Does training improve writer's cramp? An evaluation of a behavioral treatment approach using kinematic analysis

Patients with writer's cramp (WC) show uncontrollable muscle co-contractions of agonists and antagonists and unusual postures of the upper limb during writing; their handwriting is inefficient and exhausting. Currently the treatment of choice is to inject botulinum toxin in selective hand muscles. However, this treatment has two drawbacks: it is short-lasting and may be associated with adverse side effects. An alternative behavioral treatment, namely, the handwriting training developed by Mai and coworkers, was carried out and evaluated in 50 patients with WC. A digitizing tablet was used to record the handwriting movements before and after training, and then again after a follow-up period. The results indicate the efficacy of the handwriting training. Speed and smoothness of the handwriting increased during the training with effects observed after an extended follow-up period. Handwriting training leads to significant improvements, but does not bring handwriting performance to normal levels. This training should be considered as an alternative or supplement to the traditional treatment with botulinum toxin or other programs based on neuroplasticity.