Home-Based Calligraphic Handwriting Exercises in Parkinson's Disease

A Randomized Controlled Trial of Home-Based Calligraphic Handwriting Exercises in Patients With Parkinson's Disease

Parkinson's disease is a progressive neurodegenerative disorder with no curative treatment currently available. Its symptoms lead to increasing limitations in daily activities, with impairments in manual dexterity being particularly relevant. Handwriting difficulties are common in patients with Parkinson's disease; however, it remains unclear whether a rehabilitation program based on handwriting exercises can improve overall manual dexterity and daily functioning.

This randomized, single-blind controlled trial aims to evaluate the effects of a 12-week home-based calligraphic handwriting exercise program on manual dexterity in patients with Parkinson's disease. Participants will be recruited from the Movement Disorders Clinic of Hospital 12 de Octubre (Madrid, Spain) and randomly assigned to either an intervention group or a control group.

Manual dexterity will be primarily assessed using the Purdue Pegboard Test across scheduled study visits. Secondary outcomes will include measures of dexterity related to activities of daily living, quality of life, and motor function.

INCLUSION CRITERIA:

• Patients aged 40 to 80 years
• Clinical diagnosis of Parkinson's disease according to the UK Brain Bank criteria.
• Hoehn and Yahr stage 1 to 4
• Assessed in the ON-medication state (approximately 90 minutes after levodopa intake)
• Stable antiparkinsonian treatment for at least 4 weeks prior to study entry and maintained throughout the study period

EXCLUSION CRITERIA:

• Parkinson's disease-related dementia, defined as a Montreal Cognitive Assessment (MoCA) score < 21

• Upper limb comorbidities unrelated to Parkinson's disease that could interfere ith exercise performance (e.g., arthritis, recent fractures, stroke sequelae, or peripheral neuropathy)

• Severe tremor or severe dyskinesias affecting the dominant hand, defined as:

  • a score ≥ 3 on UPDRS-III items 20 or 22, or
  • score ≥ 2 on UPDRS-IV item 33