Penmanship Maintenance with Parkinson's

During one of my internships, I worked with a patient who was having trouble with his writing. I had never seen anything like his script before. The beginning of his sentence was fairly legible, but as he continued to write, the words gradually shrank in size until they were barely visible.

With little to no understanding of what was going on with this gentleman, I consulted my fieldwork supervisor. She looked at his writing sample, and passed it to another therapist. The two exchanged knowing glances. I felt like I was missing something huge.

“Does he have the diagnosis yet?” the other therapist asked my supervisor. She shook her head, and looked back at me.

“Do you know what this is, Erica?”

It was my turn to shake my head.

“I think your patient has Parkinson’s disease.”

At that time, as a student, I had no idea how she had come to that conclusion merely by looking at a writing sample. When I think back now, however, it was obvious.

Writing problems are common to many conditions, such as arthritis or multiple sclerosis. Most manifest as illegible words due to lack of hand control, or decreased ability to grip a pen or pencil. In most cases, words are often shaky or wavy. Only in Parkinson’s do the words become impossibly small, a trait known as micrographia.

Some writing strategies for Parkinson’s patients include using pens with a larger or built-up grip, or repeatedly tracing large letters or shapes on paper to make the flow of writing more consistent. Pausing between words can sometimes help, as can printing instead of writing in cursive. A great way to practice penmanship maintenance is to work on word or number puzzles that require printing one letter or number at a time.

Different methods work for different people, and no solution works 100 percent of the time, so it is always best to have a backup plan. Any of these techniques may help ease a loved one’s frustration.

My patient was discharged from the hospital before I had a chance to follow up with him. Years later, I still wonder what happened to him, and if he was ever diagnosed with Parkinson’s disease.