| Writing speed: Time taken to write an Italian proverb | 12 weeks | Time taken to the nearest 10th second to hand write the sentence (written across one line): 'Chi lascia la via vecchia per la nuova, sa quello che lascia ma non sa quello che trova' |
| Self-reported problem with handwriting: Item 2.7 on the Movement Disorders Society | 12 weeks | 0-4 scale (0: normal: no problems, 4: severe: most or all words cannot be read) asking 'Over the past week, have people usually had trouble reading your handwriting?' |
| EQ-5D-5L | 6 weeks | Standardized Instrument to measure health outcome |
| Micrograpthia under cognative motor interference: Area of 'el' 8 character text sequence writing task | 6 weeks | Area (maximum height x maximum width) of handwritten cursive 'elelelel' character sequence performed concurrently with cognative task (serial 3 subtraction). Measured to the nearest of 0.5mm |
Countries
Italy
Outcome results
None listed