Brain health in your inbox!

Subscribe to our free emails

Sign Up Now


We provide you with articles on brain science, timely topics, and healthy living for those affected by neurologic challenges or seeking better brain health.  

Therapy
By Hillary Murtha

Workshops Help People with Parkinson’s Disease Improve Handwriting

Workshops and exercises help patients with Parkinson's disease combat small handwriting.

Susan Coviello works to improve her writing
Let's Combat Micrographia workshops help Susan Coviello improve her writing. Courtesy Let's Combat Micrographia

Ten years ago, Marie Zacharko, a retired project manager in Warrington, PA, was diagnosed with Parkinson's disease. One of the earliest signs she observed was that her handwriting was becoming smaller and less legible, a symptom known as micrographia.

Keen to improve her writing, Zacharko practiced every day but saw no change. She figured she was stuck with her scrawl. Then she discovered Let's Combat Micrographia, an organization offering workshops and workbooks for people with deteriorating handwriting. She enrolled in one of the workshops, where she learned techniques to help her write better, including practicing large handwriting, hand-stretching exercises, and correct posture and support for the hand and arm while writing. Not only did her writing improve, but Zacharko, who is now 76, found it easier to open cans, and when she plays piano, she presses the keys more lightly.

Tom Way, an 82-year-old retired salesman from Pittsburgh, was diagnosed with Parkinson's disease three and a half years ago. Although he experiences tremors on his left side more than on his dominant right side, his handwriting deteriorated to the point where he couldn't read it. After participating in just one workshop, he decided it was worth it. “Learning to slow my writing down made a real difference,” he says.

Bradykinesia—the term used to describe the slow movements that are characteristic of Parkinson's disease—affects all repetitive movements, including writing, making them slower and smaller over time, says Aristide Merola, MD, PhD, director of the Madden Center for Parkinson's Disease and Related Disorders at Ohio State University's Wexner Medical Center. Micrographia is common in medical conditions known as parkinsonian syndromes, which include multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, and drug-induced parkinsonism, Dr. Merola says.

Deteriorating handwriting sometimes precedes the clinical diagnosis, he says. But the timing of when it appears varies, according to Lisa Shulman, MD, FAAN, professor of neurology at the University of Maryland School of Medicine. The pathology of Parkinson's disease begins on one side of the brain and progresses to the other, she explains. Handwriting is affected when the dominant hand becomes impaired. Eventually most people experience micrographia, and all experience a change in handwriting, Dr. Shulman says. Certain large, round cursive letters, such as A and O, typically become smaller and more closed.

Traditional medications for Parkinson's disease may help patients improve handwriting, but success is extremely variable, says Dr. Shulman.

The Let's Combat Micrographia virtual workshops provide a structured environment for practicing handwriting, asking questions, learning from others, and addressing other symptoms of Parkinson's disease, such as facial rigidity. Although the organization is trying to get third-party coverage, its workshops aren't yet covered by health insurance.

Other ways to improve handwriting may include reducing stress, improving focus, and maintaining physical fitness, says Naoya Ogura, a doctor of occupational therapy at [re+active] Therapy and Wellness in Los Angeles. He has patients write on lined paper and encourages them to make their letters reach the top and bottom lines. Ogura has seen dramatic improvements in his patients, sometimes after just one session.

A 2016 study in Frontiers in Neuroscience found that visual cues such as lined paper resulted in noticeable improvements in writing. Ogura also recommends aerobic exercise, which helps mitigate all symptoms of Parkinson's, including micrographia. To reduce stress, which can exacerbate hand tremors, he teaches clients relaxation exercises such as diaphragmatic breathing. A study in Movement Disorders showed that such techniques reduce tremors.

Movement disorder specialists, including those at the Parkinson's Foundation, recommend practicing writing every day, using a weighted pen or one with a thick grip and soft tip. They suggest practicing during “on” times (when medication is most effective) while sitting at a table in a comfortable chair, and taking breaks.

People who see improvement feel empowered. Tim Macmillan, 53, of Walpole, MA, a former volunteer firefighter who was diagnosed with Parkinson's disease in 2014, says he once again feels proud of his clear and elegant script. For Marie Zacharko, the bottom line is, “I can now read my handwriting, and other people can too.”

Handwriting Resources