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Published on: March 11, 2021
Handwriting difficulties of children with Charcot-Marie-Tooth disease type 1A
Daniel Kunovsky1, Reinie Cordier2, Paula Bray1,3
1Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.
Insights
Children with Charcot-Marie-Tooth disease type 1A (CMT1A) experience significantly slower handwriting speed and reduced legibility due to hand weakness. This study highlights the impact of CMT1A on fine motor skills in affected children.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Charcot-Marie-Tooth disease type 1A (CMT1A) often presents with upper limb dysfunction in children.
- Impaired hand function in CMT1A can lead to difficulties with essential daily activities, including handwriting.
- Early assessment of handwriting is crucial for children with CMT1A to guide therapeutic interventions.
Purpose of the Study:
- To investigate the effects of CMT1A on handwriting speed and legibility in children.
- To identify demographic, anthropometric, and physical factors associated with handwriting performance in CMT1A.
- To determine predictors of impaired handwriting in pediatric CMT1A.
Main Methods:
- Assessed handwriting speed and legibility in 30 children with CMT1A and 30 controls.
- Measured hand strength (tip pinch, lateral pinch, grip) using hand-held dynamometry.
- Analyzed associations between strength, anthropometrics, age, and handwriting using correlation and regression.
Main Results:
- Children with CMT1A demonstrated 34% slower handwriting speed and 4% reduced legibility compared to controls.
- Significant hand and finger weakness (37-48% lower) was observed in children with CMT1A.
- CMT1A diagnosis, lateral pinch weakness, and younger age were independent predictors of slower handwriting speed.
Conclusions:
- Children with CMT1A exhibit significant challenges with handwriting speed and legibility, linked to hand and finger weakness.
- Hand strength and age are key factors influencing handwriting speed in this population.
- Identifying the relationship between strength deficits and functional outcomes can inform targeted upper limb interventions for CMT1A.
Abstract:
Hand weakness and impaired manual dexterity have been reported in children with Charcot-Marie-Tooth disease type 1A (CMT1A). This early onset of upper limb involvement might explain frequent clinical referrals for assessment and treatment of impaired handwriting performance. The aim of this study was to examine the impact of CMT1A on handwriting speed and legibility, and identify demographic, anthropometric, and physical measures that might relate to handwriting performance. Handwriting speed (Handwriting Speed Test), handwriting legibility (Evaluation Tool of Children's Handwriting-Cursive), and hand strength (hand-held dynamometry of tip pinch, lateral pinch and grip) were assessed in 30 children with CMT1A (aged 8-17 years) and 30 age- and sex-matched controls. Children with CMT1A exhibited 34% slower handwriting speed (p < 0.0001) with 4% reduced legibility (p = 0.001) and 37-48% lower hand strength (p < 0.0001). All measures of strength, age, height, and weight were positively associated with handwriting speed (r = 0.39-0.79, p < 0.01). None of these factors related to handwriting legibility (p > 0.05). Regression modelling identified a diagnosis of CMT1A, lateral pinch weakness and younger age as significant independent predictors of slower handwriting speed, explaining 78% of the variance. Children with CMT1A have considerable handwriting difficulties, primarily with speed, and substantial associated hand and finger weakness. Understanding the cause-effect relationship between strength and function might provide modifiable targets for upper limb intervention.
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