Role of proprioception and vision in handwriting

The objective of this study is to better understand the role of proprioception in handwriting and test earlier conclusions stating that the automated shaping of letters was not impaired by the removal of visual control in deafferentation. To this aim we compared the performance of the deafferented patient GL, who suffers from a complete loss of cutaneous and proprioceptive sensation, with that of eight healthy age- and sex-matched subjects. The word "Parallele", written within a short sentence with and without visual control, was quantified using a digital writing tablet. Three of the 13 analyzed parameters were strikingly different in patient GL compared to healthy subjects, both with and without vision: increase of number of pen touches, increase in number of inversions in velocity, and decrease of mean stroke frequency. The changes in these three parameters indicate a strong impairment in automated behaviour in the absence of proprioception and touch. This impairment is also supported by the significantly longer movement duration, which is also significantly increased by the removal of visual control. The present study provides for the first time a quantification of handwriting in a completely deafferented patient and reveals the central role of proprioception for the storage, updating, and maintenance of skilled motor programs. The fact that the deficits are already present with visual feedback suggests that the role of vision in handwriting is only secondary.