Thomas Mathew, Lenka Abhishek, Kumar Pal Pramod
Department of Neurology National Institute of Mental Health and Neurosciences Bangalore Karnataka India.
Department of Clinical Neurosciences National Institute of Mental Health and Neurosciences Bangalore Karnataka India.
Mov Disord Clin Pract. 2017 Nov 1;4(6):806-818. doi: 10.1002/mdc3.12552. eCollection 2017 Nov-Dec.
The majority of patients with Parkinson's disease (PD) have handwriting abnormalities. Micrographia (abnormally small letter size) is the most commonly reported and easily detectable handwriting abnormality in patients with PD. However, micrographia is perhaps the tip of the iceberg representing the handwriting abnormalities in PD. Digitizing tablet technology, which has evolved over the last 2 decades, has made it possible to study the pressure and kinematic features of handwriting. This has resulted in a surge of studies investigating graphomotor impairment in patients with PD.
The objectives of this study were to review the evolution of the kinematic analysis of handwriting in PD and to provide an overview of handwriting abnormalities observed in PD along with future directions for research in this field. Articles for review were searched from the PubMed and SCOPUS databases.
Digitizing tablet technologies have resulted in a shift of focus from the analysis of only letter size to the analysis of several kinematic features of handwriting. Studies based on the kinematic analysis of handwriting have revealed that patients with PD may have abnormalities in velocity, fluency, and acceleration in addition to micrographia. The recognition of abnormalities in several kinematic parameters of handwriting has given rise to the term . In addition, certain kinematic properties potentially may be helpful in distinguishing PD from other parkinsonian disorders.
The journey from micrographia to is indeed a paradigm shift. Further research is warranted to gain better insight into the graphomotor impairments in PD and their clinical implications.
大多数帕金森病（PD）患者存在书写异常。小写症（字母尺寸异常小）是PD患者中最常报告且易于检测到的书写异常。然而，小写症可能只是PD书写异常的冰山一角。在过去20年中不断发展的数字化平板技术，使得研究书写的压力和运动学特征成为可能。这导致了大量关于PD患者书写运动障碍的研究涌现。
本研究的目的是回顾PD患者书写运动学分析的发展历程，概述PD患者中观察到的书写异常情况以及该领域未来的研究方向。从PubMed和SCOPUS数据库中检索用于综述的文章。
数字化平板技术使得研究重点从仅分析字母大小转向分析书写的多个运动学特征。基于书写运动学分析的研究表明，PD患者除小写症外，可能在速度、流畅性和加速度方面存在异常。对书写多个运动学参数异常的认识催生了“[此处原文未给出具体术语]”这一术语。此外，某些运动学特性可能有助于区分PD与其他帕金森综合征。
从小写症到“[此处原文未给出具体术语]”的转变确实是一种范式转变。有必要进行进一步研究，以更好地了解PD患者的书写运动障碍及其临床意义。
