Brief report

Kinematic analysis of handwriting movements in Schizophrenic patients

The present study investigated the relation between schizotypy and motor control against self- or other-produced action. We used an unloading task to focus on the timing component of anticipatory motor control. In the task, a weight was removed from a participants’ hand by the participants themselves or by an experimenter (voluntary versus imposed unloading). Postural disturbance at the removal timing was measured as an index of predictive function in motor control. We hypothesized that the postural disturbance in the voluntary unloading would be positively related to schizotypal traits; however, the results did not support this theory. The results showed almost zero correlation between the schizotypy scores and the postural disturbance in the voluntary unloading condition. In contrast, the schizotypy scores positively correlated with the postural disturbance in the imposed unloading condition. These findings were replicated across two participant groups and two schizotypy scales. Further analyses on subscales of the schizotypy questionnaire found moderate levels of positive correlation between each subscale for Cognitive-Perceptual and Disorganization factors and the disturbance. Accordingly, the present study did not support the idea that non-pathological individuals with high schizotypal traits have deficits in prediction of self-produced actions, at least for a temporal domain. Instead, the results suggested that individuals with high schizotypal traits, particularly for the positive and disorganization symptoms, are not good at responding to others-produced actions. The schizophrenic symptoms were discussed in terms of the failure in the processes executed after calculating prediction of sensory consequences and dysfunction in internal models for “other people”.

Suitable apparatuses for exploring the kinetics of handwriting performance are limited, which hinders a thorough understanding of the control mechanisms between the hand and a pen. This study proposes a force acquisition pen (FAP) that detects the contact forces between digits and the pen barrel, as well as the force between the pen tip and writing surface. Tests of the validity and reliability of the FAP and the variability of the acquired kinetic information of handwriting performance were conducted. Acceptable validity (R² > 0.9986, p < 0.0001) and reliability (intraclass correlation coefficients >0.79) were obtained, indicating the feasibility of the proposed pen. From the force information acquired from the digits and pen tip, kinetic parameters were determined for a detailed investigation of the coordination and control mechanism between the digits and a pen.

Ongoing monitoring of neuroleptic-induced extrapyramidal side effects (EPS) is important to maximize treatment outcome, improve medication adherence and reduce re-hospitalization. Traditional approaches for assessing EPS such as Parkinsonism, tardive akathisia, or dyskinesia rely upon clinical ratings. However, these observer-based EPS severity ratings can be unreliable and are subject to examiner bias. In contrast, quantitative instrumental methods are less subject to bias. Most instrumental methods have only limited clinical utility because of their complexity and costs. This paper describes an easy-to-use instrumental approach based on handwriting movements for quantifying EPS. Here, we present findings from psychiatric patients treated with atypical (second generation) antipsychotics. The handwriting task consisted of a sentence written several times within a 2 cm vertical boundary at a comfortable speed using an inkless pen and digitizing tablet. Kinematic variables including movement duration, peak vertical velocity and the number of acceleration peaks, and average normalized jerk (a measure of smoothness) for each up or down stroke and their submovements were analyzed. Results from 59 psychosis patients and 46 healthy comparison subjects revealed significant slowing and dysfluency in patients compared to controls. We observed differences across medications and daily dose. These findings support the ecological validity of handwriting movement analysis as an objective behavioral biomarker for quantifying the effects of antipsychotic medication and dose on the motor system.

Parkinsonian handwriting is typically characterized by micrographia, jagged line contour, and unusual fluctuations in pen velocity. In this paper we present a computational model of handwriting generation that highlights the role of the basal ganglia, particularly the indirect pathway. Whereas reduced dopamine levels resulted in reduced letter size, transition of STN–GPe dynamics from desynchronized (normal) to synchronized (PD) condition resulted in increased fluctuations in velocity in the model. We also present handwriting data from PD patients (n = 34) who are at various stages of disease and had taken medication various lengths of time before the handwriting sessions. The patient data are compared with those of age-matched controls. PD handwriting statistically exhibited smaller size and larger velocity fluctuation compared to normal handwriting.

Language can be understood as an embodied system, expressible as gestures. Perception of these gestures depends on the “mirror system,” first discovered in monkeys, in which the same neural elements respond both when the animal makes a movement and when it perceives the same movement made by others. This system allows gestures to be understood in terms of how they are produced, as in the so-called motor theory of speech perception. I argue that human speech evolved from manual gestures, with vocal gestures being gradually incorporated into the mirror system in the course of hominin evolution. Speech may have become the dominant mode only with the emergence of Homo sapiens some 170,100 years ago, although language as a relatively complex syntactic system probably emerged over the past 2 million years, initially as a predominantly manual system. Despite the present-day dominance of speech, manual gestures accompany speech, and visuomanual forms of language persist in signed languages of the deaf, in handwriting, and even in such forms as texting.

Epidemiologic studies indicate that nearly 60% of schizophrenia (SZ) patients treated with conventional antipsychotic drugs develop extrapyramidal side effects (EPS) such as parkinsonism and tardive dyskinesia. Although the prevalence of EPS has decreased due to the newer antipsychotics, EPS continue to limit the effectiveness of these medicines. Ongoing monitoring of EPS is likely to improve treatment outcome or compliance and reduce the frequency of re-hospitalization. A quantitative analysis of handwriting kinematics was used to evaluate effects of antipsychotic medication type and dose in schizophrenia patients. Twenty-seven schizophrenia patients treated with risperidone, six schizophrenia patients who received no antipsychotic medication and 47 healthy comparison participants were enrolled. Participants performed a 20-min handwriting task consisting of loops of various sizes and a sentence. Data were captured and analyzed using MovAlyzeR software. Results indicated that risperidone-treated participants exhibited significantly more dysfluent handwriting movements than either healthy or untreated SZ participants. Risperidone-treated participants exhibited lower movement velocities during production of simple loops compared to unmedicated patients. Handwriting dysfluency during sentence writing increased with dose. A 3-factor model consisting of kinematic variables derived from sentence writing accounted for 83% (r = .91) of the variability in medication dose. In contrast, we found no association between observer-based EPS severity ratings and medication dose. These findings support the importance of handwriting-based measures to monitor EPS in medicated schizophrenia patients.