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Rehabilitative interventions for impaired handwriting in people with Parkinson’s disease: a scoping review

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Abstract

Background

People with Parkinson’s disease (PD) often complain about handwriting difficulties. Currently, there is no consensus on the rehabilitative treatment and outcome measures for handwriting rehabilitation in PD.

Objectives

This study aims to investigate evidence on handwriting rehabilitation in people with PD, examining characteristics of interventions and outcomes.

Methods

A scoping review was conducted according to Arksey and O’Malley’s framework and PRISMA-ScR List. We searched electronic databases of PubMed, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, and Embase since inception to January 2023. We included interventional studies assessing the effects of structured rehabilitation programs for impaired handwriting in people with PD. Two reviewers independently selected studies, extracted data, and assessed the risk of bias using the Cochrane Collaboration’s tool for assessing Risk of Bias version 2 or the Risk Of Bias In Non-randomized Studies. We performed a narrative analysis on training characteristics and assessed outcomes.

Results

We included eight studies. The risk of bias was generally high. Either handwriting-specific or handwriting-non-specific trainings were proposed, and most studies provided a home-based training. Handwriting-specific training improved writing amplitude while handwriting-non-specific trainings, such as resistance and stretching/relaxation programs, resulted in increased writing speed.

Conclusions

The current knowledge is based on few and heterogeneous studies with high risk of bias. Handwriting-specific training might show potential benefits on handwriting in people with PD. Further high-quality randomized controlled trials are needed to reveal the effect of handwriting training in people with PD on standardized outcome measures. Handwriting-specific training could be combined to resistance training and stretching, which seemed to influence writing performance.

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Data Availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Funding

Italian Ministry of Health (MoH) Grant: Ricerca Finalizzata 2018 (GR-2018–12366005).

Author information

Authors and Affiliations

  1. Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Andrea Gardoni, Elisabetta Sarasso, Federica Agosta & Massimo Filippi

  2. Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Andrea Gardoni, Elisabetta Sarasso & Davide Corbetta

  3. Vita-Salute San Raffaele University, Milan, Italy

    Elisabetta Sarasso, Federica Agosta, Massimo Filippi & Davide Corbetta

  4. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy

    Elisabetta Sarasso

  5. Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Federica Agosta & Massimo Filippi

  6. Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

  7. Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

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  1. Andrea Gardoni
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Contributions

1. Research project: A. Conception, B. Organization, C. Execution.

2. Statistical analysis: A. Design, B. Execution, C. Review and critique.

3. Manuscript preparation: A. Writing of the first draft, B. Review and critique.

A.G.: 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B

E.S.: 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B

F.A.: 2C, 3B

M.F.: 2C, 3B

D.C.: 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B

Corresponding author

Correspondence to Davide Corbetta.

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Disclosures

A.G. has no financial disclosure to report. E.S. received research supports from the Italian Ministry of Health (MoH) Grant: Ricerca Finalizzata 2021 (GR-2021–12374005). D.C. received research supports from the Italian Ministry of Health (MoH) Grant: Ricerca Finalizzata 2018 (GR-2018–12366005). F.A. is Associate Editor of Neuroimage: Clinical, has received speaker honoraria from Biogen Idec, Italfarmaco, Roche and Zambon, and receives or has received research supports from the Italian Ministry of Health, AriSLA (Fondazione Italiana di Ricerca per la SLA), the European Research Council and Foundation Research on Alzheimer Disease. M.F. is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology; received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi; speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda; scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme; he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Italian Ministry of Health, and Fondazione Italiana Sclerosi Multipla.

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Gardoni, A., Sarasso, E., Agosta, F. et al. Rehabilitative interventions for impaired handwriting in people with Parkinson’s disease: a scoping review. Neurol Sci 44, 2667–2677 (2023). https://doi.org/10.1007/s10072-023-06752-6

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